Tuning Fork Sufficient for Screening for Diabetic Polyneuropathy

Results of a new study suggest that the tuning fork test alone is sufficient for screening purposes.

Because the scoring systems have not been validated and their predictive value is unknown, Dr. Jan-Willem G. Meijer and colleagues compared results of screening with the two versions of the International Consensus on the Diabetic Foot guidelines (ICDF)

Dr. Meijer, from the Rehabilitation Centre Tolbrug/Jeroen Bosch Hospital in Den Bosch, note that ICDF1 includes 128-Hz tuning fork testing, pin-prick testing at the hallux, monofilament testing at the plantar surface, and Achilles tendon reflex. ICDF2 uses the four measures of ICDF1 plus cotton wool testing at the hallux.

The first version of the NDV/CBO includes tuning fork and cotton wool testing at the hallux, monofilament testing, and Achilles tendon reflex. The second uses tuning fork testing alone, assessing vibration sensitivity at the hallux compared with that of the dorsal wrist. The third NDV/CBO uses tuning fork testing and monofilament testing, while the fourth is monofilament testing alone.

Included in their study cohort were 24 diabetic patients with neuropathic foot ulcers, 24 diabetics with no foot ulcers or symptoms of polyneuropathy, and 21 healthy control subjects. The scoring systems were compared with clinical standards – symptom scoring, physical examination scoring, heart rate variability testing, and nerve conduction studies.

According to their report, the authors found that the "construct validity and discriminative power of the ICDF and NDF/CBO were comparable, although monofilaments scored lower." And although the predictive value was good for all scores, the best results were obtained using the NDF/CBO2 (tuning fork testing alone), yielding a positive predictive value of 86% to 100% and negative predictive value of 66% to 97%.

Dr. Meijer’s team concludes that "use of the 128-Hz tuning fork is valid and reliable for screening purposes and manageable in clinical practice," and that it "deserves a central role in diagnosing diabetic polyneuropathy."
Diabetes Care 2005;28:2201-2205.

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