Monofilament Testing Unclear

Monofilament testing is a convenient and inexpensive tool for screening foe peripheral neuropathy that is recommended in diabetic patients by many clinical guidelines.

The Dutch authors sought to summarize the current data on the accuracy of monofilament testing. They performed a systematic review of studies examining the accuracy of the 5.07/10-g monofilament in detecting peripheral neuropathy with nerve conduction as reference standard.

They found: “173 titles and abstracts of articles to identify 54 potentially eligible studies, of which 3 were finally selected for data synthesis. All studies were limited to patients with diabetes mellitus and showed limitations according to the QUADAS tool.”

“Sensitivity ranged from 41% to 93% and specificity ranged from 68% to 100%. Because of the heterogenous nature of the studies, a meta-analysis could not be accomplished.”

The authors concluded: “Despite the frequent use of monofilament testing, little can be said about the test accuracy for detecting neuropathy in feet without visible ulcers. Optimal test application and defining a threshold should have priority in evaluating monofilament testing, as this test is advocated in many clinical guidelines. Accordingly, we do not recommend the sole use of monofilament testing to diagnose peripheral neuropathy.”

This systematic reviews raises questions on the importance of monofilament testing and reinforces that it should be used as a screening tool, and not a diagnostic one.

For the full abstract, click here.
Annals of Family Medicine7:555-558, November 2009. Accuracy of Monofilament Testing to Diagnose Peripheral Neuropathy-A Systematic Review. Jacquelien Dros, Astrid Wewerinke,