Review Article

Diagnostic Accuracy of Monofilament Tests for Detecting Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis

Table 2

The characteristics of the included studies using NCS as the reference standard.

Study (Author Year)Sample size (male)Age (years)
Mean ± SD
MonofilamentPrevalence of DPNSites and numberThresholdReference testSensitivity % (95% CI)Specificity % (95% CI)

Olaleye et al., 2001 [25]132 (84)52.92 ± 11.4SWF 5.07/10 g59.8%Noncallused site on the dorsum of the first toe just proximal to the nail bed and repeated four times on both feet(a) 2 of 8NCS(a) 62(a) 84
(b) 3 of 8(b) 58(b) 92
(c) 4 of 8(c) 35(c) 97
(d) 5 of 8(d) 30(d) 97
Perkins et al., 2001 [26]478 (319)54 (NR)SWF 5.07/10 g72.2%Noncallused site on the dorsum of the first toe just proximal to the nail bed and repeated four times on both feet(a) 1 of 8NCS(a) 77(a) 67.6
(b) 40.8(b) 96
(b) 5 of 8
Lee et al., 2003 [27]37 (20)57.0 ± 9.3SWF 5.07/10 g78.4%The dorsal surface of the foot between the base of the first and second toes, the first, third, and fifth toes, the first, third, and fifth metatarsal heads, the medial and lateral midfoot, and the heel in random order5 of 10NCS93.1100
Mythili et al., 2010 [28]100 (48)52.9 (30–80)SWF 5.07/10 g71%Both feet on the plantar surface of the hallux and centrally at the heel six times at each point1 of 6NCS98.555
Perkins et al., 2010 [29]175 (118)57 ± 8SWF 5.07/10 g28.6%Noncallused site on the dorsum of the great toe just proximal to the nail bed four times at each foot5 of 8NCS7264
Pambianco et al., 2011 [30]195 (NR)46.2 ± 7.2 (170)
41.4 ± 6.5 (25)
MF 5.07/10 g12.8%The dorsum of the great toe ten times for each foot3 of 10NCS2098
Pourhamidi et al., 2014 [31]110 (61)60 ± 1SWF 5.07/10 g44.5%Three standard points (plantar surface of distal hallux and 1st and 5th metatarsal heads) bilaterally on the sole of the foot1 of 6NDS & NCS697
Baraz et al., 2014 [32]150 (47)55.71 ± 8.95SWF 5.07/10 g38%(a) Three points in each foot: the great toe, the plantar aspect of the first, and the fifth metatarsal head(a1) 1 of 6NCS(a1) 53.8(a1) 73.9
(a2) 2 of 6(a2) 43.6(a2) 79.3
(a3) 3 of 6(a3) 35.9(a3) 84.7
(b) Four points in each foot: the plantar surface of hallux, and the first, third, and fifth metatarsal heads(b1) 1 of 8(b1) 51.3(b1) 73
(b2) 2 of 8(b2) 46.2(b2) 74.8
(b3) 4 of 8(b3) 38.5(b3) 87.4
(c) Eight points in each foot: the dorsal aspect of the first, second, third, fourth, and fifth digits; the dorsal aspect of the medial, central, and lateral aspect of mid foot(c1) 1 of 16(c1) 61.5(c1) 77.5
(c2) 2 of 16(c2) 59(c2) 79.3
(c3) 8 of 16(c3) 38.5(c3) 95.5
(d) 10 points in each foot: nine plantar sites (distal great toe, third toe, and fifth toe; first, third, and fifth metatarsal heads; medial foot, lateral foot, and heal) and one dorsal site(d1) 1 of 20(d1) 64.1(d1) 64
(d2) 2 of 20(d2) 61.5(d2) 64
(d3) 10 of 20(d3) 30.8(d3) 89.2
Ruhdorfer et al., 2015 [33]55 (28)64.3 ± 12.6SWF 5.07/10 g70%The big toe, the fifth toe, the heel, the arch of the foot, and on the dorsum of the foot1 of 1(a) SRS(a) 76(a) 79
(b) NCS(b) 67(b) 67

NR: not reported in the paper; MF: monofilament; SWF: Semmes-Weinstein monofilaments; NCS: nerve conduction study; SRS: self-reported symptoms; “1 of 6”: minimum of 6 points, 1 point reported as a positive result.