Review Article

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

Table 1

The characteristics of the included studies using VPT, NDS, SAC, and MNSI as the reference standard.

Study (author year)Sample size (male)Age (years) Mean ± SDMonofilamentSites and numberThresholdReference testSensitivity (%) (95% CI)Specificity (%) (95% CI)

Valk et al., 1997 [15]68 (36)51.6 ± NR(a) SWF 5.07/10 gThree sites on both feet: first toe, medial surface, and base of the third metatarsal bone1 of 18VPT95.845.5
(b) SWF 4.17/1 g
(c) SWF 6.10/75 g
McGill et al., 1999 [16]132 (NR)57 (47.5–65.8)MF 5.07/10 gFive sites on the right foot: great toe, dorsum between the first and second metatarsals, the plantar aspect of the first metatarsal, the plantar aspect of the fifth metatarsal, the plantar aspect of the arch(a) 5 of 5VPT(a) 31(a) 100
(b) 3 of 5(b) 37(b) 98
(c) 1 of 5(c) 39(c) 83
Nagai et al., 2001 [17]65 (NR)61.0 ± 1.3(a) SWF 5.07/10 gThree sites on the foot: great toe, the plantar aspect of the first metatarsal, the plantar aspect of the fifth metatarsalNRNumbness in the toes and loss of ankle jerk and VPT(a) 88(a) 68
(b) 85(b) 73
(b) SWF 4.56/4 g(c) 48(c) 86
(c) SWF 4.31/2 g
Paisley et al., 2002 [18]124 (84)55.4 ± 13.7MF 5.07/10 gTwice on the plantar surface of each hallux and also the 1st, 2nd, 3rd, and 5th metatarsal heads3 of 10(a) NDS(a) 87.8(a) 57.3
(b) VPT(b) 70(b) 63.8
Kamei et al., 2005 [19]82 (44)61.6 ± 11.0(a) SWF 5.07/10 gThe great toe, the plantar aspect of the first metatarsal, and site 3, the plantar aspect of the fifth metatarsal for each footNRVPT(a) 15–30(a) 92.9
(b) SWF 4.31/2 g(b) 47.5–60(b) 71.4–76.2
Jayaprakash et al., 2011 [20]1044 (532)53.3 ± 11.8SWF 5.07/10 gThe plantar surface of great toe and base of first, third, and fifth metatarsals of both feet1 of 8VPT6393
Rayman et al., 2011 [21]26565 ± NRMF 5.07/10 g(a) 3 points in each foot: tips of the first, third, and fifth toes and dorsum of hallux of both feet(a) 2 of 8VPT(a) 85(a) 88
(b) 4 points in each foot: tips of the first, third, and fifth toes(b) 5 of 8(b) 81(b) 91
Bedi and Mittal, 2012 [22]106 (48)54.99 ± 11.08SWF 5.07/10 gThe plantar surface of great toe and base of the first, third, and fifth metatarsals of both feet1 of 8VPT48.948
Bracewell et al., 2012 [23]141 (76)56.9 ± 14.7MF 5.07/10 gFive sites: the 1st, 3rd, and 5th metatarsal heads on the plantar surface, the hallux pulp, the dorsal surface of the hallux proximal to the nail foldNRVPT8483
Najafi et al., 2014 [24]107 (35)57.6 ± 10.2MF 5.07/10 gThe dorsum of the great toe midway between the nail fold and the DIP joint3 of 10MNSI16.787

NR: not reported in the paper; MF: monofilament; SWF: Semmes-Weinstein monofilaments; VPT: vibration perception threshold; VDT: vibration detection thresholds; NDS: neuropathy disability score; MNSI: Michigan neuropathy screening instrument; SAC: San Antonio Consensus for DPN diagnosis: “1 of 6”: minimum of 6 points, 1 point reported as a positive result; DIP: distal interphalangeal joint.