Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy: CI vs. NPhys trial

Peter J. Dyck; Carol J. Overland; Phillip A. Low; William J. Litchy; Jenny L. Davies; P. James B. Dyck; Peter C. O'Brien; James W. Albers; Henning Andersen; Charles F. Bolton; John D. England; Christopher J. Klein; J. Gareth Llewelyn; Michelle L. Mauermann; James W. Russell; Wolfgang Singer; A. Gordon Smith; Solomon Tesfaye; Adrian Vella

doi:10.1002/mus.21661

Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy: CI vs. NPhys trial

Peter J. Dyck, Carol J. Overland, Phillip A. Low, William J. Litchy, Jenny L. Davies, P. James B. Dyck, Peter C. O'Brien, James W. Albers, Henning Andersen, Charles F. Bolton, John D. England, Christopher J. Klein, J. Gareth Llewelyn, Michelle L. Mauermann, James W. Russell, Wolfgang Singer, A. Gordon Smith, Solomon Tesfaye, Adrian Vella

Research output: Contribution to journal › Article › peer-review

136 Scopus citations

Abstract

The purpose was to test whether physicians can validly and reproducibly diagnose diabetic sensorimotor polyneuropathy (DSPN). Twelve physicians assessed 24 patients with diabetes mellitus (DM) on consecutive days (576 examinations) with physical features and voice disguised. Results were compared to gold standard 75% group diagnosis (dx) and a nerve conduction score (Σ5 NC nds). Masking of patients was achieved. Reproducibility measured by the kappa coefficient and compared to Σ5 NC nd varied considerably among physicians: median and ranges: signs 0.8 (0.32-1.0); symptoms 0.79 (0.36-1.0), and diagnoses 0.47 (0.33-0.84), both low and high scores indicating poor performance. There was substantial agreement between 75% group dx and confirmed NC abnormality (abn). As compared to Σ5 NC, individual physicians' clinical dx was excessively variable and frequently inaccurate. Study physician dx from signs and symptoms were excessively variable, often overestimating DSPN. Specific approaches to improving clinical proficiency should be tested.

Original language	English (US)
Pages (from-to)	157-164
Number of pages	8
Journal	Muscle and Nerve
Volume	42
Issue number	2
DOIs	https://doi.org/10.1002/mus.21661
State	Published - Aug 2010

Keywords

Diabetes mellitus
Diabetic sensorimotor polyneuropathy
Nerve conduction score

ASJC Scopus subject areas

Physiology
Clinical Neurology
Cellular and Molecular Neuroscience
Physiology (medical)

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10.1002/mus.21661

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Dyck, P. J., Overland, C. J., Low, P. A., Litchy, W. J., Davies, J. L., Dyck, P. J. B., O'Brien, P. C., Albers, J. W., Andersen, H., Bolton, C. F., England, J. D., Klein, C. J., Llewelyn, J. G., Mauermann, M. L., Russell, J. W., Singer, W., Smith, A. G., Tesfaye, S., & Vella, A. (2010). Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy: CI vs. NPhys trial. Muscle and Nerve, 42(2), 157-164. https://doi.org/10.1002/mus.21661

Dyck, PJ, Overland, CJ, Low, PA , Litchy, WJ, Davies, JL, Dyck, PJB, O'Brien, PC, Albers, JW, Andersen, H, Bolton, CF, England, JD, Klein, CJ, Llewelyn, JG, Mauermann, ML, Russell, JW, Singer, W, Smith, AG, Tesfaye, S & Vella, A 2010, 'Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy: CI vs. NPhys trial', Muscle and Nerve, vol. 42, no. 2, pp. 157-164. https://doi.org/10.1002/mus.21661

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abstract = "The purpose was to test whether physicians can validly and reproducibly diagnose diabetic sensorimotor polyneuropathy (DSPN). Twelve physicians assessed 24 patients with diabetes mellitus (DM) on consecutive days (576 examinations) with physical features and voice disguised. Results were compared to gold standard 75% group diagnosis (dx) and a nerve conduction score (Σ5 NC nds). Masking of patients was achieved. Reproducibility measured by the kappa coefficient and compared to Σ5 NC nd varied considerably among physicians: median and ranges: signs 0.8 (0.32-1.0); symptoms 0.79 (0.36-1.0), and diagnoses 0.47 (0.33-0.84), both low and high scores indicating poor performance. There was substantial agreement between 75% group dx and confirmed NC abnormality (abn). As compared to Σ5 NC, individual physicians' clinical dx was excessively variable and frequently inaccurate. Study physician dx from signs and symptoms were excessively variable, often overestimating DSPN. Specific approaches to improving clinical proficiency should be tested.",

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AU - Llewelyn, J. Gareth

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AU - Smith, A. Gordon

AU - Tesfaye, Solomon

AU - Vella, Adrian

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AB - The purpose was to test whether physicians can validly and reproducibly diagnose diabetic sensorimotor polyneuropathy (DSPN). Twelve physicians assessed 24 patients with diabetes mellitus (DM) on consecutive days (576 examinations) with physical features and voice disguised. Results were compared to gold standard 75% group diagnosis (dx) and a nerve conduction score (Σ5 NC nds). Masking of patients was achieved. Reproducibility measured by the kappa coefficient and compared to Σ5 NC nd varied considerably among physicians: median and ranges: signs 0.8 (0.32-1.0); symptoms 0.79 (0.36-1.0), and diagnoses 0.47 (0.33-0.84), both low and high scores indicating poor performance. There was substantial agreement between 75% group dx and confirmed NC abnormality (abn). As compared to Σ5 NC, individual physicians' clinical dx was excessively variable and frequently inaccurate. Study physician dx from signs and symptoms were excessively variable, often overestimating DSPN. Specific approaches to improving clinical proficiency should be tested.

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Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy: CI vs. NPhys trial

Abstract

Keywords

ASJC Scopus subject areas

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