Waarde van monofilament bij diagnostiek van perifere neuropathie*

Objective

To document the diagnostic accuracy of the 10g monofilament test in peripheral neuropathy.

Design

Systematic review.

Method

We searched Medline and Embase for studies published up until August 2010 that evaluated the accuracy of the 5.07/10g monofilament test in detecting peripheral neuropathy of any etiology, using nerve conduction as the reference standard. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool.

Results

We reviewed the titles and abstracts of 233 articles to select 62 studies, of which 5 satisfied the methodological criteria for data synthesis. All 5 studies were limited to patients with diabetes mellitus, were heterogenous in nature and showed limitations according to the QUADAS tool. Pooled sensitivity was 82% (95% CI: 66-92) and pooled specificity 77% (95% CI: 55-90).

Conclusion

Despite the frequent use of monofilament testing, little can be said about the test accuracy in detecting neuropathy in feet without visible ulcers. Since the test is advocated in several clinical guidelines, priority should be given in further research to the definition of thresholds and optimal application of the test. For the time being we therefore do not recommend the single use of the monofilament test to diagnose peripheral neuropathy.

Conflict of interest: none declared. Financial support: The Netherlands Organisation for Health Research and Development (ZonMw) supported this work (grant number 4200.0018), but it had no role in the design of the study, data collection, analysis or interpretation of the data, or in the approval for publication of the finished manuscript.