Hire Justin M, Ramadorai Uma E, Contractor Dhruti, Jacobs Jeremy M, Bojescul John A, Abell Brian E
Department of Orthopaedics and Rehabilitation, Dwight D. Eisenhower Army Medical Center, 300 Hospital Road, Fort Gordon, GA 30905.
Mil Med. 2014 Apr;179(4):442-4. doi: 10.7205/MILMED-D-13-00423.
Semmes-Weinstein monofilament (SWM) evaluation for protective sensation in diabetic feet is a widely used tool to guide patient care. Little evidence is available for alternative testing modalities for use when monofilament is not available or is deformed. Multiple varieties of intravenous angiocatheter tubing were subjected to biomechanical testing on a digital scale to assess the force generated once bending was observed by five independently tested raters. A 5.07 SWM (10 g) was tested in similar manner to establish a baseline and validate testing methodology. The 24 gauge × 0.75 in angiocatheter measured the closest to the 5.07 SWM (10 g) at an average force of 22 ± 0.91 g compared with 10.2 ± 0.13 g. Large-gauge angiocatheters measured greater forces. High intra-rater and inter-rater reliability was observed with all values greater than 0.98 (p < 0.001). A 24 gauge × 0.75 in angiocatheter tubing can be used as an alternative to the standard 5.07 SWM (10 g) for testing protective sensation in diabetic feet. Reviewing previously published receiver operating characteristics, this modality would yield estimated sensitivity and specificity values greater than 0.8 and 0.7, respectively, for detecting insensate feet tested at the bilateral metatarsal heads.
使用Semmes-Weinstein单丝（SWM）评估糖尿病足的保护性感觉是一种广泛用于指导患者护理的工具。当单丝不可用或变形时，关于替代测试方法的证据很少。对多种静脉血管导管进行了数字秤上的生物力学测试，以评估由五名独立测试的评估者观察到弯曲后产生的力。以类似方式测试了5.07 SWM（10 g）以建立基线并验证测试方法。24号×0.75英寸的血管导管测得的力最接近5.07 SWM（10 g），平均力为22±0.91 g，而相比之下为10.2±0.13 g。大口径血管导管测得的力更大。所有值均大于0.98（p <0.001），观察到评估者内和评估者间的高可靠性。24号×0.75英寸的血管导管可替代标准的5.07 SWM（10 g）用于测试糖尿病足的保护性感觉。回顾先前发表的受试者工作特征，这种方法在检测双侧跖骨头处测试的无感觉足部时，估计的敏感性和特异性值分别大于0.8和0.7。
