The purpose of this systematic review is to evaluate current evidence in the literature
on the efficacy of Semmes Weinstein monofilament examination (SWME) in diagnosing
diabetic peripheral neuropathy (DPN).
The PubMed database was searched through August 2008 for articles pertaining to DPN
and SWME with no language or publication date restrictions. Studies with original
data comparing the diagnostic value of SWME with that of one or more other modalities
for DPN in patients with diabetes mellitus were analyzed. Data were extracted by two
independent investigators. Diagnostic values were calculated after classifying data
by reference test, SWME methodology, and diagnostic threshold.
Of the 764 studies identified, 30 articles were selected, involving 8365 patients.
There was great variation in both the reference test and the methodology of SWME.
However, current literature suggests that nerve conduction study (NCS) is the gold
standard for diagnosing DPN. Four studies were identified which directly compared
SWME with NCS and encompassed 1065 patients with, and 52 patients without diabetes
mellitus. SWME had a sensitivity ranging from 57% (95% confidence interval [CI], 44%
to 68%) to 93% (95% CI, 77% to 99%), specificity ranging from 75% (95% CI, 64% to
84%) to 100% (95% CI, 63% to 100%), positive predictive value (PPV) ranging from 84%
(95% CI, 74% to 90%) to 100% (95% CI, 87% to 100%), and negative predictive value
(NPV) ranging from 36% (95% CI, 29% to 43%) to 94% (95% CI, 91% to 96%).
There is great variation in the current literature regarding the diagnostic value
of SWME as a result of different methodologies. To maximize the diagnostic value of
SWME, a three site test involving the plantar aspects of the great toe, the third
metatarsal, and the fifth metatarsals should be used. Screening is vital in identifying
DPN early, enabling earlier intervention and management to reduce the risk of ulceration
and lower extremity amputation.