Ocenjevanje zaznavnega praga za dotik na spodnjih udih z monofilamenti : pregled literature

Pantner, Barbara (author), Puh, Urška (mentor)

Uvod: Občutenje na stopalu nas varuje pred poškodbami in sodeluje pri uravnavanju gibanja tako, da zagotavlja informacije za ohranjanje ravnotežja med hojo in stojo. Kvantitativno ocenimo zaznavni prag za dotik z monofilamenti. Pražne vrednosti zaznav lahko variirajo od lahnega dotika do grobega pritiska. Namen: Pregled izsledkov raziskav o ponovljivosti in zanesljivosti ocenjevanja zaznavnega praga za dotik z monofilamenti na spodnjih udih. Metode: Raziskovalni članki so bili pridobljeni v podatkovni zbirki PubMed do konca oktobra 2017. Rezultati: V pregled je bilo vključenih 12 člankov. V eni raziskavi so ugotavljali ponovljivost ocenjevanja in v 10 zanesljivost posameznega preiskovalca in med preiskovalci s Semmes-Weinsteinovimi monofilamenti ter v eni zanesljivost med preiskovalci z Weinsteinovim izboljšanim testom občutenja (Weinstein enhanced sensory test, WEST). Ocenjevanje je ponovljivo le v primeru, da so monofilamenti pravilno umerjeni (CV: 6–9 %). Zanesljivost za posameznega preiskovalca je bila pri zdravih odraslih v štirih raziskavah nizka do odlična (ICC = 0,36–0,92), pri pacientih s sladkorno boleznijo v dveh raziskavah nizka do odlična (ICC = 0,49–0,92) in pri pacientih z gobavostjo v dveh raziskavah dobra do odlična (ICC = 0,83–0,92). Zanesljivost med preiskovalci s Semmes-Weinsteinovimi monofilamenti je bila pri zdravih odraslih v dveh raziskavah nizka do odlična (ICC = 0,07–0,92), pri zdravih šolskih otrocih v eni raziskavi dobra do odlična (ICC = 0,88–0,96), pri pacientih s sladkorno boleznijo v dveh raziskavah nizka do dobra (ICC = 0,46–0,88) in pri pacientih z gobavostjo v treh raziskavah dobra do odlična (ICC = 0,76–0,95). Zanesljivost je bila dobra do odlična (ICC = 0,76–0,96) v šestih raziskavah, ko so ocenjevali izkušeni preiskovalci. Najbolj zanesljivo ocenjevanje je bilo na 1. prstu in 1. stopalnici na plantarni strani stopala (ICC = 0,52¬–0,94) in pri določitvi zaznavnega praga 2/3 (vsaj dve zaznavi od treh prejetih dražljajev) (ICC = 0,88–0,95), 2/2 (ICC = 0,92–0,94) in 3/3 (ICC = 0,61–0,92). Zanesljivost med preiskovalci z WEST pri pacientkah s hallux valgus je bila dobra (ICC = 0,84). Zaključek: Ocenjevanje zaznavnega praga z monofilamenti je najbolj zanesljivo ko ocenjuje isti izkušen preiskovalec, in sicer na področju 1. prsta in glavici 1. stopalnice plantarno in določi zaznavni prag z 2/3 (vsaj dve zaznavi od treh prejetih dražljajev) ali z 2/2. Ponovljivost sil monofilamentov je optimalna, vendar bi bilo potrebno ponovljivost raziskati še na ljudeh. O zanesljivosti ocenjevanja so potrebne nadaljnje raziskave pri pacienti z nevrološkimi okvarami, starejših odraslih, otrocih in tudi pri sladkornih bolnikih.

• Language: Slovenian
• Keywords: ponovljivost, zanesljivost, Semmes-Weinsteinovi monofilamenti, WEST, senzorika
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2018
• PID: 20.500.12556/RUL-101929
• COBISS.SI-ID: 5462635
• Publication date in RUL: 13.07.2018

Secondary language

• Language: English
• Title: Assessment of touch treshold on lower limbs with monofilaments : literature review

Abstract

Introduction: Foot sensitivity protects us from injuries and participates in posture control by providing information during standing and walking. Touch detection threshold can be quantitatively assessed with monofilaments. Detection threshold values can vary from light touch to deep pressure. Purpose: To review studies of repeatability and reliability of touch threshold assessment with monofilaments on lower limbs. Methods: Research articles were conducted using database PubMed until the end of October 2017. Results: 12 articles were included in the review. One study established repeatability, and 10 studies intra-rater and inter-rater reliability of Semmes-Weinstein monofilaments, and in one study interrater reliability of assessment with Weinstein enhanced sensory test (WEST) was established. Use of monofilaments is repeatable if filaments are well calibrated (CV: 6–9 %). Intra-rater reliability was poor to excellent (ICC = 0.36–0.92) in four studies with healthy adults, poor to excellent (ICC = 0.49–0.92) in two studies with diabetic patients and good to excellent (ICC = 0.83–0.92) in two studies with leprosy patients. Inter-rater reliability was poor to excellent (ICC = 0,07–0,92) in two studies with healthy adults, good to excellent (ICC = 0.88–0.96) in one study with healthy school children, poor to good (ICC = 0.46–0.88) in two studies with diabetic patients and good to excellent (ICC = 0.76–0.95) in three studies with leprosy patients. In six studies reliability was good to excellent (ICC = 0.76–0.96) when assessment was done by experienced researchers. Most reliable assessment was performed on plantar surface of the 1. digit and the 1. metatarsal head (ICC = 0.52¬–0.94) and when detection threshold was determinated with 2/3 (at least two detections out of three applications) (ICC = 0.88–0.95) or 2/2 answers (ICC = 0.92–0.94). Interrater reliability with WEST was good (ICC = 0.84) in patients with hallux valgus. Conclusions: Assessment of touch threshold with monofilaments is most reliable if performed by experienced researchers on plantar surface of the 1. digit and the 1. metatarsal head and if touch threshold is determinate with 2/3 (at least two detections out of three applications) or with 2/2 answers. Monofilaments are repeatable tool, but repeatability of their use should be established on humans. Further studies of reliability are needed in patients with neurological disorders, older adults, children and diabetic patients.

• Keywords: repeatability, reliability, Semmes-Weinstein monofilaments, WEST, sensitivity