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An Initial Evaluation of a Proof-of-Concept 128-Hz Electronic Tuning Fork in the Detection of Peripheral Neuropathy

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  • 1 Health Access Network, Lincoln, ME.
  • | 2 Independent Clinical Research Consultant, O'Brien Medical, LLC, Orono, ME.
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Background

Diabetic peripheral neuropathy (DPN) is an essential precursor leading to diabetic limb loss. Neurologic screening tests, including the 128-Hz tuning fork (TF), have long been used to identify and track the progression of DPN, thereby guiding the implementation of preventive strategies. Although a sensitive indicator of neuropathy, shortcomings of TF testing include the lack of standardization and quantification of clinical findings. In an attempt to overcome these limitations, a novel 128-Hz electronic TF (ETF) prototype has been developed that is capable of performing accurate timed vibration tests (TVTs). This study was designed to assess the ability of the ETF to detect sensory impairment compared with three established neurologic screening methods: the Semmes-Weinstein monofilament test, the biothesiometer, and the sharp/dull discrimination test.

Methods

Fifty-five test patients were recruited from the primary author's practice and enrolled according to an approved protocol. The 10-g Semmes-Weinstein monofilament test and the sharp/dull discrimination test were administered in standard fashion to the plantar aspects of digits 1 and 5 bilaterally. The ETF and the biothesiometer (25-V setting) were applied to the dorsal aspects of the distal phalanx of the hallux and fifth metatarsal head bilaterally.

Results

The sensitivity and specificity of neuropathy detection for the ETF were 0.953 and 0.761, respectively, using conventional tests as reference standards.

Conclusions

Performance of TVTs with the ETF detected sensory impairment compared with three conventional neurologic screening methods. Given these findings, the ETF could facilitate the use of standardized TVTs as an indicator of DPN progression.

Corresponding author: Todd O'Brien, DPM, Health Access Network, 175 W Broadway, Lincoln, ME 04457. (E-mail: obrienmedical@roadrunner.com)