Almpanidis E1,2, Heneghan NR3
1University of Birmingham, Birmingham, United Kingdom, 2Nuffield Health, Oxford, United Kingdom, 3University of Birmingham, Centre of Precision Rehabilitation for Spinal Pain, Birmingham, United Kingdom
Background: Cutaneous sensory testing in physiotherapy practice commonly uses pin prick or cotton wool to generate a categorical response (´yes´, or ´no´). The Semmes-Weinstein Esthesiometer (SWE), which includes a series of numbered monofilaments to quantify sensory threshold and is widely used in neurological medicine has not yet been evaluated for its measurement properties in physiotherapy. Clinically, SWE provides a means by which subtle changes in disease progression or response to management interventions can be evaluated.
Purpose: To investigate the inter-examiner reliability of Semmes-Weinstein Esthesiometer (SWE) for quantifying cutaneous sensory threshold.
Methods: A prospective, within day, inter-examiner reliability study was designed. A convenience sample of asymptomatic subjects was recruited from a university population. Sample size was based on a power calculation where n>26 for a 5% significance level with reliability (ICC 2.1) powered at >0.8. Two raters were randomly selected from a sample of experienced physiotherapists (>5 years of experience). Participant exclusion criteria: neurological deficit (sensory loss, motor weakness, abnormal reflexes) or presence of upper limb pain. A Sense Lab Esthesiometer kit (SenseLab Somedic Sweden) comprising of 17 flexible nylon fibers of varying diameter and length, was used. Familiarisation of the sensation preceded the main study using skin over the patient's hand. Cutaneous sensory thresholds were recorded from skin over the thenar eminence. Three measures were performed for each subject. The mean value from the three measures was used for data analysis. Descriptive statistics (mean scores), data normality testing, reliability statistics intraclass correlation coefficient (ICC: 2,1) and Bland-Altman limits of agreement were undertaken. Data analysis was performed using SPSS version 20.0.0 where p 0.05.
Results: Sample comprised 26 subjects (11 males), mean age (SD) 26.5 (3.5) years. Calculation of data values between examiners showed normal distribution (0.906-0.924). ICC calculation showed substantial inter-examiner reliability of 0.7 (95% CI: 0.274 - 0.854, p=0.003). 95% limits of agreement were between -1.8 and 2.0 with a mean of 0.1 (SD 1.96).
Conclusion(s): This is the first study to evaluate inter-examiner reliability of physiotherapists using the SWE. The evidence supports the use of SWE from physiotherapists to assess cutaneous sensory threshold.
Implications: Results show that SWE has the potential to become a useful clinical outcome measure in physiotherapy for quantifying cutaneous sensory threshold and also when evaluating sensory change over time in response to management interventions. Further research in patient population is warranted.
Keywords: Reliability, Cutaneous Sensory Threshold, Semmes-Weinstein Esthesiometer
Funding acknowledgements: This study was not funded.
Purpose: To investigate the inter-examiner reliability of Semmes-Weinstein Esthesiometer (SWE) for quantifying cutaneous sensory threshold.
Methods: A prospective, within day, inter-examiner reliability study was designed. A convenience sample of asymptomatic subjects was recruited from a university population. Sample size was based on a power calculation where n>26 for a 5% significance level with reliability (ICC 2.1) powered at >0.8. Two raters were randomly selected from a sample of experienced physiotherapists (>5 years of experience). Participant exclusion criteria: neurological deficit (sensory loss, motor weakness, abnormal reflexes) or presence of upper limb pain. A Sense Lab Esthesiometer kit (SenseLab Somedic Sweden) comprising of 17 flexible nylon fibers of varying diameter and length, was used. Familiarisation of the sensation preceded the main study using skin over the patient's hand. Cutaneous sensory thresholds were recorded from skin over the thenar eminence. Three measures were performed for each subject. The mean value from the three measures was used for data analysis. Descriptive statistics (mean scores), data normality testing, reliability statistics intraclass correlation coefficient (ICC: 2,1) and Bland-Altman limits of agreement were undertaken. Data analysis was performed using SPSS version 20.0.0 where p 0.05.
Results: Sample comprised 26 subjects (11 males), mean age (SD) 26.5 (3.5) years. Calculation of data values between examiners showed normal distribution (0.906-0.924). ICC calculation showed substantial inter-examiner reliability of 0.7 (95% CI: 0.274 - 0.854, p=0.003). 95% limits of agreement were between -1.8 and 2.0 with a mean of 0.1 (SD 1.96).
Conclusion(s): This is the first study to evaluate inter-examiner reliability of physiotherapists using the SWE. The evidence supports the use of SWE from physiotherapists to assess cutaneous sensory threshold.
Implications: Results show that SWE has the potential to become a useful clinical outcome measure in physiotherapy for quantifying cutaneous sensory threshold and also when evaluating sensory change over time in response to management interventions. Further research in patient population is warranted.
Keywords: Reliability, Cutaneous Sensory Threshold, Semmes-Weinstein Esthesiometer
Funding acknowledgements: This study was not funded.
Topic: Outcome measurement; Neurology; Musculoskeletal
Ethics approval required: Yes
Institution: University of Birmingham, United Kingdom
Ethics committee: Ethics Committee of the University of Birmingham, United Kingdom
Ethics number: Not available
All authors, affiliations and abstracts have been published as submitted.
