Accuracy of Vibration Test, Temperature, Ankle Reflex and Pinprick Sensation Examination against Biothesiometer Test for the Identification of Peripheral Neuropathy: A Cross-sectional study

Accuracy of Vibration Test, Temperature, Ankle Reflex and Pinprick Sensation Examination against Biothesiometer Test for the Identification of Peripheral Neuropathy: A Cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Accuracy of Vibration Test, Temperature, Ankle Reflex and Pinprick Sensation Examination against Biothesiometer Test for the Identification of Peripheral Neuropathy: A Cross-sectional study Li Huan, Siew Mooi Ching, Kai Wei Lee, Abdul Hanif Khan Yusof Khan, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4825888/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Detection of peripheral neuropathy is important for early intervention to prevent the complication. This cross-sectional study aimed to evaluate the accuracy of vibration test, temperature, ankle reflex, and pinprick sensation examination compared to the biothesiometer test for the identification of peripheral neuropathy in a community setting. Methods : A cross-sectional study was conducted among adults aged 18 years and above who visited retail pharmacies in Malaysia, utilizing a convenience sampling method from March 2021 to May 2022. Peripheral neuropathy was assessed using the biothesiometer test, vibration test, temperature, ankle reflex, and pinprick sensation examination. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each screening tool. SPSS version 26 was used to perform the analysis. Results : A total of 1,283 participants were recruited. The prevalence of peripheral neuropathy was 22.7%. Among the screening tools, ankle reflex had the highest sensitivity (34.12%), followed by vibration (31.76%), pinprick sensation (24.41%), and temperature (6.76%). All tests demonstrated high specificity (95.02%-97.78%). Vibration testing had the highest PPV (83.72%). Conclusion : Vibration testing had the highest PPV among the screening tools evaluated, suggesting its potential usefulness for the early detection of peripheral neuropathy in a non-clinical setting. However, further research is needed to validate these findings and assess the cost-effectiveness of implementing these screening tools in community-based settings. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Peripheral neuropathy pharmacy screening tool Malaysia INTRODUCTION There are 1 in 10 or total of 537 million adults with diabetes in 2021 according to International Diabetes Federation. 1 According to the National Health and Morbidity Survey 2019, one out of every five adults in Malaysia has diabetes. 2 The prevalence of diabetes has increased from 11.2% in 2011 to 18.3% in 2019, marking a significant 68.3% rise. 2 The most common complications of diabetes include peripheral neuropathy and damage to the autonomic nervous system, which severely lowers quality of life and causes pain in those who have peripheral neuropathy. 3 , 4 One of the local study show that the prevalence of diabetic peripheral neuropathy in a primary care setting was 50.7% among diabetic patient in Malaysia but little is known at the community level. 5 Early detection and management of DPN are critical in preventing further complications, including diabetic foot ulcers, local or systemic infections, and lower-limb amputations. 6 Yet early diagnosis remains challenging, without universal consensus on optimal detection paradigms. 7 – 9 Several screening tests are available for the identification of peripheral neuropathy, including vibration perception threshold (VPT) using a biothesiometer, 9 vibration sensation using a tuning fork, temperature sensation, 10 ankle reflex, 11 and pinprick sensation examination. 12 , 13 However, the accuracy of these tests compared to the biothesiometer, which is considered the gold standard, remains unclear especially in Malaysia. This cross-sectional study aimed to evaluate the accuracy of vibration test using a tuning fork, temperature sensation, ankle reflex, and pinprick sensation examination in comparison to the biothesiometer test for the identification of peripheral neuropathy. By assessing the sensitivity, specificity, and predictive values of these screening tests, this study seeks to provide valuable insights into their utility in clinical practice. The findings of this study could help healthcare professionals make informed decisions about the most appropriate screening tools for the early detection of peripheral neuropathy, thereby facilitating timely intervention and management to prevent complications and improve patient outcomes. MATERIALS AND METHODS Study design and setting This cross-sectional study was conducted at 7 retail pharmacies in Selangor, Malaysia between March 15, 2021, and May 5, 2022. Malaysia. Selangor was chosen due to its large population size, representing the largest state in Malaysia, thus offering insights into real-world conditions for early detection of peripheral neuropathy in a non-clinical setting. Study population and sampling Malaysian individuals aged ≥ 18 years who were willing to provide informed consent were included. Those critically ill or mentally challenged were excluded. Convenience sampling was used to recruit 1283 participants, based on a sample size calculation using 2.38% peripheral neuropathy prevalence among the Parsi community in Bombay. 14 Thus, the sample size required was 899 with a 95% confidence interval (CI), power of 80%, and a p-value of < 0.05. However, the total number of participants required was adjusted to 1283 as to account for possible missing or incomplete data at a rate of 30%. 15 Data collection A self-administered questionnaire was used to collect socio-demographic, lifestyle, co-morbidity, and family history data. Peripheral neuropathy was assessed using: Clinical examination for diminished/absent ankle reflex, reduced vibration sensation (128Hz tuning fork), impaired pinprick sensation, and altered temperature discrimination and Vibration Perception Threshold (VPT) using a digital biothesiometer on 6 sites per foot. Biothesiometer test Biothesiometry is a diagnostic technique that uses a biothesiometer device to measure the vibratory perception threshold (VPT) of peripheral nerves in order to detect early signs of peripheral neuropathy 16 .The biothesiometer comes equipped with a digital indicator that shows a range from 0–50 Volts and it also includes a portable vibration probe that operates on 230V, with a tolerance of +/- 20% and a frequency of 50Hz and alternate current (AC). The test was carried out by an experienced operator in a controlled environment that was quiet and temperature-regulated to conduct the screening process. The probe which vibrates at an amplitude proportional to the square of the applied voltage was used during the screening process. The vibration probe was placed at six predetermined sites on the sole of each foot, including the plantar aspects of the tip of the first toe, base of the first, third and fifth toes, medial aspect of the midfoot, and the heel during the screening process. To make sure that the participants understood the screening procedure, the probe was placed on the distal palmar surface if their hand before initiating the procedure. The probe was then applied perpendicularly on each predetermined site on the sole of the foot, with the voltage gradually increased at a rate of 1mV/sec. The voltage level at which participants first perceived a vibration was defined as the vibration perception threshold (VPT) value. The VPT was recorded using the mean of three voltage reading taken by the biothesiometer at each site. More severe sensory dysfunction or poor performance were indicated by a higher vibration unit value. The cut-off values for mild and significant peripheral neuropathy were 15 volts and 25 volts, respectively. 17 Operational definition To diagnose peripheral neuropathy, the cut off point for the biothesiometer are as below: <15 V: no peripheral neuropathy; 15-24.9V: mild peripheral neuropathy and ≥ 25 V: significant peripheral neuropathy. To diagnose peripheral neuropathy using biothesiometry 18 , those with < 15v were categorise normal and those score ≥ 15v were categorised as abnormal for peripheral neuropathy. The threshold values for vibration perception and categories of neuropathy are determined based on age, as follows. For individuals over 50, normal is 1-15v, mild is 16-20v, moderate is 21-25v, and severe is 26-50v. For those 50 and below, normal is 1-10v, mild is 11-15v, moderate is 16-20v, and severe is 21-50v. Ankle reflex: reduced or absence ankle reflex consider positive for the test. Vibration sensation: individual who subjectively perceived reduction in vibration sensation from 128Hz tuning fork was consider positive for the clinical examination. Pinprick sensation: Reduced ability to feel pain from orange stick were positive for the test. Temperature discrimination: Individual who subjectively unable to differentiate the temperature of the cold tuning folk place on the feet. Statistical analysis Statistical Package for the Social Sciences version 26.0 were used to perform the statistical analysis. Mean and standard deviation (SD) were used for continuous data and frequency and percentage for the categorical data. The sensitivity and specificity of the screening tests (ankle reflex, vibration test, pin prick test and temperature test was evaluated using either Chi-Square test. The significance level was set at a p-value < 0.05. Ethics Ethical approval s were obtained from the Medical Research Ethics Committee, Ministry of Health Malaysia (NMRR-20-971-54860) and Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia (JKEUPM-2020-367). Written informed consent was obtained from all participants. RESULTS The study involved 1283 participants, whose average age was 40.6 ± 12.9 years. Most of the participants were of Chinese (54.1%) and almost half had completed tertiary education (43.4%). A large percentage of the participants did not drink alcohol (80.6%), were non-smokers (83.5%), and non-vegetarian (97.6%). Hypertension (21.8%) was more common than diabetes (12.9%) among the participants. Only a small number of participants had underlying neurological conditions (3.2%), and 7.3% reported had a family history of neurological problem. (Table 1). Table 1: Socio-demographics, lifestyle, medical history, family history, and diabetes related complications of the study population (n=1283). Characteristics n (%) Age in years, mean (SD) 40.6 (12.9) Gender Male 648 (50.5) Female 635 (49.5) Ethnicity Malays 372 (29.0) Chinese 694 (54.1) Indian 161 (12.5) Others 56 (4.4) Highest Education level achieved, none, n (%) 39 (3.0) Primary school 126 (9.8) Secondary school 446 (34.8) Pre-University 115 (9.0) Tertiary level 557 (43.4) Personal monthly income in Ringgit Malaysia, mean (SD) 4246.2 (4403.3) Alcohol intake 249 (19.4) Smoking 212 (16.5) Vegetarianism 31 (2.4) Hypertension 280 (21.8) Diabetes 166 (12.9) Neurological disorders* 41 (3.2) Family history of neurological disorders 94 (7.3) Complications among those with diabetes Stroke 11 (6.6) Heart disease 26 (15.7) Renal disease 15 (9.0) Eye disease 43 (25.9) Foot ulceration 6 (3.6) * Examples of neurological disorders are Guillain-Barre syndrome and chronic inflammatory demyelinating polyneuropathy. The biothesiometer test showed that 291 participants (22.7%) tested positive for peripheral neuropathy while 943 participants tested negative. Table 2 shows distribution of findings across four different screening examination for peripheral neuropathy: Ankle reflex, Vibration, Pinprick sensation, temperature. For ankle reflex, majority (87.0%) of the participants had normal result while only (13.0%) of participants had reduced or absence ankle reflex. For the vibration test, most of the participants (89.9%) showed normal result and a little portion (10.1%) had abnormal results. For pinprick sensation, there were 91.1% of participants had normal pin prick sensation while 8.1% of the participants had reduced pinprick sensation. For the temperature discrimination test, majority of the participants (94.5%) had normal results while only 5.5% of them had abnormal result. Table 2. Distribution of findings for each screening examination test in detecting peripheral neuropathy (n=1283) Types of screening examination Findings n (%) Ankle reflex Normal 1116 (87.0) Reduced or absence 167 (13.0) Vibration Normal 1154 (89.9) Abnormal 129 (10.1) Pinprick sensation Normal 1179 (91.9) Reduced 104 (8.1) Temperature Normal 1213 (94.5) Abnormal 70 (5.5) Table 3 shows accuracy of ankle reflex, vibration Test, pinprick sensation and temperature Examination against biothesiometer Test in detecting peripheral neuropathy. The sensitivity of ankle reflex is highest (34.12%) followed by vibration (31.76%), pinprick sensation test (24.41%) and temperature (6.76%). The specificity of all of the test is with high specificity ranging from 95.02%-97.78%. The positive predictive value is highest in vibration (83.72%) followed by pinprick sensation, ankle reflex and temperature. Table 3. Sensitivity and Specificity of Ankle reflex, vibration, pinprick sensation and temperature (n=1283) Sensitivity (%) Specificity (%) PPV (%) NPV (%) Ankle reflex 34.12 94.59 69.46 79.93 Vibration 31.76 97.78 83.72 79.90 Pinprick sensation 24.41 97.77 79.81 78.20 Temperature 6.76 95.02 32.86 73.87 PPV: Positive Predictive Value NPV: Negative Predictive Value DISCUSSION The prevalence of peripheral neuropathy identified in this study was 22.7%, which is lower and within an acceptable range compared to another study conducted in India among patients with underlying diabetes, where the prevalence was reported as 34.9% 4 This cross-sectional study also aimed to evaluate the accuracy of vibration test, temperature, ankle reflex, and pinprick sensation examination compared to the biothesiometer test for the identification of peripheral neuropathy in a community setting. Among the other screening tools evaluated, ankle reflex had the highest sensitivity (34.12%), followed by vibration (31.76%), pinprick sensation (24.41%), and temperature (6.76%). However, all tests demonstrated high specificity (95.02–97.78%), indicating its effectiveness in ruling out false positives. These findings contrast with those of Jayaprakash et al. (2011), who reported a sensitivity of 90.7% and specificity of 37.3% for ankle reflex and 62.5% sensitivity and 95.3% specificity for tuning folk in detecting peripheral neuropathy. 4 The positive predictive value (PPV) for the vibration test was found to be the highest among the screening tools assessed in this study, at 83.72%. This implies that when the vibration test detects abnormal findings suggestive of peripheral neuropathy, there is a high likelihood (approximately 83.72%) that the patient actually has peripheral neuropathy. The high specificity observed in the vibration test indicates that it is very accurate in correctly identifying patients without peripheral neuropathy (true negatives). When combined with the high PPV, it suggests that abnormal results on the vibration test are particularly reliable indicators of the presence of peripheral neuropathy. Moreover, study reported a strong correlation between abnormal vibration perception test results and nerve conduction studies further supports the validity and reliability of the vibration test in detecting peripheral neuropathy. 19 This correlation strengthens the confidence in using the vibration test as an effective screening tool for identifying individuals with peripheral neuropathy. Regarding the pin prick sensation, our study showed low sensitivity of 24.41% but high- specificity (97.7%). The result was in contrast with the study by Paisley et al (2002), as their study showed that the sensitivity and specificity of pain sensation were 87% and 39% respectively. 20 This is most probably due to different equipment used during pin prick test, as our study uses orange stick to test while Paisley uses Neurotip, which has a higher sensitivity for assessing nerve function. 20 The temperature discrimination had the lowest sensitivity (6.76%) among other clinical examination. Our finding was similar to the study by Bhabhor and Vidja, 2019, 21 as their study revealed that the sensitivity for cold discrimination using thermal perception sensitometer was 10.52%.Thermal perception sensitometer has a lower sensitivity but higher specificity in detection of peripheral neuropathy. 21 Similarly, study by Viswanathan, 2002 also show the same findings as our study, as they found out that using Tip-therm examination had a sensitivity as low as 2.7% with a high specificity of 97.3% against biothesiometer in detecting peripheral neuropathy. 22 CONCLUSION Vibration testing had the highest PPV among the screening tools evaluated, suggesting its potential usefulness for the early detection of peripheral neuropathy in a non-clinical setting. However, further research is needed to validate these findings and assess the cost-effectiveness of implementing these screening tools in community-based settings. Implication of the study Clinical examination is more “subjective” measure in assessing the peripheral neuropathy as compared to electrophysiological measures. However, it is easier to administer during the daily clinical practice without the need of advanced equipment. Even though, there is high dispersity over the sensitivity may be caused by the different methods such as strength of the application and the time between elicit the vibration of the tuning fork and application to the test site. However, the high PPV of the vibration test underscores its value as a reliable tool for identifying individuals with peripheral neuropathy, particularly when combined with its high specificity and correlation with nerve conduction studies. Strength and limitations One of the strengths of this study is the large sample size (n = 1,283) and the community-based setting, which provides insights into the performance of these screening tools in a real-world, non-clinical environment. However, the study also has some limitations. The convenience sampling method used may have introduced selection bias, and the cross-sectional design does not allow for the assessment of the temporal relationship between the screening tools and the development of peripheral neuropathy. In conclusion, this study demonstrates among the other screening tools evaluated, vibration testing had the highest positive predictive value. These findings suggest that the vibration testing may be useful tools for the early detection of peripheral neuropathy in a non-clinical setting. However, further research is needed to validate these findings and to evaluate the cost-effectiveness of implementing these screening tools in community-based settings. Declarations Competing interests All authors declare no personal or professional conflicts of interest relating to any aspect of this study. Funding This research was funded by Procter & Gamble (M) Sdn. Bhd (Vote ID: 6380068). The funder had no role in study design, data collection and analysis, the decision to publish or the preparation of the manuscript. Author Contribution The SMC conceptualizes, analyzes, and interprets patient data. SMC, LH, AHKYK and KWL conceived and designed the study, with SMC, ATC, NKD, SV and TXH performing the data extraction. LH, LYJ, FKH, and WAES analyzed the data, SMC, WC, VR, and LH evaluated the quality, and SMC, LH, and KWL drafted the manuscript. All authors have reviewed and critically provided feedback on the manuscript. Acknowledgement The authors would like to thank all the participants in the study, for their contributions in the diagnosis of peripheral neuropathy. Data Availability The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request References IDF. IDF Diabetes Atlas. 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The comparison of thermal perception sensitometer in reference to biothesiometer in diagnosis of peripheral neuropathy in Type 2 diabetes mellitus. MedPulse International Journal of Physiology. 2019;12:47-9. https:// doi:10.26611/1031228 Viswanathan V, Snehalatha C, Seena R, Ramachandran A. Early recognition of diabetic neuropathy: evaluation of a simple outpatient procedure using thermal perception. Postgraduate medical journal. 2002;78(923):541-2. https:// doi: 10.1136/pmj.78.923.541. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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University","correspondingAuthor":false,"prefix":"","firstName":"Sajesh","middleName":"","lastName":"Veettil","suffix":""},{"id":338177019,"identity":"01b002a3-ab01-40aa-a5b9-84fbd3cebe75","order_by":7,"name":"Teh Xian Hui","email":"","orcid":"","institution":"Hospital Pulau Pinang, Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Teh","middleName":"Xian","lastName":"Hui","suffix":""},{"id":338177020,"identity":"5bbe2254-609a-4874-9528-afe3e82d3518","order_by":8,"name":"Leong Yong Jian","email":"","orcid":"","institution":"Hospital Pulau Pinang, Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Leong","middleName":"Yong","lastName":"Jian","suffix":""},{"id":338177021,"identity":"46e24781-cc23-4e82-a9d9-5000d67c84d2","order_by":9,"name":"Fan Kee Hoo","email":"","orcid":"","institution":"Universiti Putra Malaysia","correspondingAuthor":false,"prefix":"","firstName":"Fan","middleName":"Kee","lastName":"Hoo","suffix":""},{"id":338177022,"identity":"7b79f030-b0f9-42b7-ba71-a6d91a92d6b3","order_by":10,"name":"Wan Wan Aliaa Wan Sulaiman","email":"","orcid":"","institution":"Universiti Putra Malaysia","correspondingAuthor":false,"prefix":"","firstName":"Wan","middleName":"Wan Aliaa Wan","lastName":"Sulaiman","suffix":""},{"id":338177024,"identity":"4f18d03b-2aa2-41a7-96c8-413f68bc573d","order_by":11,"name":"Wei Chao Loh","email":"","orcid":"","institution":"Universiti Putra Malaysia","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"Chao","lastName":"Loh","suffix":""},{"id":338177026,"identity":"9d3890e6-807e-431d-be24-ed60eb6625cc","order_by":12,"name":"Mansi Patil","email":"","orcid":"","institution":"Asha Kiran JHC Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mansi","middleName":"","lastName":"Patil","suffix":""},{"id":338177027,"identity":"357ee591-d72b-417d-a2cd-691c42d325ea","order_by":13,"name":"Vasudevan Ramachandran","email":"","orcid":"","institution":"University College of MAIWP International, Taman Batu Muda","correspondingAuthor":false,"prefix":"","firstName":"Vasudevan","middleName":"","lastName":"Ramachandran","suffix":""}],"badges":[],"createdAt":"2024-07-30 05:44:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4825888/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4825888/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70532539,"identity":"3fd243b5-ac7a-4c53-8ca3-28ab6a100ce5","added_by":"auto","created_at":"2024-12-04 06:09:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":455695,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4825888/v1/bea7ac7f-f906-4839-a583-636eb981d68d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Accuracy of Vibration Test, Temperature, Ankle Reflex and Pinprick Sensation Examination against Biothesiometer Test for the Identification of Peripheral Neuropathy: A Cross-sectional study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThere are 1 in 10 or total of 537\u0026nbsp;million adults with diabetes in 2021 according to International Diabetes Federation.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e According to the National Health and Morbidity Survey 2019, one out of every five adults in Malaysia has diabetes.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The prevalence of diabetes has increased from 11.2% in 2011 to 18.3% in 2019, marking a significant 68.3% rise.\u003csup\u003e2\u003c/sup\u003e The most common complications of diabetes include peripheral neuropathy and damage to the autonomic nervous system, which severely lowers quality of life and causes pain in those who have peripheral neuropathy.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e One of the local study show that the prevalence of diabetic peripheral neuropathy in a primary care setting was 50.7% among diabetic patient in Malaysia but little is known at the community level.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Early detection and management of DPN are critical in preventing further complications, including diabetic foot ulcers, local or systemic infections, and lower-limb amputations.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Yet early diagnosis remains challenging, without universal consensus on optimal detection paradigms.\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSeveral screening tests are available for the identification of peripheral neuropathy, including vibration perception threshold (VPT) using a biothesiometer,\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e vibration sensation using a tuning fork, temperature sensation,\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e ankle reflex,\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e and pinprick sensation examination.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e However, the accuracy of these tests compared to the biothesiometer, which is considered the gold standard, remains unclear especially in Malaysia. This cross-sectional study aimed to evaluate the accuracy of vibration test using a tuning fork, temperature sensation, ankle reflex, and pinprick sensation examination in comparison to the biothesiometer test for the identification of peripheral neuropathy. By assessing the sensitivity, specificity, and predictive values of these screening tests, this study seeks to provide valuable insights into their utility in clinical practice. The findings of this study could help healthcare professionals make informed decisions about the most appropriate screening tools for the early detection of peripheral neuropathy, thereby facilitating timely intervention and management to prevent complications and improve patient outcomes.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy design and setting\u003c/h2\u003e\n \u003cp\u003eThis cross-sectional study was conducted at 7 retail pharmacies in Selangor, Malaysia between March 15, 2021, and May 5, 2022. Malaysia. Selangor was chosen due to its large population size, representing the largest state in Malaysia, thus offering insights into real-world conditions for early detection of peripheral neuropathy in a non-clinical setting.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy population and sampling\u003c/h2\u003e\n \u003cp\u003eMalaysian individuals aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years who were willing to provide informed consent were included. Those critically ill or mentally challenged were excluded. Convenience sampling was used to recruit 1283 participants, based on a sample size calculation using 2.38% peripheral neuropathy prevalence among the Parsi community in Bombay.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Thus, the sample size required was 899 with a 95% confidence interval (CI), power of 80%, and a p-value of \u0026lt;\u0026thinsp;0.05. However, the total number of participants required was adjusted to 1283 as to account for possible missing or incomplete data at a rate of 30%.\u003csup\u003e15\u003c/sup\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eData collection\u003c/h2\u003e\n \u003cp\u003eA self-administered questionnaire was used to collect socio-demographic, lifestyle, co-morbidity, and family history data. Peripheral neuropathy was assessed using: Clinical examination for diminished/absent ankle reflex, reduced vibration sensation (128Hz tuning fork), impaired pinprick sensation, and altered temperature discrimination and Vibration Perception Threshold (VPT) using a digital biothesiometer on 6 sites per foot.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eBiothesiometer test\u003c/h2\u003e\n \u003cp\u003eBiothesiometry is a diagnostic technique that uses a biothesiometer device to measure the vibratory perception threshold (VPT) of peripheral nerves in order to detect early signs of peripheral neuropathy \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.The biothesiometer comes equipped with a digital indicator that shows a range from 0\u0026ndash;50 Volts and it also includes a portable vibration probe that operates on 230V, with a tolerance of +/- 20% and a frequency of 50Hz and alternate current (AC).\u003c/p\u003e\n \u003cp\u003eThe test was carried out by an experienced operator in a controlled environment that was quiet and temperature-regulated to conduct the screening process. The probe which vibrates at an amplitude proportional to the square of the applied voltage was used during the screening process. The vibration probe was placed at six predetermined sites on the sole of each foot, including the plantar aspects of the tip of the first toe, base of the first, third and fifth toes, medial aspect of the midfoot, and the heel during the screening process.\u003c/p\u003e\n \u003cp\u003eTo make sure that the participants understood the screening procedure, the probe was placed on the distal palmar surface if their hand before initiating the procedure. The probe was then applied perpendicularly on each predetermined site on the sole of the foot, with the voltage gradually increased at a rate of 1mV/sec. The voltage level at which participants first perceived a vibration was defined as the vibration perception threshold (VPT) value. The VPT was recorded using the mean of three voltage reading taken by the biothesiometer at each site. More severe sensory dysfunction or poor performance were indicated by a higher vibration unit value. The cut-off values for mild and significant peripheral neuropathy were 15 volts and 25 volts, respectively.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eOperational definition\u003c/h2\u003e\n \u003cp\u003eTo diagnose peripheral neuropathy, the cut off point for the biothesiometer are as below: \u0026lt;15 V: no peripheral neuropathy; 15-24.9V: mild peripheral neuropathy and \u0026ge;\u0026thinsp;25 V: significant peripheral neuropathy. To diagnose peripheral neuropathy using biothesiometry\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, those with \u0026lt;\u0026thinsp;15v were categorise normal and those score\u0026thinsp;\u0026ge;\u0026thinsp;15v were categorised as abnormal for peripheral neuropathy. The threshold values for vibration perception and categories of neuropathy are determined based on age, as follows. For individuals over 50, normal is 1-15v, mild is 16-20v, moderate is 21-25v, and severe is 26-50v. For those 50 and below, normal is 1-10v, mild is 11-15v, moderate is 16-20v, and severe is 21-50v.\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eAnkle reflex: reduced or absence ankle reflex consider positive for the test.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eVibration sensation: individual who subjectively perceived reduction in vibration sensation from 128Hz tuning fork was consider positive for the clinical examination.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ePinprick sensation: Reduced ability to feel pain from orange stick were positive for the test.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eTemperature discrimination: Individual who subjectively unable to differentiate the temperature of the cold tuning folk place on the feet.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cp\u003eStatistical Package for the Social Sciences version 26.0 were used to perform the statistical analysis. Mean and standard deviation (SD) were used for continuous data and frequency and percentage for the categorical data. The sensitivity and specificity of the screening tests (ankle reflex, vibration test, pin prick test and temperature test was evaluated using either Chi-Square test. The significance level was set at a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eEthics\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003es were obtained from the Medical Research Ethics Committee, Ministry of Health Malaysia (NMRR-20-971-54860) and Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia (JKEUPM-2020-367). Written informed consent was obtained from all participants.\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe study involved 1283 participants, whose average age was 40.6 \u0026plusmn; 12.9 years. Most of the participants were of Chinese (54.1%) and almost half had completed tertiary education (43.4%). A large percentage of the participants did not drink alcohol (80.6%), were non-smokers (83.5%), and non-vegetarian (97.6%). Hypertension (21.8%) was more common than diabetes (12.9%) among the participants. Only a small number of participants had underlying neurological conditions (3.2%), and 7.3% reported had a family history of neurological problem. (Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1: Socio-demographics, lifestyle, medical history, family history, and diabetes related complications of the study population (n=1283).\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"87%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003eAge in years, mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e40.6 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e648 (50.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e635 (49.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003eEthnicity\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Malays\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e372 (29.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Chinese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e694 (54.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Indian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e161 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e56 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003eHighest Education level achieved, none, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e39 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003ePrimary school\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e126 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003eSecondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e446 (34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003ePre-University\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e115 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003eTertiary level\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e557 (43.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003ePersonal monthly income in Ringgit Malaysia, mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e4246.2 (4403.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003eAlcohol intake\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e249 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e212 (16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003eVegetarianism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e31 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e280 (21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e166 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003eNeurological disorders*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e41 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003eFamily history of neurological disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e94 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003eComplications among those with diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e11 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e26 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Renal disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e15 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Eye disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e43 (25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.76767676767676%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Foot ulceration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; 6 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e* Examples of neurological disorders are Guillain-Barre syndrome and chronic inflammatory demyelinating polyneuropathy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe biothesiometer test showed that 291 participants (22.7%) tested positive for peripheral neuropathy while 943 participants tested negative. Table 2 shows distribution of findings across four different screening examination for peripheral neuropathy: Ankle reflex, Vibration, Pinprick sensation, temperature. For ankle reflex, majority (87.0%) of the participants had normal result while only (13.0%) of participants had reduced or absence ankle reflex. For the vibration test, most of the participants (89.9%) showed normal result and a little portion (10.1%) had abnormal results. For pinprick sensation, there were 91.1% of participants had normal pin prick sensation while 8.1% of the participants had reduced pinprick sensation. For the temperature discrimination test, majority of the participants (94.5%) had normal results while only 5.5% of them had abnormal result.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Distribution of findings for each screening examination test in detecting peripheral neuropathy (n=1283)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.04081632653061%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTypes of screening examination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFindings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.04081632653061%\" valign=\"bottom\"\u003e\n \u003cp\u003eAnkle reflex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"bottom\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e1116 (87.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.04081632653061%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"bottom\"\u003e\n \u003cp\u003eReduced or absence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e167 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.04081632653061%\" valign=\"bottom\"\u003e\n \u003cp\u003eVibration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"bottom\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e1154 (89.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.04081632653061%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"bottom\"\u003e\n \u003cp\u003eAbnormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e129 (10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.04081632653061%\" valign=\"bottom\"\u003e\n \u003cp\u003ePinprick sensation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"bottom\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e1179 (91.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.04081632653061%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"bottom\"\u003e\n \u003cp\u003eReduced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e104 (8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.04081632653061%\" valign=\"bottom\"\u003e\n \u003cp\u003eTemperature\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"bottom\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e1213 (94.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.04081632653061%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"bottom\"\u003e\n \u003cp\u003eAbnormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e70 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3 shows accuracy of ankle reflex, vibration Test, pinprick sensation and temperature Examination against biothesiometer Test in detecting peripheral neuropathy. The sensitivity of ankle reflex is highest (34.12%) followed by vibration (31.76%), pinprick sensation test (24.41%) and temperature (6.76%). The specificity of all of the test is with high specificity ranging from 95.02%-97.78%. The positive predictive value is highest in vibration (83.72%) followed by pinprick sensation, ankle reflex and temperature.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. Sensitivity and Specificity of Ankle reflex, vibration, pinprick sensation and temperature \u0026nbsp; (n=1283)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003eSensitivity (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003eSpecificity (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003ePPV (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003eNPV (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"bottom\"\u003e\n \u003cp\u003eAnkle reflex\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e34.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e94.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e69.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e79.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"bottom\"\u003e\n \u003cp\u003eVibration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e31.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e97.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e83.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e79.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"bottom\"\u003e\n \u003cp\u003ePinprick sensation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e24.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e97.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e79.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e78.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"bottom\"\u003e\n \u003cp\u003eTemperature\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"bottom\"\u003e\n \u003cp\u003e6.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e95.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"bottom\"\u003e\n \u003cp\u003e32.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e73.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePPV: Positive Predictive Value NPV: Negative Predictive Value\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe prevalence of peripheral neuropathy identified in this study was 22.7%, which is lower and within an acceptable range compared to another study conducted in India among patients with underlying diabetes, where the prevalence was reported as 34.9%\u003csup\u003e4\u003c/sup\u003e This cross-sectional study also aimed to evaluate the accuracy of vibration test, temperature, ankle reflex, and pinprick sensation examination compared to the biothesiometer test for the identification of peripheral neuropathy in a community setting.\u003c/p\u003e \u003cp\u003eAmong the other screening tools evaluated, ankle reflex had the highest sensitivity (34.12%), followed by vibration (31.76%), pinprick sensation (24.41%), and temperature (6.76%). However, all tests demonstrated high specificity (95.02\u0026ndash;97.78%), indicating its effectiveness in ruling out false positives. These findings contrast with those of Jayaprakash et al. (2011), who reported a sensitivity of 90.7% and specificity of 37.3% for ankle reflex and 62.5% sensitivity and 95.3% specificity for tuning folk in detecting peripheral neuropathy.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe positive predictive value (PPV) for the vibration test was found to be the highest among the screening tools assessed in this study, at 83.72%. This implies that when the vibration test detects abnormal findings suggestive of peripheral neuropathy, there is a high likelihood (approximately 83.72%) that the patient actually has peripheral neuropathy. The high specificity observed in the vibration test indicates that it is very accurate in correctly identifying patients without peripheral neuropathy (true negatives). When combined with the high PPV, it suggests that abnormal results on the vibration test are particularly reliable indicators of the presence of peripheral neuropathy. Moreover, study reported a strong correlation between abnormal vibration perception test results and nerve conduction studies further supports the validity and reliability of the vibration test in detecting peripheral neuropathy.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e This correlation strengthens the confidence in using the vibration test as an effective screening tool for identifying individuals with peripheral neuropathy.\u003c/p\u003e \u003cp\u003eRegarding the pin prick sensation, our study showed low sensitivity of 24.41% but high- specificity (97.7%). The result was in contrast with the study by Paisley et al (2002), as their study showed that the sensitivity and specificity of pain sensation were 87% and 39% respectively.\u003csup\u003e20\u003c/sup\u003e This is most probably due to different equipment used during pin prick test, as our study uses orange stick to test while Paisley uses Neurotip, which has a higher sensitivity for assessing nerve function.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe temperature discrimination had the lowest sensitivity (6.76%) among other clinical examination. Our finding was similar to the study by Bhabhor and Vidja, 2019,\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e as their study revealed that the sensitivity for cold discrimination using thermal perception sensitometer was 10.52%.Thermal perception sensitometer has a lower sensitivity but higher specificity in detection of peripheral neuropathy.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Similarly, study by Viswanathan, 2002 also show the same findings as our study, as they found out that using Tip-therm examination had a sensitivity as low as 2.7% with a high specificity of 97.3% against biothesiometer in detecting peripheral neuropathy.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eVibration testing had the highest PPV among the screening tools evaluated, suggesting its potential usefulness for the early detection of peripheral neuropathy in a non-clinical setting. However, further research is needed to validate these findings and assess the cost-effectiveness of implementing these screening tools in community-based settings.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eImplication of the study\u003c/h2\u003e \u003cp\u003eClinical examination is more \u0026ldquo;subjective\u0026rdquo; measure in assessing the peripheral neuropathy as compared to electrophysiological measures. However, it is easier to administer during the daily clinical practice without the need of advanced equipment. Even though, there is high dispersity over the sensitivity may be caused by the different methods such as strength of the application and the time between elicit the vibration of the tuning fork and application to the test site. However, the high PPV of the vibration test underscores its value as a reliable tool for identifying individuals with peripheral neuropathy, particularly when combined with its high specificity and correlation with nerve conduction studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStrength and limitations\u003c/h2\u003e \u003cp\u003eOne of the strengths of this study is the large sample size (n\u0026thinsp;=\u0026thinsp;1,283) and the community-based setting, which provides insights into the performance of these screening tools in a real-world, non-clinical environment. However, the study also has some limitations. The convenience sampling method used may have introduced selection bias, and the cross-sectional design does not allow for the assessment of the temporal relationship between the screening tools and the development of peripheral neuropathy.\u003c/p\u003e \u003cp\u003eIn conclusion, this study demonstrates among the other screening tools evaluated, vibration testing had the highest positive predictive value. These findings suggest that the vibration testing may be useful tools for the early detection of peripheral neuropathy in a non-clinical setting. However, further research is needed to validate these findings and to evaluate the cost-effectiveness of implementing these screening tools in community-based settings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eAll authors declare no personal or professional conflicts of interest relating to any aspect of this study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research was funded by Procter \u0026amp; Gamble (M) Sdn. Bhd (Vote ID: 6380068). The funder had no role in study design, data collection and analysis, the decision to publish or the preparation of the manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe SMC conceptualizes, analyzes, and interprets patient data. SMC, LH, AHKYK and KWL conceived and designed the study, with SMC, ATC, NKD, SV and TXH performing the data extraction. LH, LYJ, FKH, and WAES analyzed the data, SMC, WC, VR, and LH evaluated the quality, and SMC, LH, and KWL drafted the manuscript. All authors have reviewed and critically provided feedback on the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank all the participants in the study, for their contributions in the diagnosis of peripheral neuropathy.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eIDF. IDF Diabetes Atlas. Accessed on 22nd March 2024 from https://diabetesatlas.org/#:~:text=537%20million%20adults%20(20%2D79,2021%20%2D%201%20every%205%20seconds. [Accessed: 2024].\u003c/li\u003e\n\u003cli\u003eInstitute for Public Health (IPH) NIoH, Ministry of Health Malaysia. National Health and Morbidity Survey (NHMS) 2019: Vol. I: NCDs \u0026ndash; Non-Communicable Diseases: Risk Factors and other Health Problems. Available: https:// www.iku.gov.my/nhms [Accessed: 2020].\u003c/li\u003e\n\u003cli\u003ePop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes care. 2017;40(1):136-54. https://doi:10.2337/dc16-2042.\u003c/li\u003e\n\u003cli\u003eFeldman EL, Callaghan BC, Pop-Busui R, Zochodne DW, Wright DE, Bennett DL, et al. Diabetic neuropathy. Nature Reviews Disease Primers. 2019;5(1):41. https:// doi: 10.1038/s41572-019-0097-9.\u003c/li\u003e\n\u003cli\u003eMimi O, Teng CL, Chia YC. The prevalence of diabetic peripheral neuropathy in an outpatient setting. Med J Malaysia. 2003;58(4):533-8. Available: https://pubmed.ncbi.nlm.nih.gov/15190629/v. [Accessed: 2003 Oct].\u003c/li\u003e\n\u003cli\u003eHicks CW, Selvin E. Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Current diabetes reports. 2019;19(10):86. https:// doi: 10.1007/s11892-019-1212-8.\u003c/li\u003e\n\u003cli\u003eYang Z, Chen R, Zhang Y, Huang Y, Hong T, Sun F, et al. Scoring systems to screen for diabetic peripheral neuropathy. Cochrane Database Syst Rev. 2018;2018(7). https:// doi:10.1002/14651858.CD010974. \u003c/li\u003e\n\u003cli\u003ePetropoulos IN, Ponirakis G, Khan A, Almuhannadi H, Gad H, Malik RA. Diagnosing Diabetic Neuropathy: Something Old, Something New. Diabetes \u0026amp; metabolism journal. 2018;42(4):255-69. https:// doi: 10.4093/dmj.2018.0056.\u003c/li\u003e\n\u003cli\u003eJayaprakash P, Bhansali A, Bhansali S, Dutta P, Anantharaman R, Shanmugasundar G, et al. Validation of bedside methods in evaluation of diabetic peripheral neuropathy. The Indian journal of medical research. 2011;133(6):645-9. Available: https:// https://pubmed.ncbi.nlm.nih.gov/21727664/.[Accessed: 2011 Jun].\u003c/li\u003e\n\u003cli\u003eWeintrob N, Amitay I, Lilos P, Shalitin S, Lazar L, Josefsberg Z. Bedside neuropathy disability score compared to quantitative sensory testing for measurement of diabetic neuropathy in children, adolescents, and young adults with type 1 diabetes. J Diabetes Complications. 2007;21(1):13-9. https:// doi: 10.1016/j.jdiacomp. \u003c/li\u003e\n\u003cli\u003eAsad A, Hameed MA, Khan UA, Ahmed N, Butt MU. Reliability of the neurological scores for assessment of sensorimotor neuropathy in type 2 diabetics. J Pak Med Assoc. 2010;60(3):166-70.Available:https://pubmed.ncbi.nlm.nih.gov/20225769/.[Accessed: 2010 Mar].\u003c/li\u003e\n\u003cli\u003eChan AW, MacFarlane IA, Bowsher D, Campbell JA. Weighted needle pinprick sensory thresholds: a simple test of sensory function in diabetic peripheral neuropathy. J Neurol Neurosurg Psychiatry. 1992;55(1):56-9. https:// doi: 10.1136/jnnp.55.1.56.\u003c/li\u003e\n\u003cli\u003eMeijer JW, van Sonderen E, Blaauwwiekel EE, Smit AJ, Groothoff JW, Eisma WH, et al. Diabetic neuropathy examination: a hierarchical scoring system to diagnose distal polyneuropathy in diabetes. Diabetes care. 2000;23(6):750-3. https:// doi: 10.2337/diacare.23.6.750 \u003c/li\u003e\n\u003cli\u003eBharucha NE, Bharucha AE, Bharucha EP. Prevalence of peripheral neuropathy in the Parsi community of Bombay. Neurology. 1991;41(8):1315-7. https:// doi: 10.1212/wnl.41.8.1315.\u003c/li\u003e\n\u003cli\u003eChing SM et al. Using Biothesiometer, Neuropathy Symptom Score, and Neuropathy Disability Score for the Early Detection of Peripheral Neuropathy: A Cross-Sectional Study, Accepted for publication. QMJ. 2024;-(-):-.\u003c/li\u003e\n\u003cli\u003eKasalov\u0026aacute; Z. [Biothesiometry in the diagnosis of peripheral neuropathies]. Cas Lek Cesk. 2002;141(7):223-5. Available: https:// https://pubmed.ncbi.nlm.nih.gov/12053759/.[Accessed: 2002 Apr].\u003c/li\u003e\n\u003cli\u003eChawla A, Bhasin G, Chawla RJTIJoFP. Validation of neuropathy symptoms score (NSS) and neuropathy disability score (NDS) in the clinical diagnosis of peripheral neuropathy in middle aged people with diabetes. 2013;12(1):1-4. Available:https:// https://print.ispub.com/api/0/ispub-article/1517. [Accessed: 2013 Dce].\u003c/li\u003e\n\u003cli\u003eAdeleye OO, Ogbera AO, Fasanmade O, Ogunleye OO, Dada AO, Ale AO, et al. Latent Autoimmune Diabetes Mellitus in Adults (LADA) and it\u0026rsquo;s characteristics in a subset of Nigerians initially managed for type 2 diabetes. International Archives of Medicine. 2012;5(1):23. https:// doi: 10.1186/1755-7682-5-23.\u003c/li\u003e\n\u003cli\u003eOnde ME, Ozge A, Senol MG, Togrol E, Ozdag F, Saracoglu M, et al. The sensitivity of clinical diagnostic methods in the diagnosis of diabetic neuropathy. J Int Med Res. 2008;36(1):63-70. https:// doi: 10.1177/147323000803600109.\u003c/li\u003e\n\u003cli\u003ePaisley A, Abbott C, van Schie C, Boulton A. A comparison of the Neuropen against standard quantitative sensory-threshold measures for assessing peripheral nerve function. Diabetic medicine : a journal of the British Diabetic Association. 2002;19(5):400-5. https:// doi: 10.1046/j.1464-5491.2002.00706.x.\u003c/li\u003e\n\u003cli\u003eBhabhor M, Vidja K. The comparison of thermal perception sensitometer in reference to biothesiometer in diagnosis of peripheral neuropathy in Type 2 diabetes mellitus. MedPulse International Journal of Physiology. 2019;12:47-9. https:// doi:10.26611/1031228\u003c/li\u003e\n\u003cli\u003eViswanathan V, Snehalatha C, Seena R, Ramachandran A. Early recognition of diabetic neuropathy: evaluation of a simple outpatient procedure using thermal perception. Postgraduate medical journal. 2002;78(923):541-2. https:// doi: 10.1136/pmj.78.923.541. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Peripheral neuropathy, pharmacy, screening tool, Malaysia","lastPublishedDoi":"10.21203/rs.3.rs-4825888/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4825888/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Detection of peripheral neuropathy is important for early intervention to prevent the complication. This cross-sectional study aimed to evaluate the accuracy of vibration test, temperature, ankle reflex, and pinprick sensation examination compared to the biothesiometer test for the identification of peripheral neuropathy in a community setting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A cross-sectional study was conducted among adults aged 18 years and above who visited retail pharmacies in Malaysia, utilizing a convenience sampling method from March 2021 to May 2022. Peripheral neuropathy was assessed using the biothesiometer test, vibration test, temperature, ankle reflex, and pinprick sensation examination. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each screening tool. SPSS version 26 was used to perform the analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 1,283 participants were recruited. The prevalence of peripheral neuropathy was 22.7%. Among the screening tools, ankle reflex had the highest sensitivity (34.12%), followed by vibration (31.76%), pinprick sensation (24.41%), and temperature (6.76%). All tests demonstrated high specificity (95.02%-97.78%). Vibration testing had the highest PPV (83.72%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Vibration testing had the highest PPV among the screening tools evaluated, suggesting its potential usefulness for the early detection of peripheral neuropathy in a non-clinical setting. However, further research is needed to validate these findings and assess the cost-effectiveness of implementing these screening tools in community-based settings.\u003c/p\u003e","manuscriptTitle":"Accuracy of Vibration Test, Temperature, Ankle Reflex and Pinprick Sensation Examination against Biothesiometer Test for the Identification of Peripheral Neuropathy: A Cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-26 06:16:17","doi":"10.21203/rs.3.rs-4825888/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"119daeea-3ad6-4e04-9171-e04b7c921fa7","owner":[],"postedDate":"August 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":35828285,"name":"Health sciences/Diseases"},{"id":35828286,"name":"Health sciences/Health care"},{"id":35828287,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2024-12-04T06:09:12+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-26 06:16:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4825888","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4825888","identity":"rs-4825888","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}