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Semmes-Weinstein Monofilament Examination for Predicting Physical Performance and the Risk of Falls in Older People: Results of the Pro.V.A. Longitudinal Study

Published:September 19, 2017DOI:https://doi.org/10.1016/j.apmr.2017.08.480

      Abstract

      Objective

      To investigate whether the Semmes-Weinstein monofilament examination (SWME) was associated with, and could predict, measures of physical performance and the risk of fall in older people.

      Design

      Prospective study.

      Setting

      Community.

      Participants

      Older participants (N=2826) enrolled in the Progetto Veneto Anziani (Pro.V.A.) study and a subsample of persons (n=1885) who did not report falls at baseline for longitudinal analyses.

      Interventions

      Not applicable.

      Main Outcome Measures

      Falls reported in the year preceding the assessment and Short Physical Performance Battery (SPPB) were recorded at baseline and again after 4.4 years.

      Results

      At baseline, 830 participants (29.4%) had experienced falls in the previous year, with a higher prevalence of falls in those positive at SWME than in those negative at SWME (35.8% vs 28.0%; P=.001). Using logistic regression, participants positive at SWME had a (significant) 66% higher risk of presenting worse SPPB score (95% confidence interval, 1.51–1.83) and between 25% and 32% higher risks of having experienced ≥1 fall or recurrent falls than did those negative at SWME. The incidence of falls at follow-up was higher in the positive SWME group than in the negative SWME group (42.2% vs 30.7%; P=.001), and multinomial logistic regression showed that the former had a 13% higher risk of decline in SPPB scores (95% confidence interval, 1.03–1.25), particularly for gait and balance; 48% higher risk of having had 1 fall; and 77% higher risk of recurrent falls. At both baseline and follow-up, the larger the extension of neuropathy (negative SWME vs unilateral impairment in positive SWME vs bilateral impairment in positive SWME), the greater its negative effect on falls and physical performance.

      Conclusions

      SMWE was associated with, and could predict, lower extremity physical performance and falls in older people.

      Keywords

      List of abbreviations:

      SPPB (Short Physical Performance Battery), SWME (Semmes-Weinstein monofilament examination)
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      References

        • McClure R.J.
        • Turner C.
        • Peel N.
        • Spinks A.
        • Eakin E.
        • Hughes K.
        Population-based interventions for the prevention of fall-related injuries in older people.
        in: Spinks A. Cochrane Database of systematic reviews. Wiley, Chichester2005 (;1:CD004441.)
        • Vrancken A.F.
        • Kalmijn S.
        • Brugman F.
        • Rinkel G.J.
        • Notermans N.C.
        The meaning of distal sensory loss and absent ankle reflexes in relation to age: a meta-analysis.
        J Neurol. 2006; 253: 578-589
        • Anish L.
        • Nagappa M.
        • Mahadevan A.
        • Taly A.B.
        Neuropathy in elderly: lessons learnt from nerve biopsy.
        Age Ageing. 2015; 44: 312-317
        • Resnick H.E.
        • Vinik A.I.
        • Schwartz A.V.
        • et al.
        Independent effects of peripheral nerve dysfunction on lower-extremity physical function in old age: the Women’s Health and Aging Study.
        Diabetes Care. 2000; 23: 1642-1647
        • Caronni A.
        • Cattalini C.
        • Previtera A.M.
        Balance and mobility assessment for ruling-out the peripheral neuropathy of the lower limbs in older adults.
        Gait Posture. 2016; 50: 109-115
        • Abbott C.A.
        • Malik R.A.
        • van Ross E.R.
        • Kulkarni J.
        • Boulton A.J.
        Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K..
        Diabetes Care. 2011; 34: 2220-2224
        • Feng Y.
        • Schlösser F.J.
        • Sumpio B.E.
        The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy.
        J Vasc Surg. 2009; 50 (682.e1): 675-682
        • Riskowski J.L.
        • Quach L.
        • Manor B.
        • Menz H.B.
        • Lipsitz L.A.
        • Hannan M.T.
        Idiopathic peripheral neuropathy increases fall risk in a population-based cohort study of older adults.
        J Foot Ankle Res. 2012; 5: P19
        • Manor B.
        • Li L.
        Characteristics of functional gait among people with and without peripheral neuropathy.
        Gait Posture. 2009; 30: 253-256
        • Resnick H.E.
        • Stansberry K.B.
        • Harris T.B.
        • et al.
        Diabetes, peripheral neuropathy, and old age disability.
        Muscle Nerve. 2002; 25: 43-50
        • Chiles N.S.
        • Phillips C.L.
        • Volpato S.
        • et al.
        Diabetes, peripheral neuropathy, and lower-extremity function.
        J Diabet Complications. 2014; 28: 91-95
        • de Mettelinge T.R.
        • Calders P.
        • Palmans T.
        • Vanden Bossche L.
        • Van Den Noortgate N.
        • Cambier D.
        Vibration perception threshold in relation to postural control and fall risk assessment in elderly.
        Disabil Rehabil. 2013; 35: 1712-1717
        • Corti M.C.
        • Guralnik J.M.
        • Sartori L.
        • et al.
        The effect of cardiovascular and osteoarticular diseases on disability in older Italian men and women: rationale, design, and sample characteristics of the Progetto Veneto Anziani (PRO.V.A.) Study.
        J Am Geriatr Soc. 2002; 50: 1535-1540
        • Pickering T.G.
        • Hall J.E.
        • Appel L.J.
        • et al.
        Recommendations for blood pressure measurement in humans and experimental animals. Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association.
        Circulation. 2005; 111: 697-716
        • Drouin P.
        • Blickle J.F.
        • Charbonnel B.
        • et al.
        Diagnosis and classification of diabetes mellitus.
        Diabetes Care. 2009; 32: S62-S67
        • The Consensus Committee of the American Autonomic Society and the American Academy of Neurology
        Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy.
        Neurology. 1996; 46: 1470
        • Perkins B.A.
        • Olaleye D.
        • Zinman B.
        • Bril V.
        Simple screening tests for peripheral neuropathy in the diabetes clinic.
        Diabetes Care. 2001; 24: 250-256
        • Lee S.
        • Kim H.
        • Choi S.
        • Park Y.
        • Kim Y.
        • Cho B.
        Clinical usefulness of the two-site Semmes-Weinstein monofilament test for detecting diabetic peripheral neuropathy.
        J Korean Med Sci. 2003; 18: 103-107
        • Apelqvist J.
        • Bakker K.
        • van Houtum W.H.
        • Schaper N.C.
        Practical guidelines on the management and prevention of the diabetic foot.
        Diabetes Metab Res Rev. 2008; 24: S181-S187
        • Guralnik J.M.
        • Ferrucci L.
        • Simonsick E.M.
        • Salive M.E.
        • Wallace R.B.
        Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.
        N Engl J Med. 1995; 332: 556-561
        • Perez-Zepeda M.U.
        • Belanger E.
        • Zunzunegui M.V.
        • Phillips S.
        • Ylli A.
        • Guralnik J.
        Assessing the validity of self-rated health with the Short Physical Performance Battery: across-sectional analysis of the international mobility in aging study.
        PLoS One. 2016; 11: 1-11
        • Perera S.
        • Mody S.H.
        • Woodman R.C.
        • Studenski S.A.
        Meaningful change and responsiveness in common physical performance measures in older adults.
        J Am Geriatr Soc. 2006; 54: 743-749
      1. World Health Organization. Manual of the international statistical classification of diseases, injuries, and causes of death: based on the recommendations of the Ninth Revision Conference, 1975, and adopted by the Twenty-Ninth World Health Assembly. Published Online First in 1977. Available at: http://apps.who.int/iris/handle/10665/40492. Accessed June 28, 2017.

        • Deandrea S.
        • Lucenteforte E.
        • Bravi F.
        • Foschi R.
        • La Vecchia C.
        • Negri E.
        Risk factors for falls in community-dwelling older people.
        Epidemiology. 2010; 21: 658-668
        • Pagel K.J.
        • Kaul M.P.
        • Dryden J.D.
        Lack of utility of Semmes-Weinstein monofilament testing in suspected carpal tunnel syndrome.
        Am J Phys Med Rehabil. 2002; 81: 597-600
        • Craig A.B.
        • Strauss M.B.
        • Daniller A.
        • Miller S.S.
        Foot sensation testing in the patient with diabetes: introduction of the quick & easy assessment tool.
        Wounds. 2014; 26: 221-231
        • Mahieu R.
        • Coenen M.N.
        • van Bemmel T.
        • van der Zaag-Loonen H.J.
        • Theuvenet W.J.
        Detecting intrinsic muscle weakness of the hallux as an addition to early-stage screening of the feet in patients with diabetes.
        Diabetes Res Clin Pract. 2016; 119: 83-87
        • Strotmeyer E.S.
        • de Rekeneire N.
        • Schwartz A.V.
        • et al.
        The relationship of reduced peripheral nerve function and diabetes with physical performance in older white and black adults: the Health, Aging, and Body Composition (Health ABC) Study.
        Diabetes Care. 2008; 31: 1767-1772
        • Timar B.
        • Timar R.
        • Gaiă L.
        • Oancea C.
        • Levai C.
        • Lungeanu D.
        The impact of diabetic neuropathy on balance and on the risk of falls in patients with type 2 diabetes mellitus: a cross-sectional study.
        PLoS One. 2016; 11: e0154654
        • Roman de Mettelinge T.
        • Delbaere K.
        • Calders P.
        • Gysel T.
        • Van Den Noortgate N.
        • Cambier D.
        The impact of peripheral neuropathy and cognitive decrements on gait in older adults with type 2 diabetes mellitus.
        Arch Phys Med Rehabil. 2013; 94: 1074-1079
        • Richardson J.K.
        • Ashton-Miller J.A.
        • Lee S.G.
        • Jacobs K.
        Moderate peripheral neuropathy impairs weight transfer and unipedal balance in the elderly.
        Arch Phys Med Rehabil. 1996; 77: 1152-1156
        • Richardson J.K.
        • Hurvitz E.A.
        Peripheral neuropathy: a true risk factor for falls.
        J Gerontol A Biol Sci Med Sci. 1995; 50: M211-M215