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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 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.)
- The meaning of distal sensory loss and absent ankle reflexes in relation to age: a meta-analysis.J Neurol. 2006; 253: 578-589
- Neuropathy in elderly: lessons learnt from nerve biopsy.Age Ageing. 2015; 44: 312-317
- 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
- Balance and mobility assessment for ruling-out the peripheral neuropathy of the lower limbs in older adults.Gait Posture. 2016; 50: 109-115
- Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K..Diabetes Care. 2011; 34: 2220-2224
- The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy.J Vasc Surg. 2009; 50 (682.e1): 675-682
- Idiopathic peripheral neuropathy increases fall risk in a population-based cohort study of older adults.J Foot Ankle Res. 2012; 5: P19
- Characteristics of functional gait among people with and without peripheral neuropathy.Gait Posture. 2009; 30: 253-256
- Diabetes, peripheral neuropathy, and old age disability.Muscle Nerve. 2002; 25: 43-50
- Diabetes, peripheral neuropathy, and lower-extremity function.J Diabet Complications. 2014; 28: 91-95
- Vibration perception threshold in relation to postural control and fall risk assessment in elderly.Disabil Rehabil. 2013; 35: 1712-1717
- 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
- 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
- Diagnosis and classification of diabetes mellitus.Diabetes Care. 2009; 32: S62-S67
- Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy.Neurology. 1996; 46: 1470
- Simple screening tests for peripheral neuropathy in the diabetes clinic.Diabetes Care. 2001; 24: 250-256
- Clinical usefulness of the two-site Semmes-Weinstein monofilament test for detecting diabetic peripheral neuropathy.J Korean Med Sci. 2003; 18: 103-107
- Practical guidelines on the management and prevention of the diabetic foot.Diabetes Metab Res Rev. 2008; 24: S181-S187
- 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
- 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
- Meaningful change and responsiveness in common physical performance measures in older adults.J Am Geriatr Soc. 2006; 54: 743-749
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.
- Risk factors for falls in community-dwelling older people.Epidemiology. 2010; 21: 658-668
- Lack of utility of Semmes-Weinstein monofilament testing in suspected carpal tunnel syndrome.Am J Phys Med Rehabil. 2002; 81: 597-600
- Foot sensation testing in the patient with diabetes: introduction of the quick & easy assessment tool.Wounds. 2014; 26: 221-231
- 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
- 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
- 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
- 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
- Moderate peripheral neuropathy impairs weight transfer and unipedal balance in the elderly.Arch Phys Med Rehabil. 1996; 77: 1152-1156
- Peripheral neuropathy: a true risk factor for falls.J Gerontol A Biol Sci Med Sci. 1995; 50: M211-M215
Article info
Publication history
Published online: September 19, 2017
Footnotes
Supported by the Fondazione Cassa di Risparmio of Padua and Rovigo, the University of Padua, the Azienda Unità Locale Socio Sanitaria 15 and 18 of the Veneto Region and by the Veneto Regional Authority (Ricerca Sanitaria Finalizzata n. 156/03). Also financed by a grant from the University of Padua (Population aging – Economics, health, retirement and the welfare state - POPA_EHR).
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
