Assessment of the diagnostic accuracy of Vibrasense compared to a biothesiometer and nerve conduction study for screening diabetic peripheral neuropathy.

AIMS: Peripheral neuropathy is a common microvascular complication in diabetes and a risk factor for the development of diabetic foot ulcers and amputations. Vibrasense (Ayati Devices) is a handheld, battery-operated, rapid screening device for diabetic peripheral neuropathy (DPN) that works by quantifying vibration perception threshold (VPT). In this study, we compared Vibrasense against a biothesiometer and nerve conduction study for screening DPN. METHODS: A total of 562 subjects with type 2 diabetes mellitus underwent neuropathy assessments including clinical examination, 10-g monofilament test, VPT evaluation with Vibrasense and a standard biothesiometer. Those with an average VPT ≥ 15 V with Vibrasense were noted to have DPN. A subset of these patients (N = 61) underwent nerve conduction study (NCS). Diagnostic accuracy of Vibrasense was compared against a standard biothesiometer and abnormal NCS. RESULTS: Average VPTs measured with Vibrasense had a strong positive correlation with standard biothesiometer values (Spearman's correlation 0.891, P < 0.001). Vibrasense showed sensitivity and specificity of 87.89% and 86.81% compared to biothesiometer, and 82.14% and 78.79% compared to NCS, respectively. CONCLUSIONS: Vibrasense demonstrated good diagnostic accuracy for detecting peripheral neuropathy in type 2 diabetes and can be an effective screening device in routine clinical settings. TRIAL REGISTRATION: Clinical trials registry of India (CTRI/2022/11/047002). Registered 3 November 2022.  https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=76167 .

Detection of vertical interocular phase disparities using luster as cue.

Interocular disparities in contrast generate an impression of binocular luster, providing a cue for their detection. Disparities in the carrier spatial phase of horizontally oriented Gabor patches also generate an impression of luster, so the question arises as to whether it is the disparities in local contrast that accompany the phase disparities that give rise to the luster. We examined this idea by comparing the detection of interocular spatial phase disparities with that of interocular contrast disparities in Gabor patches, in the latter case that differed in overall contrast rather than phase between the eyes. When bandwidth was held constant and Gabor spatial frequency was varied, the detection of phase and contrast disparities followed a similar pattern. However, when spatial frequency was fixed and Gabor envelope standard deviation (and hence number of modulation cycles) was varied, thresholds for detecting phase disparities followed a U-shaped function of Gabor standard deviation, whereas thresholds for contrast disparities, following an initial decline, were more-or-less constant as a function of Gabor standard deviation. After reviewing a number of possible explanations for the U-shape found with phase disparities, we suggest that the likely cause is binocular sensory fusion, the strength of which increases with the number of modulation cycles. Binocular sensory fusion would operate to reduce phase but not contrast disparities, thus selectively elevating phase disparity thresholds.

Self-assessment of olfactory function using the "Sniffin' Sticks".

BACKGROUND: A precise and reliable test of the olfactory function is indispensable for the diagnosis of the olfactory disorder (OD). Despite of this, in a clinical context, often there is no place in daily routine for time-consuming procedures. This study aimed to examine if the assessment of olfactory function using the "Sniffin' Sticks" is suitable for self-assessment. METHODS: Participants comprised 84 healthy control subjects (HC) and 37 OD patients. The "Sniffin' Sticks" test battery consisting of odor threshold (T), discrimination (D) and identification (I) tests was used for self- and assisted assessments. To save time, we applied the 8-item wide step version of the T test and the 8-item D test, whereas the I task remained the same as the original version. The whole test included two sessions, with each session comprising a self-assessment part performed by the participants themselves, and an assisted-assessment part performed by the examiner. RESULTS: Sniffin' Sticks self-assessment was efficient in distinguishing between self-reported HC subjects and OD patients (p's < 0.01), and the scores did not differ significantly from the assisted-assessment (p's > 0.05). In the self-administered I and TDI tests, there was a moderate to excellent test-retest reliability (ICC = 0.51-0.93, p's < 0.01), and a strong to excellent correlation with the assisted assessment (r = 0.71-0.92, p's < 0.01). However, the self-administered T and D tests only exhibited low to moderate test-retest reliability (ICC = 0.30-0.72, p's < 0.05) and correlations with the assisted test (r = 0.31-0.62, p's < 0.05). CONCLUSIONS: The Identification self-test is appropriate to be solely applied, and is therefore an easy-to-use alternative for olfactory screening in a larger segment of patients. The whole "Sniffin' Sticks" self-test also shows good measurement properties and is therefore a suitable backup in clinical practice, but improvement is needed due to the simplified D and T self-test.

Assessment of olfactory function by Sniffin' sticks in bakery workers exposed to flour dust.

OBJECTIVE: This study used the Sniffin' Sticks test battery to evaluate olfactory function in employees of a bakery exposed to flour dust. SUBJECTS AND METHODS: The study enrolled 43 individuals with exposure (i.e., to flour) plus 41 healthy volunteers as controls. Olfactory function was assessed in these subjects through the use of the Sniffin' Sticks test battery. The overall score was calculated by adding up the scores for each of the 12 separate odors. A score of 6 or less was deemed anosmia, from 7 to 10 hyposmia, and a score of 11 or 12 was taken to indicate no impairment of olfaction. RESULTS: There was a statistically significant difference between the scores obtained in the exposure group (10.09±2.29) and the control group (10.73±2.07), the exposure group having a lower score (p<0.05). Within the exposure group, men and women did not score differently (p>0.05). Furthermore, in this group, the overall score did not correlate significantly with age, sex, length of employment, or use of tobacco or alcohol use (p>0.05). Using the scheme employed in this study, 9.3% of the exposed workers were anosmic, compared to 9.8% in the controls, whereas 34.9% of baker workers were hyposmic, compared to just 14.6% of the controls. Thus, our study shows that impairment of the ability to smell was present in 44.2% of individuals exposed occupationally to flour dust. CONCLUSIONS: This study reveals that being exposed to flour dust reduces the ability to smell normally. In order to minimize the impact of being exposed, workplaces should ensure adequate ventilation and provide workers with protective facemasks.

NEURO TOUCH: A novel digital device for assessment and screening of peripheral neuropathy.

BACKGROUND: Most of the patients suffering from diabetes develop Sensory neuropathy which proceeds with development of painful neuropathy. This can lead to formation of ulcers in later stages. Currently, available Quantitative Sensory Testing (QST) devices take more time to perform and are expensive. NEURO TOUCH is such device which combines four parameters of QST in one unit. Its portable, battery operated and handy device with real time display of results along with data storage and data transfer facility. It can perform tactile sensation threshold, vibration and thermal testing threshold along with skin temperature measurement. This study was undertaken to establish the diagnostic validity, reproducibility and repeatability for early detection of peripheral neuropathy. METHODS: A total of 317 subjects were recruited for QST assessment with NEURO TOUCH; Tactile threshold sensation, vibration perception and thermal threshold testing along with skin temperature. A subset of 30 subjects in each group were considered for repeatability and reproducibility test. RESULTS: The mean difference for vibration perception threshold was 0.6 when compared with gold standard device. Regarding the cold and warm perception threshold the mean difference was 1.1 and 2 °C respectively when compared with gold standard device. For skin temperature measures there was a mean difference of 1.2 °C with respect to standard device. CONCLUSIONS: The NEURO TOUCH device was easy-to-use, compact and provided an efficient multimodality approach which can help for screening of peripheral neuropathy patients with type 2 diabetes.

The Assessment of Neurosensory Disturbance Following Bilateral Sagittal Split Osteotomy With Subjective and Three-Dimensional Evaluation.

PURPOSE: Inferior alveolar neurosensory disturbance (IAND) is the most common complication of bilateral sagittal split osteotomy (BSSO). The aim of the present study was to evaluate IAND with subjective tests postoperatively and assess the relationship between three-dimensional measurements of the mandibular canal (MC) and IAND. METHODS: Eighteen patients (Mean age: 24.05 ±â€Š5.85 years) treated with BSSO were retrieved from the archive. Subjective tests (light touch, tactile sensitivity, 2-point discrimination, brush-stroke directional discrimination, sharp/blunt discrimination, dental vitality, questionnaire) and three-dimensional measurements related to MC and fixation screws were done postoperatively (on average 20.43 ±â€Š8.76 months after surgery). Statistical significance was set at P  < 0.05. RESULTS: Subjective test results were found compatible with each other except brush-stroke directional discrimination test. According to the questionnaire, IAND was apparent in all patients immediately after surgery, and recovery after 1 to 2 years was statistically significant ( P  < 0.05). Preoperative ramus width, medial and lateral cancellous bone lengths, the decrease in MC length, and the presence of screw in MC were not related to IAND ( P  < 0.05). CONCLUSIONS: There is a high incidence of IAND following BSSO, and the subjective tests are efficient to evaluate the disturbance. Spontaneous recovery of the nerve occurs during the follow-up periods. Instead of preoperative measurements of bone thickness, MC length, and the position of fixation screws, the surgical procedure seems to be more important in IAND occurrence.

Assessment of Sensory Thresholds in Dogs using Mechanical and Hot Thermal Quantitative Sensory Testing.

Quantitative sensory testing (QST) is used to evaluate the function of the somatosensory system in dogs by assessing the response to applied mechanical and thermal stimuli. QST is used to determine normal dogs' sensory thresholds and evaluate alterations in peripheral and central sensory pathways caused by various disease states, including osteoarthritis, spinal cord injury, and cranial cruciate ligament rupture. Mechanical sensory thresholds are measured by electronic von Frey anesthesiometers and pressure algometers. They are determined as the force at which the dog exhibits a response indicating conscious stimulus perception. Hot thermal sensory thresholds are the latency to respond to a fixed or ramped temperature stimulus applied by a contact thermode. Following a consistent protocol for performing QST and paying attention to details of the testing environment, procedure, and individual study subjects are critical for obtaining accurate QST results for dogs. Protocols for the standardized collection of QST data in dogs have not been described in detail. QST should be performed in a quiet, distraction-free environment that is comfortable for the dog, the QST operator, and the handler. Ensuring that the dog is calm, relaxed, and properly positioned for each measurement helps produce reliable, consistent responses to the stimuli and makes the testing process more manageable. The QST operator and handler should be familiar and comfortable with handling dogs and interpreting dogs' behavioral responses to potentially painful stimuli to determine the endpoint of testing, reduce stress, and maintain safety during the testing process.

Assessment of Spatial Lingual Tactile Sensitivity using a Gratings Orientation Test.

Individual thresholds by R-index estimates are calculated using a gratings orientation test (6 different tools of increasing grating size from 0.20-1.25 mm) to assess spatial lingual tactile sensitivity. During the experiment, the subjects are blindfolded and asked to specify the orientation of the grating (either horizontal or vertical) placed on the tongue. R-index is based on Signal Detection Theory (SDT), and it is an estimated probability of correctly identifying a target stimulus (the signal, e.g., the correct orientation) compared to an alternative stimulus (the noise, e.g., the incorrect orientation). Once the R-index values for each subject and each tool dimension are calculated, it is possible to derive the individual threshold by interpolating the two R-indices immediately below and above the established cut-off (typically 75%) based on one-sided R-index critical values. This procedure can be helpful in the medical field to study the association between oral tactile sensitivity, speech clarity, and swallowing disorders, as well as in sensory and consumer studies to explore individual variation in texture perception, food preferences, and eating behavior.

Assessment of Somatosensory Function and Self-harm in Adolescents.

Importance: Self-harm is a risk factor for suicide in adolescents, with the prevalence highest in young people in group and residential care programs. Although no established risk factors for self-harm exist, adolescents who self-harm may have decreased pain sensitivity, but this has not been systematically investigated. Objective: To assess somatosensory function using quantitative sensory testing (QST) in children and adolescents living in care grouped by the number of episodes of self-harm in the past year and compare their somatosensory profiles with community control participants to investigate associations with the incidence or frequency of self-harm. Design, Setting, and Participants: Recruitment for this cross-sectional study began January 2019 and ended March 2020. Exclusion criteria included intellectual disability (intelligence quotient <70), autism spectrum disorder, or recent serious injury. Children and adolescents aged 12 to 17 years with no underlying health conditions were recruited from local authority residential care settings in Glasgow, UK, and schools and youth groups in London and Glasgow, UK. The volunteer sample of 64 participants included adolescents ages 13 to 17 years (34 [53%] females; 50 [78%] living in residential care; mean [SD] age, 16.34 [1.01] years) with varying incidents of self-harm in the past year (no episodes, 31 [48%]; 1-4 episodes, 12 [19%]; and ≥5 episodes, 2 [33%]). Exposures: Participants were tested using a standardized QST protocol to establish baseline somatosensory function. Main Outcomes and Measures: Associations between somatosensory sensitivity, incidence and frequency of self-harm, residential status, age, gender, and prescription medication were calculated. Secondary outcomes assessed whether self-harm was associated with specific types of tests (ie, painful or nonpainful). Results: A total of 64 participants ages 13 to 17 years completed testing (mean [SD] age, 16.3 [1.0] years; 34 [53%.] females and 30 [47%] males; 50 [78%] living in group homes). Adolescents with 5 or more self-harm incidences showed significant pain hyposensitivity compared with community control participants after adjusting for age, gender, and prescription drug use (SH group with 5 or more episodes vs control: -1.03 [95% CI, -1.47 to -0.60]; P < .001). Hyposensitivity also extended to nonpainful stimuli, similarly adjusted (SH group with 5 or more episodes vs control: -1.73; 95% CI, -2.62 to -0.84; P < .001). Pressure pain threshold accounted for most of the observed variance (31.1% [95% CI, 10.5% to 44.7%]; P < .001). Conclusions and Relevance: The findings of this study suggest that sensory hyposensitivity is a phenotype of Adolescents who self-harm and that pressure pain threshold has clinical potential as a quick, inexpensive, and easily interpreted test to identify adolescents at increased risk of repeated self-harm.

Assessment of Olfactory Function in Children and Adolescents: An Overview.

Valid and reliable tools for assessing olfactory function are necessary for the diagnosis of olfactory dysfunction. Olfactory testing can be challenging in a pediatric population due to shorter attention span, linguistic development, and lower olfactory experience in this age group. The aim of this article is to present an overview about olfactory tests that are suitable for a pediatric population. Publications were included when reporting new developed methods of psychophysical olfactory testing in children or adaptation and applications of existing olfactory tests for a pediatric population. Olfactory tests for all 3 major aspects of olfactory function-olfactory threshold, odor discrimination, and odor identification-were included. Olfactory tests were evaluated regarding test validity, test reliability, normative data, and test availability. The current literature shows that several tests are available to assess olfactory function in children. Especially odor identification abilities in a pediatric population are well examined and understood. Tests for olfactory threshold and odor discrimination are less frequently used. In terms of the abovementioned evaluation criteria, only a few tests met all or 3 of these 4 criteria. Based on the current literature the following tests can be recommended for valid and reliable olfactory testing in children: "U-Sniff" odor identification test, the "Sniffin' Sticks" olfactory threshold test, pBOT-6 olfactory threshold and odor identification test, NIH-Toolbox, and Smell Wheel. Age has to be considered when evaluating olfactory function in children.

Validation study of a novel approach for assessment of retronasal olfactory function with combination of odor thresholds and identification.

PURPOSE: The present study aimed to establish a test battery for the clinical assessment of retronasal odor thresholds and retronasal odor identification. STUDY DESIGN: Prospective case-control series. METHODS: Sixty participants (36 women, 24 men, mean age 37.6 ± 19.4 years) were enrolled in this study; 36 were healthy controls and 24 were patients with olfactory dysfunction. Orthonasal olfactory function was assessed with the "Sniffin' Sticks" test battery. Retronasal olfaction was assessed with oral odorant delivery using special containers for threshold function, and with oral tasteless powders for odor identification. RESULTS: Retronasal and orthonasal olfaction were significantly correlated for threshold scores, identification score, and the sum of threshold and identification score (TI score). Validity analyses showed that the retronasal TI score was able to discriminate between healthy controls and patients with olfactory dysfunction. CONCLUSIONS: Normosmic participants can be distinctly differentiated from patients with olfactory dysfunction using a valid test battery comprised of retronasal threshold and identification tests. Based on the current findings, we advocate a TI score of 16 as a cut-off between patients and controls. Therefore, TI scores of 17 and above would indicate retronasal normosmia.

The Influence of Cognitive Parameters on Olfactory Assessment in Healthy Children and Adolescents.

Olfactory threshold and odor identification tests are frequently used for assessment of olfactory function in children and adolescents. Whether olfactory test results are influenced by cognitive parameters or sex in children and adolescents is largely unknown. The aim of this study was to investigate the influence of cognition, age and sex on "Sniffin' Sticks" olfactory threshold and "U-Sniff" odor identification performance in a pediatric population. A total of 200 participants between age 6 and 17 years were included. Olfactory function (olfactory threshold and odor identification) was assessed using the "Sniffin' Sticks." In addition, age appropriate cognitive testing was applied. The results of this study indicate that odor identification test performance is positively correlated with age (r = 0.31) and verbal abilities of children (r = 0.24). Olfactory threshold results are only marginally influenced by age (r = 0.18) and are not associated with cognitive test performance. Olfactory assessment using olfactory threshold and "U-Sniff" odor identification testing is suitable for children and adolescents when considering age in the interpretation of test results.

Assessment of an Electronic Mechanical Sensory Threshold Testing Device (RatMet) in Wistar rats (Rattus norvegicus).

von Frey (vF) monofilaments are used to quantify mechanical hypersensitivity and nociception in rodents; however, this method of testing has been criticized due to inconsistencies in testing methods, filament properties, and nonlinearity. This study compared withdrawal thresholds measured by using vF monofilaments with those of a novel mechanical threshold testing device currently in development (RatMet) in a carrageenan inflammatory model in 9- to 11-wk-old male Wistar rats. Rats were randomly assigned to assessment of mechanical hypersensitivity after intraplantar carrageenan injection by using either vF monofilaments (n = 10) or the RatMet device equipped with 3 sizes of probe tips (0.9 mm [RM0.9], n = 15; 0.5 mm [RM0.5], n = 11; and 0.09 mm [RM0.09], n = 11). All RatMet probe sizes and vF monofilaments identified a reduction in withdrawal threshold after treatment. Systematic differences in threshold were identified between vF and both RM0.9 and RM0.5 groups; RM0.09 did not differ from vF. Withdrawal thresholds showed linear relationships with probe diameter, square root of probe diameter, and area of the RatMet probes. In contrast, exponential relationships were observed with the vF monofilaments. Furthermore, none of the RatMet probe results differed in accuracy when comparing a single test with the averages of 3 or 5 tests per time point. Overall, the RatMet device measurements have construct validity even when the number of testing replicates is low. These data indicate that the RatMet device produces data comparable with those from vF monofilaments, with the potential for a shortened testing period without a decrease in accuracy.

Assessment of Tactile Sensitivity Threshold Using Cochet-Bonnet Esthesiometer and Semmes-Weinstein Monofilaments and Their Use in Corneal Neurotization.

PURPOSE: Although the Cochet-Bonnet esthesiometer (CBE) measures corneal sensitivity, it has heretofore only been tested on the index pulp. Tactile skin sensitivity thresholds are measured with Semmes-Weinstein monofilaments (SWM). This study measured skin sensitivity thresholds in healthy individuals using CBE and SWM, and compared both instruments in territories involved in corneal neurotization. METHODS: Overall, 27 healthy individuals were tested by a single examiner at 9 territories on the face, neck, forearm, and leg, using 20-thread SWM and CBE with a diameter of 0.12 mm. Both sides were tested. Thresholds were compared for both instruments and between the different territories using Bayesian methods. RESULTS: Mean sensitivity levels for SWM ranged from 0.010 to 1.128 g, while mean sensitivity levels for CBE ranged from 0.006 to 0.122 g. Thresholds measured with SWM were significantly higher than with CBE. Both instruments demonstrated higher thresholds in the leg territory than the forearm. However, the forearm presented higher thresholds than the head territories. No significant differences were found between the head territories themselves. Overall, right-side territories exhibited lower thresholds than left-side territories. CONCLUSIONS: We have reported the first mapping of skin sensitivity thresholds using CBE. Thresholds measured with CBE and SWM were coherent. The use of CBE on the skin is particularly relevant to the field of corneal neurotization.

Assessment of odor hedonic perception: the Sniffin' sticks parosmia test (SSParoT).

Qualitative olfactory dysfunction is characterized as distorted odor perception and can have a profound effect on quality of life of affected individuals. Parosmia and phantosmia represent the two main subgroups of qualitative impairment and are currently diagnosed based on patient history only. We have developed a test method which measures qualitative olfactory function based on the odors of the Sniffin' Sticks Identification subtest. The newly developed test is called Sniffin' Sticks Parosmia Test (SSParoT). SSParoT uses hedonic estimates of two oppositely valenced odors (pleasant and unpleasant) to assess hedonic range (HR) and hedonic direction (HD), which represent qualitative olfactory perception. HR is defined as the perceivable hedonic distance between two oppositely valenced odors, while HD serves as an indicator for overall hedonic perception of odors. This multicenter study enrolled a total of 162 normosmic subjects in four consecutive experiments. Cluster analysis was used to group odors from the 16-item Sniffin' Sticks Identification test and 24-additional odors into clusters with distinct hedonic properties. Eleven odor pairs were found to be suitable for estimation of HR and HD. Analysis showed agreement between test-retest sessions for all odor pairs. SSparoT might emerge as a valuable tool to assess qualitative olfactory function in health and disease.

Concurrent validity of electronic von Frey as an assessment tool for burn associated pain.

An important challenge in pain assessment is the inability of an evaluator to corroborate, using objective signs or indicators, the subjective pain report of a patient. In this scenario, the Electronic von Frey (EVF) anaesthesiometer rises as a valuable Quantitative Sensory Testing modality for pain evaluation. Although EVF showed good reproducibility when applied to healthy areas in humans, its use for evaluation of burn-related pain threshold has not yet been validated. The present study demonstrated the concurrent validity of EVF by determining its correlation with the traditionally used Visual Analog Scale (VAS). EVF was compared to VAS through pain measurements obtained from 44 patients with superficial partial thickness burns treated with silver sulfadiazine. A very good and significant positive correlation between both methods was detected. Baseline clinical and demographic parameters did not significantly affect the association between EVF and VAS. Additionally, EVF had significant and moderate positive correlation with the amount of analgesic used and with the Burns Specific Pain Anxiety Scale scores. Regular pain assessment is essential for the establishment of an appropriate treatment plan; thus, it is critical that we continue to refine our pain assessment skills to avoid chronic pain and psychological trauma in burn patients.

Assessment of Midline Lingual Point-Pressure Somatosensation Using Von Frey Hair Monofilaments.

Detection and discrimination threshold estimates for oral point pressure are assessed using Von Frey Hair monofilaments. Consistent with previously published protocols, threshold estimates are determined using a two-interval forced choice (2-IFC) paradigm with a three down/one up approach. Detection threshold estimates determine the mean force in which a participant can identify the presence of pressure. During the detection threshold procedure, the participant is instructed to choose which of two sequentially presented observation intervals contained the tactile test stimulus. If the participant performs three correct detections in a row (i.e., 3 'hits'), the researcher decreases the stimulus to the next lower target force level. With one incorrect detection (a 'miss'), the researcher increases the force delivered to the next higher level. This threshold estimation approach is known as a 3-down/1-up adaptive staircase. Reponses are recorded on a paper ballot, and a participant's estimated threshold is defined as the geometric mean of five reversals. During the discrimination threshold procedure, the participant is asked to make a choice between two serially presented stimuli as to which is the "harder" or "stronger" pressure. The same scoring of 'hits', 'misses', and stopping points are used. Detection and discrimination testing for oral point pressure at tongue midline takes approximately 20 min to complete. Using these commercially-available clinical tools, individual touch sensation profiles for the midline tongue can be achieved in a relatively time and cost effective means.

Non-invasive assessment of vibration perception and protective sensation in people with diabetes mellitus: inter- and intra-rater reliability.

BACKGROUND: Testing of protective sensation and vibration perception are two of the most commonly used non-invasive methods of screening for diabetes-related peripheral neuropathy (DPN). However, there is limited research investigating the reliability of these tests in people with diabetes. The aim of this study was to determine the inter- and intra-rater reliability of methods used to test vibration perception and protective sensation in a community-based population of adults with type 2 diabetes. METHODS: Three podiatrists with varying clinical experience tested four- and 10-site, 10 g monofilament and vibration perception threshold (VPT). In a separate cohort, the reliability of a graduated tuning fork as well as two methods of conventional tuning fork (on/off method and dampening method) was undertaken by a new graduate podiatrist and podiatrist with one-year's clinical experience. The intra- (Cohen's К) and inter-rater (Cohen's or Fleiss' К) reliability of each test was determined. RESULTS: Fifty participants (66% male, 100% type 2, 32% with DPN) underwent monofilament and neurothesiometer testing with 44 returning for the retest. Twenty-four participants (63% male, 100% type 2, 4% with DPN) underwent tuning fork testing and returned for retest. All tests demonstrated acceptable inter-rater reliability ranging from moderate (10-site monofilament, К: 0.54, CI: 0.38-0.70, p = 0.02) to substantial (graduated tuning fork, К: 0.68, CI: 0.41-0.95, p < 0.01). The 10-site monofilament (К: 0.44-0.77) outperformed the 4-site test (К: 0.34-0.67) and the dampened tuning fork method (К: 0.41-0.49) showed lower intra-rater reliability compared to both conventional (К: 0.52-0.57) and graduated methods (К: 0.50-0.57). CONCLUSION: We support the current recommendations of using more than one test to screen and monitor progression of DPN. Four- and 10-site 10 g monofilament testing have similarly acceptable levels of reliability and the neurothesiometer is the most reliable method of assessing vibration perception function. Use of a graduated tuning fork was slightly more reliable than other methods of tuning fork application however all had substantial reliability. Years of clinical experience only marginally affected test reliability overall and due to subjective nature of the tests we suggest that testing should be performed regularly and repetitively.

Affordable Rapid Olfaction Measurement Array: A Novel, Essential Oil-Based Test Strongly Correlated with UPSIT and Subjective Outcome Measures.

BACKGROUND: Olfactory dysfunction is an important facet of numerous disease states ranging from sinonasal disease to neurocognitive disorders. Due to expense and/or logistical barriers, objective olfactory testing is not common. We describe the creation of a novel, essential oil-based smell test, Affordable Rapid Olfaction Measurement Array (AROMA), composed at 14 scents at different concentrations and demonstrate correlation of AROMA with the University of Pennsylvania Smell Identification Test (UPSIT), patient age, Sinonasal Outcomes Test (SNOT-22), and perceived loss of smell. METHODS: AROMA was developed for point-of-care olfactory testing and compared to the UPSIT, as well as subjective outcome measures as noted above. About 37 healthy controls were prospectively recruited to assess the reliability of AROMA using a test-retest protocol. An additional cohort of 38 participants with sinonasal disease were prospectively recruited to complete the AROMA and UPSIT, and were compared with a cohort of 30 healthy controls. Spearman correlation correlated AROMA and UPSIT results, patient age, SNOT-22, and perceived loss of smell. RESULTS: AROMA demonstrated good test-retest reliability (r = 0.85, P < .001). Spearman's rho correlation of AROMA to UPSIT was statistically significant at ρ = 0.75 (P < .001). SNOT-22, age, and perceived sense of smell were all significantly correlated with both AROMA (ρ = -0.548, -0.557, -0.642, respectively) and UPSIT (ρ = -0.367, -0.460, -0.552, respectively). CONCLUSION: AROMA has a strong correlation with UPSIT and may be more strongly correlated with sinonasal outcomes. Additionally, AROMA is reusable; level of odorant is not static; and AROMA can test both odor detection and identification. LEVEL OF EVIDENCE: 2b.

The use of quantitative sensory testing in cancer pain assessment: A systematic review.

OBJECTIVE: To summarize the literature on the use of quantitative sensory testing (QST) in the assessment of pain in people with cancer and to describe which QST parameters consistently demonstrate abnormal sensory processing in patients with cancer pain. DATABASES AND DATA TREATMENT: Medline, EMBASE, AMED, CINAHL, SCOPUS and CENTRAL were searched for observational or experimental studies using QST in patients with a cancer diagnosis and reporting pain. Search strategies were based on the terms "quantitative sensory testing", "cancer", "pain", "cancer pain" and "assessment". Databases were searched from inception to January 2019. Data were extracted and synthesized narratively, structured around the different QST modalities and sub-grouped by cancer pain aetiology (tumour- or treatment-related pain). RESULTS: Searches identified 286 records of which 18 met the eligibility criteria for inclusion. Three studies included patients with tumour-related pain, and 15 studies included patients with pain from chemotherapy-induced peripheral neuropathy (CIPN). Across all studies, 50% (9/18) reported sensory abnormities using thermal detection thresholds (cool and warm), 44% (8/18) reported abnormal mechanical detection thresholds using von-Frey filaments and 39% (7/18) found abnormal pinprick thresholds. Abnormal vibration and thermal pain (heat/cold) thresholds were each reported in a third of included studies. CONCLUSION: This systematic review highlights the lack of published data characterizing the sensory phenotype of tumour-related cancer pain. This has implications for our understanding of the underlying pathophysiological mechanisms of cancer pain. Understanding the multiple mechanisms driving cancer pain will help to move towards rational individualized analgesic treatment choices. SIGNIFICANCE: This systematic review found that pain in cancer patients is associated with abnormal sensory responses to thermal, mechanical and pinprick stimuli. However, these findings are based primarily on studies of chemotherapy-induced peripheral neuropathy and data on tumour-related pain are lacking, warranting further research.