Overall Clinical Bottom Line: Based on our review of the best available research, the 5.07110-g Semmes-Weinstein monofilament exam can be used by physical therapists to screen for risk of future development of foot ulceration in people with diabetes mellitus. While no standardized protocol for testing exists, we recommend using the eight-site method described by Rith-Najarian et al (1 992). In this method, a positive test result is defined as greater than or equal to one missed response. A positive test response can result in a moderate increase in probability of developing an ulcer and a negative test response can result in a small but meaningful decrease in probability of developing an ulcer. Differences in outcomes in the various studies reviewed appear to be influenced by the different Semmes-Weinstein monofilament exam testing protocols used. Therefore, we would not recommend generalizing the results obtained from this protocol to the generic use of the Semmes-Weinstein monofilament exam. Further research is necessary to validate these outcomes in a broader sample of patients.
Clinical Scenario: Physical therapists who see patients in outpatient, acute, geriatric, or rehabilitation settings who present with a diagnosis of or risk factors for diabetes mellitus (DM) would benefit from a quick and accurate screening tool for loss of protective sensation in the lower extremities (LE). Early identification of loss of protective sensation is necessary for proper patient care and management to decrease the risk of future foot ulceration or LE complications.
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