Monofilament test alone may not rule in or rule out peripheral neuropathy


Different grades of monofilament are used to test the sensitivity of different areas of a patient’s foot. This systematic review set out to establish the accuracy of this method for diagnosing diabetic peripheral neuropathy.

Clinical question:

In diabetic patients does monofilament testing diagnose peripheral neuropathy?

The evidence:

Fourteen studies were included in the review, comprising data from 3,142 participants.  When data from all studies was combined, the reviewers found:

  • Sensitivity of the test was 62% (95% CI, 60% to 64%).
  • Specificity was 73% (95% CI, 72% to 75%).

That is, 62% of people with peripheral neuropathy tested positive using monofilament test, and 73% of people without peripheral neuropathy tested negative.

The CRD appraisal notes:

This review concluded that monofilament assessment has fairly good diagnostic accuracy in detecting diabetic peripheral neuropathy but should not be used as a sole diagnostic method.

Appraisal hints:

This review has been appraised by the Centre for Reviews and Dissemination (CRD).  They comment on:

  • The poor quality of the individual studies included in the review.  Only three studies reported blinding of the examiners to the neuropathic status of patients.
  • Studies in which reported proper validation against a gold standard of diagnosis had a slightly better performance.
  • More recent, better quality research may be available.


The full text of the CRD Appraisal is available below.  No abstract of the original research is available.

Nowakowski P E.  A meta-analysis of the diagnostic accuracy of the monofilament in detecting diabetic peripheral neuropathy.  Centre for Reviews and Dissemination, 2012.

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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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