The present study aimed to determine the within- and between-subject intra- and inter-rater reliability of pressure and vibration senses measurements with SWM presented with a 6-piece foot kit and 128 and 256 Hz tuning fork in diabetic patients. Reliability of SWM and tuning fork on/off tests are important in the evaluation of periodic clinical sensation. Previous studies demonstrated that SWM and tuning fork are appropriate tools to clinically evaluate pressure and vibration senses, respectively. Limited studies evaluated the reliability of graduated tuning fork for the detection of fracture- and immune-mediated polyneuropathies however, the tuning fork on/off test reliability was overlooked. Tuning fork test determines the ability of subjects to discriminate vibration sensation. The graduated tuning fork and tuning fork on/off tests are available in every dialectology clinic. Reliability of SWM in healthy and elderly people was evaluated by the previous studies. Monofilaments are used to detect the pressure sensation in neuropathic patients. The higher the value of the monofilament, the stiffer and more difficult it is to bend. Monofilaments, often called SWM, are calibrated, single fiber nylon threads, identified by values ranging from 1.65 to 6.65 that generate reproducible buckling stress. Monofilaments and tuning fork are non-invasive, available and easy to use instruments. Previous studies demonstrated that Semmes-Weinstein Monofilament (SWM) and tuning fork are appropriate tools for the clinical evaluation of pressure and vibration sense, respectively. Several instruments are frequently used to screen peripheral neuropathies such as monofilaments, tuning fork, and biothesiometry. The ideal instrument for neuropathy examination should be easily accessible, simple to use, and reliable with high sensitivity and specificity. This test is a complex, costly, and time consuming method and not suitable for clinical evaluations. Nerve conduction velocity is a gold standard test to detect neuropathy. According to the Polish Diabetes Society, diabetic patient’s feet should be examined at every medical visit. Periodical sensory examinations are appropriate to detect neuropathy and decrease the risk of diabetic foot ulcer. Early diagnosis of PSN is important in diabetic patients to prevent diabetic foot problems. Approximately 50% of diabetic patients experience peripheral neuropathy and more than 50% of them experience symptomatic neuropathy. ![]() Previous research recognized sensory neuropathy as the major cause of ulceration in diabetic patients. Peripheral neuropathy involves sensory, motor and autonomous systems and causes decreased pressure sensation, increased vibration perception threshold, foot deformities, and dry skin. We conclude that the Rydel-Seiffer graduated tuning fork is a suitable tool for screening for sensation loss and that diabetic patients with a tuning-fork score of less than or equal to 4.0 are vulnerable to ulceration.Peripheral Sensory Neuropathy (PSN) is the main risk factor for foot ulceration and lower extremity amputations in diabetic patients. The tuning fork score was less than or equal to 4.0 in 95% of the ulcerated feet. Age-related Rydel-Seiffer tuning fork vibration sensation was impaired in 79% of 38 ulcerated feet of 26 patients. It correlated well (r = -0.90, p less than 0.001) with the thresholds obtained with an electromagnetic instrument (Vibrameter) in diabetic patients, in whom vibration perception score was impaired compared with control subjects (4.0 +/- 1.8 (+/- SD) vs 5.4 +/- 1.4, p less than 0.001). Vibration perception score measured with the tuning fork declined with age (p less than 0.001) in the control subjects. The performance of the Rydel-Seiffer graduated tuning fork was examined in healthy subjects and in various groups of diabetic patients in order to evaluate its efficacy for identifying patients whose loss of vibration sensation may expose them to the risk of foot injury.
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