ACHIEVING BEST PRACTICE

Testing vibration sense is a recognised component of neuropathy assessment. One hundred consecu-tive patients attending diabetic annual review and podiatry clinics were enrolled in a study to compare a 10 g Semmes–Weinstein monofilament and a 128Hz tun-ing fork with VibraTip®, a novel, key-fob-sized source of fixed amplitude vibration for the identification of periph-eral neuropathy. Patients were tested sequentially with the three devices in random order on either the left or right foot. Of the 100 patients 55 felt both the vibrating tuning fork and VibraTip, the remaining 45 patients felt neither. Pressure from the 10 g monofilament was per-ceived by 53 patients of whom 51 also felt VibraTip®. VibraTip ® proved a practical, hygienic, simple, rapid and very specific test of the integrity of vibration sense, eas-ily controlled with a null stimulus, that appeared highly engaging for patients. As the utility of testing for neu-ropathy is no more or less than a strategy to persuade patients to change their behaviour, VibraTip ® may be a useful addition to sensory nerve function testing at the clinical interface