CLINICAL RESEARCH ARTICLE

Improving Perception Threshold Tracking for Rapid Evaluation of Diabetic Peripheral Neuropathy

Frederik Østergaard Klit

orcid.org/0009-0009-5627-598X

Health Science and Technology, Aalborg University, Aalborg, Denmark

Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark

Contribution: Writing - review & editing, Writing - original draft, Investigation, Data curation, Formal analysis, Visualization, Project administration, Validation

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Vitus Milver Bollerslev,

Vitus Milver Bollerslev

Health Science and Technology, Aalborg University, Aalborg, Denmark

Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark

Contribution: Data curation, Investigation, Writing - review & editing

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Mette Krabsmark Borbjerg,

Mette Krabsmark Borbjerg

orcid.org/0000-0003-0178-3409

Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark

Contribution: Data curation, Investigation, Writing - review & editing

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Johan Røikjer,

Johan Røikjer

orcid.org/0000-0002-4578-1328

Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark

Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark

Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

Contribution: Conceptualization, Methodology, Supervision, Project administration, Writing - original draft, Writing - review & editing, Resources, Funding acquisition

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Niels Ejskjær,

Niels Ejskjær

Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark

Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark

Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

Contribution: Conceptualization, Methodology, Supervision, Writing - review & editing, Resources, Funding acquisition

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Carsten Dahl Mørch,

Corresponding Author

Carsten Dahl Mørch

[email protected]

orcid.org/0000-0001-6693-2028

Health Science and Technology, Aalborg University, Aalborg, Denmark

Center for Neuroplasticity and Pain, Aalborg University, Aalborg, Denmark

Correspondence:

Carsten Dahl Mørch ([email protected])

Contribution: Conceptualization, Methodology, Software, Data curation, Formal analysis, Supervision, Visualization, Project administration, Resources, Writing - original draft, Writing - review & editing, Funding acquisition

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Frederik Østergaard Klit,

Frederik Østergaard Klit

orcid.org/0009-0009-5627-598X

Health Science and Technology, Aalborg University, Aalborg, Denmark

Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark

Contribution: Writing - review & editing, Writing - original draft, Investigation, Data curation, Formal analysis, Visualization, Project administration, Validation

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Vitus Milver Bollerslev,

Vitus Milver Bollerslev

Health Science and Technology, Aalborg University, Aalborg, Denmark

Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark

Contribution: Data curation, Investigation, Writing - review & editing

Search for more papers by this author

Mette Krabsmark Borbjerg,

Mette Krabsmark Borbjerg

orcid.org/0000-0003-0178-3409

Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark

Contribution: Data curation, Investigation, Writing - review & editing

Search for more papers by this author

Johan Røikjer,

Johan Røikjer

orcid.org/0000-0002-4578-1328

Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark

Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark

Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

Contribution: Conceptualization, Methodology, Supervision, Project administration, Writing - original draft, Writing - review & editing, Resources, Funding acquisition

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Niels Ejskjær,

Niels Ejskjær

Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark

Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark

Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

Contribution: Conceptualization, Methodology, Supervision, Writing - review & editing, Resources, Funding acquisition

Search for more papers by this author

Carsten Dahl Mørch,

Corresponding Author

Carsten Dahl Mørch

[email protected]

orcid.org/0000-0001-6693-2028

Health Science and Technology, Aalborg University, Aalborg, Denmark

Center for Neuroplasticity and Pain, Aalborg University, Aalborg, Denmark

Correspondence:

Carsten Dahl Mørch ([email protected])

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First published: 02 December 2024

https://doi.org/10.1002/mus.28310

Funding: Center for Neuroplasticity and Pain (CNAP) is supported by the Danish National Research Foundation (DNRF121).

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ABSTRACT

Introduction/Aims

Accurate assessment of diabetic peripheral neuropathy (DPN) is essential to prevent further complications, yet current methods have limitations. Perception threshold tracking (PTT) offers promise as a novel approach for rapid evaluation of both large and small fiber dysfunction. To enhance efficiency, this study explores the Psi method compared to the Method of Limits (MoL) in estimating perception thresholds. The aim is to assess agreement, uncertainty, and the number of stimuli required for adequate estimation by each method.

Methods

Forty-three participants with diabetes underwent an estimated sural nerve conduction study, quantitative sensory testing, vibration perception threshold testing, and PTT. PTT utilized both patch and pin electrode configurations to activate large and small fibers, respectively. The uncertainty of perception thresholds was estimated as the inverse slope of the psychometric functions.

Results

Perception thresholds were significantly higher for the patch electrode (2.5 [2.1–3.0] mA) compared to the pin electrode (0.71 [0.56–0.91] mA; rmANOVA, p < 0.001). Bland–Altman analysis revealed a non-significant 3.3% bias between the methods, but wide limits of agreement (−42%–84%). Uncertainty was lower for the Psi method (0.80 [0.58;1.11] mA) compared to MoL (2.0 [1.2;2.9] mA; rmANOVA, p < 0.005). The Psi method achieved acceptable perception threshold estimation with only 30 stimuli.

Discussion

At the group level, the MoL and Psi methods produced similar perception thresholds. However, the Psi method required fewer stimuli and yielded less uncertainty in perception threshold estimation compared to MoL. Future studies should prioritize the Psi method for its efficiency and reliability.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Supporting Information

Filename	Description
mus28310-sup-0001-Supinfo1.docxWord 2007 document , 15.3 KB	Data S1.
mus28310-sup-0002-FigureS1.jpgJPEG image, 60.4 KB	Figure S1. A diagram of the experimental setup of perception threshold tracking. For assessment of large nerve fibers, a patch electrode (cathode) was placed 2 cm proximal to the 2nd metatarsophalangeal joint and the larger anode was placed on the right hindfoot inferior to the center of the lateral malleolus. For assessment of small nerve fibers, a single pin electrode made of 16 interconnected pin cathodes and a concentric planar anode was used. The schematics of the pin electrode is depicted in the lower left corner. It was placed on site of the cathode 2 cm proximal to the 2nd metatarsophalangeal joint. The electrical stimulation was applied by in a current controlled manner using an electrical stimulator (DS5, Digitimer Ltd., UK). The participant indicated the perception of each electrical stimulation by pushing a handheld button. The electrical stimulator was controlled through a digital/analog converter (LabBench IO, Invernotrs Way, Denmark) by the computer program (LabBench, Invernotrs Way, Denmark) in accordance with the response from the participant.
mus28310-sup-0003-FigureS2.jpgJPEG image, 90.2 KB	Figure S2. An example of perception threshold estimation: The perception threshold was estimated using the pin electrode and (A) Method of Limits (MoL) and (B) the Psi Method. (C) The data obtained by the MoL were fitted to the logistic psychometric function post hoc. (D) During the Psi method, the responses were fitted to the psychometric function using the Quick model.
mus28310-sup-0004-FigureS3.jpgJPEG image, 21.3 KB	Figure S3. Scatter plot of the thresholds obtained by the Method of Limits (MoL) and the Psi methods for the patch (cross) and the pin (circles) electrodes showed a strong correlation (R = 0.95, p < 0.001).
mus28310-sup-0005-FigureS4.jpgJPEG image, 23.7 KB	Figure S4. Scatter plot of the slopes obtained by the Method of Limits (MoL) and the Psi methods for the patch (cross) and the pin (circles) electrodes showed a weak correlation (R = 0.35, p < 0.005).
mus28310-sup-0006-FigureS5.jpgJPEG image, 32.1 KB	Figure S5. Deviation from the final threshold (%) by stimulation number.

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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Volume71, Issue2

February 2025

Pages 183-190

Improving Perception Threshold Tracking for Rapid Evaluation of Diabetic Peripheral Neuropathy

ABSTRACT

Introduction/Aims

Methods

Results

Discussion

Conflicts of Interest

Open Research

Data Availability Statement

Supporting Information

References

References

Information

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Improving Perception Threshold Tracking for Rapid Evaluation of Diabetic Peripheral Neuropathy

ABSTRACT

Introduction/Aims

Methods

Results

Discussion

Conflicts of Interest

Open Research

Data Availability Statement

Supporting Information

References

References

Related

Information