Reliability of clinical nerve function assessment in peripheral neuropathies.

Area of Science:

• Neurology
• Tropical Medicine
• Clinical Trials

Background:

• Neuropathy assessment often relies on electroneurophysiological tests, which are not widely available in low-resource settings.
• Manual muscle strength testing (MMST) and monofilament testing (MFT) provide reliable alternatives for evaluating sensory and motor nerve function.
• Leprosy programs require accessible and dependable methods for neuropathy assessment.

Purpose of the Study:

• To evaluate the reliability of manual muscle strength testing (MMST) and monofilament testing (MFT) in leprosy patients.
• To assess the reliability of newly introduced test sites for MMST and MFT in the TENLEP trials.
• To validate these methods for use in multi-centre randomized clinical trials in low-resource countries.

Main Methods:

• A multi-centre randomized clinical trial involving six leprosy programs across four Asian countries.
• Two independent assessors in each center evaluated 30 leprosy-affected individuals using MFT and MMST.
• Included new test sites for sural, radial cutaneous, posterior tibial, and common peroneal nerves.

Main Results:

• Monofilament testing (MFT) demonstrated good to very good reliability across nearly all tested nerves.
• Manual muscle strength testing (MMST) also exhibited good to very good agreement between assessors, with minor exceptions.
• New test sites for both MFT and MMST showed acceptable reliability.

Conclusions:

• MMST and MFT are confirmed as reliable methods for assessing nerve function in leprosy.
• The newly incorporated test sites for MMST and MFT are reliable and suitable for clinical application.
• These findings support the use of MMST and MFT in resource-limited settings for neuropathy management in leprosy.