The Evaluation of Distal Symmetric Polyneuropathy: A Physician Survey of
Clinical Practice.
Authors Callaghan BC, Kerber K, Smith AL, Fendrick AM, Feldman EL
Submitted By Eva Feldman on 2/22/2012
Status Published
Journal Archives of neurology
Year 2011
Date Published 3/1/2012
Volume : Pages Not Specified : Not Specified
PubMed Reference 22083798
Abstract OBJECTIVE: To define current clinical practice for evaluating distal symmetric
polyneuropathy. DESIGN: Using a modified Dillman method, we sent surveys to 600
internists, 600 neurologists, and 45 neuromuscular specialists selected from the
American Medical Association Physician Masterfile. Survey questions pertained to
which tests providers would order in the following 3 scenarios: (1) the initial
evaluation of distal symmetric polyneuropathy, (2) the use of additional tests
if the initial evaluation was unrevealing, and (3) patients with diabetes. The t
test was used to compare the number of tests ordered by physician type, and the
?(2) test was used to compare proportions of tests ordered. SETTING: National
survey of physicians. PARTICIPANTS: Internists, neurologists, and neuromuscular
specialists. RESULTS: The response rate was 35%. Overall, many tests were
ordered for the full evaluation of distal symmetric polyneuropathy (mean [SD],
16.5 [7.2] tests), and there was substantial variation within and between
provider types. Internists ordered fewer tests (mean [SD], 14.5 [6.1] tests)
than did neurologists (mean [SD], 17.5 [7.9] tests) (P < .001). Regarding the
glucose tolerance test, substantial differences were found between physician
types, with neurologists and neuromuscular specialists ordering this test more
frequently (28.6% and 72.3%, respectively) and internists ordering it less
frequently (4.1%). A brain and/or spine magnetic resonance imaging scan was
ordered by 19.8% of internists and 12.9% of neurologists. CONCLUSIONS: From the
supporting evidence, current practice intent on evaluating distal symmetric
polyneuropathy is highly variable and differs widely. For this disorder of the
peripheral nerves, a high-yield test such as the glucose tolerance test is
rarely used, whereas magnetic resonance imaging is likely overused. Research
that defines the optimal evaluation of distal symmetric polyneuropathy has the
potential to result in more efficient care.

Investigators with authorship
Eva FeldmanUniversity of Michigan