Reliability of Semmes Weinstein monofilament and ballpoint sensory testing, and voluntary muscle testing in Bangladesh

The reliability of methods of testing nerve function is important, since di agnostic decision making is a direct function of the quality of the test. T hree methods of nerve function testing were investigated at the Danish Bang ladesh Leprosy Mission (DBLM) in north Bangladesh, and assessed for inter-o bserver reliability. The three methods were 1) ballpoint pen test (BPT) for sensory function; 2) graded Semmes Weinstein monofilament test (SWM) for s ensory function and 3) voluntary muscle testing (VMT) for motor function. T he weighted kappa (kappa(w)) statistic was used to express inter-observer r eliability. Using this statistic, 0 represents agreement no better than ran dom, and 1.0 complete agreement. kappa(w) values of greater than or equal t o 0.80 are reckoned to be adequate for monitoring and research. Fifty-three patients were tested, a Senior physiotechnician acting as 'gold standard' against whom four other staff physiotechnicians were assessed. All three te sting methods were found to have minimal inter-observer variation, with the kappa(w) for inter-observer agreement using BPT being 0.86, the SWM 0.92, and VMT 0.94. It is concluded that in trained and experienced hands, all th ree methods are reliable and repeatable to a level allowing confident use o f results obtained in monitoring and research.