Unipedal stance testing in the assessment of peripheral neuropathy

Objective: To define further the relation between unipedal stance testing a nd peripheral neuropathy. Design: Prospective cohort. Setting: Electroneuromyography laboratory of a Veterans Affairs medical cen ter and a university hospital. Patients: Ninety-two patients referred for lower extremity electrodiagnosti c studies. Main Outcome Measures: A standardized history and physical examination desi gned to detect peripheral neuropathy. 3 trials of unipedal stance, and elec trodiagnostic studies. Results: Peripheral neuropathy was identified by electrodiagnostic testing in 32%. These subjects had a significantly shorter (p < .001) unipedal stan ce time (15.7s, longest of 3 trials) than the patients without peripheral n europathy (37.1s). Abnormal unipedal stance time (<45s) identified peripher al neuropathy with a sensitivity of 83% and a specificity of 71%, whereas a normal unipedal stance time had a negative predictive value of 90%. Abnorm al unipedal stance time was associated with an increased risk of having per ipheral neuropathy on univariate analysis (odds ratio = 8.8, 95% confidence interval = 2.5-31), and was the only significant predictor of peripheral n europathy in the regression model. Aspects of the neurologic examination di d not add to the regression model compared with abnormal unipedal stance ti me. Conclusions: Unipedal stance testing is useful in the clinical setting both to identify and to exclude the presence of peripheral neuropathy.