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Introdução: O pé diabético é uma complicação que comporta um risco considerável em pacientes diabéticos. A consequente perda de sensibilidade protetora nos membros inferiores obriga a um diagnóstico precoce devido à eminente possibilidade de ulceração ou amputação do membro afetado. Para avaliar a perda de sensibilidade protetora, o monofilamento de Semmes-Weinstein (SW) de 10 gf é o instrumento de primeira linha mais utilizado. Objetivo: Este estudo foi conduzido com o objetivo geral de realizar uma verificação metrológica e avaliar o desempenho do monofilamento SW de 10 gf na avaliação da perda de sensibilidade protetora. Materiais e Metodologia: Recorrendo a um equipamento de medição desenvolvido para o efeito, procedeu-se a uma verificação metrológica de três monofilamentos selecionados, através de um método manual e automatizado sob condições controladas. Realizou-se igualmente uma avaliação da perceção da força que o examinador exerce no momento de avaliar um determinado paciente utilizando o seu próprio dedo ou um objeto. Resultados: A força de compressão dos monofilamentos SW de 10 gf revelou-se altamente dependente do número de utilizações, da temperatura ambiente e humidade relativa do ar, do ângulo de incidência do monofilamento na região cutânea a avaliar, da velocidade de deslocamento do monofilamento e da ação e movimento da mão do examinador. O erro relativo associado aos monofilamentos SW é elevado e significativo, chegando a variar de 14 % a 215 %, analisando todos os monofilamentos testados no seu conjunto e em todas as condições em que estiveram expostos. A ação da mão do examinador apresenta uma grande irregularidade. A perceção que o examinador tem da força adequada que necessita de exercer, apresentou valores médios que excederam 90 gf. Conclusão: A hipótese inicialmente formulada para este estudo confirmou-se. Efetivamente todos os monofilamentos testados registaram erros relativos superiores a 10 % e a sua força de compressão é altamente dependente de fatores externos. Quanto à perceção que o examinador tem sobre a força adequada que deverá exercer para avaliar um paciente com o seu próprio dedo ou um objeto adequado (na ausência de um monofilamento SW), ficou claro que profissional de saúde coloca uma força muito superior aos 10 gf, o aconselhado para identificar uma possível perda de sensibilidade protetora no pé diabético.
Introduction: Diabetic foot is a complication that carries a considerable risk in diabetic patients. The consequent loss of protective sensitivity in the lower limbs requires an early diagnosis due to the imminent possibility of ulceration or amputation of the affected limb. To assess the loss of protective sensitivity, the 10 gf Semmes-Weinstein (SW) monofilament is the most used first-line instrument. Objective: This study was conducted with the general objective of performing a metrological verification and evaluating the performance of the 10 gf SW monofilament in the evaluation of the loss of protective sensitivity. Materials and Methodology: Using a measuring equipment developed for this purpose, a metrological characterization was carried out of three selected monofilaments, using a manual and automated method under controlled conditions. An assessment of the perceived strength that the examiner exerts at the time of evaluating a specific patient using his own finger or an object was also carried out. Results: The buckling force of the 10 gf SW monofilaments proved to be highly dependent on the number of uses, the ambient temperature and relative humidity, the angle of incidence of the monofilament in the cutaneous region to be evaluated, the displacement speed of the monofilament and the action and movement of the examiner's hand. The relative error associated with SW monofilaments is high and significant, varying from 14 % to 215 %, analyzing all monofilaments tested as a whole and in all conditions in which they were exposed. The action of the examiner's hand is very irregular. The examiner's perception of the adequate strength he needs to exercise, presented average values that exceeded 90 gf. Conclusion: The hypothesis initially formulated for this study was confirmed. All monofilaments tested registered relative errors above 10% and its buckling force is highly dependent on external factors. As for the examiner's perception of the adequate force he should exert to assess a patient with his own finger or an appropriate object (in the absence of a SW monofilament), it was clear that a health professional puts a force much higher than 10 gf, recommended to identify a possible loss of protective sensitivity in the diabetic foot.
Introduction: Diabetic foot is a complication that carries a considerable risk in diabetic patients. The consequent loss of protective sensitivity in the lower limbs requires an early diagnosis due to the imminent possibility of ulceration or amputation of the affected limb. To assess the loss of protective sensitivity, the 10 gf Semmes-Weinstein (SW) monofilament is the most used first-line instrument. Objective: This study was conducted with the general objective of performing a metrological verification and evaluating the performance of the 10 gf SW monofilament in the evaluation of the loss of protective sensitivity. Materials and Methodology: Using a measuring equipment developed for this purpose, a metrological characterization was carried out of three selected monofilaments, using a manual and automated method under controlled conditions. An assessment of the perceived strength that the examiner exerts at the time of evaluating a specific patient using his own finger or an object was also carried out. Results: The buckling force of the 10 gf SW monofilaments proved to be highly dependent on the number of uses, the ambient temperature and relative humidity, the angle of incidence of the monofilament in the cutaneous region to be evaluated, the displacement speed of the monofilament and the action and movement of the examiner's hand. The relative error associated with SW monofilaments is high and significant, varying from 14 % to 215 %, analyzing all monofilaments tested as a whole and in all conditions in which they were exposed. The action of the examiner's hand is very irregular. The examiner's perception of the adequate strength he needs to exercise, presented average values that exceeded 90 gf. Conclusion: The hypothesis initially formulated for this study was confirmed. All monofilaments tested registered relative errors above 10% and its buckling force is highly dependent on external factors. As for the examiner's perception of the adequate force he should exert to assess a patient with his own finger or an appropriate object (in the absence of a SW monofilament), it was clear that a health professional puts a force much higher than 10 gf, recommended to identify a possible loss of protective sensitivity in the diabetic foot.
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Keywords
Pé diabético Monofilamento de Semmes-Weinstein de 10 gf Verificação metrológica Força de compressão Erro relativo Diabetic foot 10 gf Semmes-Weinstein monofilament Metrological verification Buckling force Relative error