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dc.contributor.authorWorthington, Anne; orcid: 0000-0002-2331-3750; email: anne.worthington@postgrad.manchester.ac.uk
dc.contributor.authorKalteniece, Alise; email: alise.kalteniece@manchester.ac.uk
dc.contributor.authorFerdousi, Maryam; orcid: 0000-0002-7989-8233; email: maryam.ferdousi@manchester.ac.uk
dc.contributor.authorD’Onofrio, Luca; orcid: 0000-0003-3905-0139; email: luca.donofrio@uniroma1.it
dc.contributor.authorDhage, Shaishav; email: Shaishav.Dhage@christie.nhs.uk
dc.contributor.authorAzmi, Shazli; email: shazli.azmi@manchester.ac.uk
dc.contributor.authorAdamson, Clare; email: clare.adamson@mft.nhs.uk
dc.contributor.authorHamdy, Shaheen; email: Shaheen.Hamdy@manchester.ac.uk
dc.contributor.authorMalik, Rayaz A.; orcid: 0000-0002-7188-8903; email: ram2045@qatar-med.cornell.edu
dc.contributor.authorCalcutt, Nigel A.; email: ncalcutt@health.ucsd.edu
dc.contributor.authorMarshall, Andrew G.; email: andrew.marshall@manchester.ac.uk
dc.date.accessioned2021-07-14T23:29:39Z
dc.date.available2021-07-14T23:29:39Z
dc.date.issued2021-07-12
dc.identifierhttps://chesterrep.openrepository.com/bitstream/handle/10034/625264/diagnostics-11-01247-v2.pdf?sequence=2
dc.identifierhttps://chesterrep.openrepository.com/bitstream/handle/10034/625264/additional-files.zip?sequence=3
dc.identifierhttps://chesterrep.openrepository.com/bitstream/handle/10034/625264/diagnostics-11-01247.xml?sequence=4
dc.identifier.citationDiagnostics, volume 11, issue 7, page e1247
dc.identifier.urihttp://hdl.handle.net/10034/625264
dc.descriptionFrom MDPI via Jisc Publications Router
dc.descriptionHistory: accepted 2021-07-07, pub-electronic 2021-07-12
dc.descriptionPublication status: Published
dc.descriptionFunder: American Diabetes Association; Grant(s): 1-17ICTS-062
dc.description.abstractImpaired rate-dependent depression of the Hoffman reflex (HRDD) is a potential biomarker of impaired spinal inhibition in patients with painful diabetic neuropathy. However, the optimum stimulus-response parameters that identify patients with spinal disinhibition are currently unknown. We systematically compared HRDD, performed using trains of 10 stimuli at five stimulation frequencies (0.3, 0.5, 1, 2 and 3 Hz), in 42 subjects with painful and 62 subjects with painless diabetic neuropathy with comparable neuropathy severity, and 34 healthy controls. HRDD was calculated using individual and mean responses compared to the initial response. At stimulation frequencies of 1, 2 and 3 Hz, HRDD was significantly impaired in patients with painful diabetic neuropathy compared to patients with painless diabetic neuropathy for all parameters and for most parameters when compared to healthy controls. HRDD was significantly enhanced in patients with painless diabetic neuropathy compared to controls for responses towards the end of the 1 Hz stimulation train. Receiver operating characteristic curve analysis in patients with and without pain showed that the area under the curve was greatest for response averages of stimuli 2–4 and 2–5 at 1 Hz, AUC = 0.84 (95%CI 0.76–0.92). Trains of 5 stimuli delivered at 1 Hz can segregate patients with painful diabetic neuropathy and spinal disinhibition, whereas longer stimulus trains are required to segregate patients with painless diabetic neuropathy and enhanced spinal inhibition.
dc.languageen
dc.publisherMDPI
dc.rightsLicence for this article: https://creativecommons.org/licenses/by/4.0/
dc.sourceeissn: 2075-4418
dc.subjectdiabetic neuropathy
dc.subjectpain
dc.subjectspinal disinhibition
dc.subjectH-reflex
dc.titleOptimal Utility of H-Reflex RDD as a Biomarker of Spinal Disinhibition in Painful and Painless Diabetic Neuropathy
dc.typearticle
dc.date.updated2021-07-14T23:29:39Z
dc.date.accepted2021-07-07


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