title: The evaluation of distal symmetric polyneuropathy: a physician survey of clinical practice.
abstract: OBJECTIVE
  To define current clinical practice for evaluating distal symmetric polyneuropathy.
  
  
  METHODS
  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 χ(2) test was used to compare proportions of tests ordered.
  
  
  METHODS
  National survey of physicians.
  
  
  METHODS
  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.
authors.affiliation: Department of Neurology, University of Michigan, 109 Zina Pitcher Place, Ann Arbor, MI 48104, USA. . bcallagh@med.umich.edu
authors.forename: Brian C
authors.initials: BC
authors.lastname: Callaghan
authors.forename: Kevin
authors.initials: K
authors.lastname: Kerber
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Smith
authors.forename: A Mark
authors.initials: AM
authors.lastname: Fendrick
authors.forename: Eva L
authors.initials: EL
authors.lastname: Feldman
mesh_terms: D000328:Adult; D000368:Aged; D003625:Data Collection; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005951:Glucose Tolerance Test; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D007388:Internal Medicine; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009462:Neurology; D009468:Neuromuscular Diseases; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D010820:Physicians; D015203:Reproducibility of Results; D013038:Specialization; D014481:United States / Q000453:epidemiology; D014505:Urban Population
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