Unipedal stance testing in the assessment of peripheral neuropathy

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