Reliability and Validity of the Ten Test for the Assessment of Digit Sensation.

Abstract

Purpose: The ten test (TT) is a sensory assessment used to quantify the sensation of each digit. Because it does not require additional equipment, it may have utility in telemedicine. Our purpose was to evaluate the validity and reliability of the TT.

Methods: Adult patients with nontrauma upper-extremity complaints were evaluated within an academic outpatient clinic. Two examiner groups (hand surgeons [group 1] and residents/physician assistants [group 2]) administered the TT and static two-point discrimination (2PD). Hand surgeons were blinded to the results obtained by the initial examiners. The TT is administered by having the patient define an area of normal sensation with their uninvolved index finger and then rate digital sensation against the involved hand on a 1-10 scale, with 10 defined as perfectly normal sensation. A cut-point analysis was employed, and both sensory assessments were categorized as either normal (2PD ≤5 mm, TT ≥9) or abnormal sensation for the entire median-nerve distribution and individual digit level. Agreement statistics including sensitivity (Sn) and specificity (Sp) were calculated for the TT, using static 2PD as the reference standard. Interrater reliability was compared between the groups of examiners.

Results: A total of 201 patients (1,005 digits) were examined. The Sn/Sp for the TT was 53%/84% and 54%/85% at the digit-level and median-nerve distribution level, respectively. Interrater reliability for the TT between the groups of examiners was substantial at the digit level (κ = 0.68, SE = 0.02).

Conclusions: The Sn/Sp for the TT was 53%/84% when using static 2PD as the reference standard. Interrater reliability for TT was substantial (κ = 0.68). The TT can serve as an alternative to other sensory assessments that require instrumentation. As telemedicine programs continue to evolve within upper-extremity surgery, the TT may be a useful tool with virtual applications.

Type of study/level of evidence: Diagnostic I.