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To the Editor:
Technology Assessments should be fair and balanced reports based on in-depth, accurate reviews of articles deemed worthy of representing the best in the field. However, the recent Assessment on quantitative sensory testing (QST) falls short.1 Here is an example of how inadequately the Assessment reviewed and reported just one article.
The single paragraph addressing current perception threshold (CPT) testing reports that one study “detected differences between neuropathic and nonneuropathic groups. CPT to 2 kHz stimulation correlated best with vibratory thresholds, and CPT to 5 Hz stimulation correlated with thermal.”2 But then we are told that a study by Tack et al.3 found only moderate correlation between clinical evaluation of neuropathy and vibratory thresholds and CPT data.1
First, the Assessment designates the article by Tack et al. as a Class II study (Class I, the highest).3 However, this contradicts the Assessment’s classification criteria requiring “a blinded evaluation.”1 Nothing in Tack et al. reports blinded evaluations.3
Second, the Assessment selectively describes the findings of Tack et al. in the following two sentences: “Correlation between VPT and CPT were maximal at 2,000 Hz for CPT (r = 0.61). Correlation between CPT at 250 Hz or 5 Hz with clinical evaluation of neuropathy were less than for 2,000 Hz.”1 The Assessment neglects the correlation coefficients between CPT and neurologic disability score (NDS) in the subgroup of 22 patients with overt neurologic findings. The coefficient for the 2,000 Hz CPT with “large fiber pathology” was 0.88, while between the 5 Hz CPT and “small fiber pathology” it was 0.74.3 So, yes, the correlation of 5 Hz with clinical examination was less than the correlation of 2,000 Hz with the clinical examination, but they were both higher than the correlation between CPT and VPT. …
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