The assessment of vibration sense in the musculoskeletal examination: Moving towards a valid and reliable quantitative approach to vibration testing in clinical practice.

Impairment of vibration sense is an early sign of nerve pathology. A range of devices can evaluate vibration sense, with moderate to excellent reliability demonstrated for the Somedic Vibrameter. However, devices are expensive and time-consuming for use in practice, and tuning forks are used but not supported by rigorous research. The aims of this study were to evaluate the inter-rater reliability and precision of a novel device to improve use of a tuning fork, and to evaluate its concurrent validity with the Vibrameter. Following a power calculation, a double-blinded, prospective, reliability and validity study recruited 19 healthy subjects who were tested by two physiotherapists using both instruments testing over the median nerve distribution. Inter-rater reliability was determined using Intraclass Correlation Coefficients, 2.1 (0.798 for the Vibrameter and 0.520 for the tuning fork), and precision using Bland Altman plots and Standard Error of Measurement (Vibrameter 0.289 μm, tuning fork 2.55 s). Concurrent validity using Pearson's Product Moment Correlation was 0.515-0.634. The Vibrameter results support previous reliability studies. The tuning fork and novel device demonstrated a strong correlation with the Vibrameter supporting concurrent validity; although it possesses moderate inter-rater reliability. Further research exploring reliability in pathological populations is now indicated.