A collection of comments and questions from practice nurses, podiatrists and clinicians with an interest in diabetes

Q: How should VibraTip™ best be used?
A: VibtaTip™ press on patient´s footHold the device between thumb and forefinger with your thumb on the silver button. Touch the skin of the patients foot at the sites you wish to test very lightly with the rounded tip of the device and squeeze the device firmly between your fingers when you wish to activate it. It may be easiest to apply the device gently when held parallel to the skin (as shown) rather than vertically. Touch the patient´s foot lightly saying ‘this is touch one’ and ‘this is touch two’. Activate the device at either the first or second touch and then ask the patient which of the two touches vibrated?

Q: How long do you apply it for?
A: As long as it takes to say ‘this is touch one’ or ‘this is touch two’. If the devices is activated whilst these words are being spoken, any minimal noise from the device will be masked and the specificity of the question will be maximized.

Q: What frequency does VibraTip™ operate at?
A: A little more than 128Hz - i.e. Something around the E or F above middle C. Unlike a tuning fork (recommendations for which vary in the literature from 128 to 512Hz), the AMPLITUDE of vibration intensity provided by VibraTip™ is stable and doesn’t decay whilst being applied to the skin

Q: How does VibraTip™ compare with the monofilament?
A: A trial of 100 consecutive patients presenting to diabetic annual review clinic and podiatry showed excellent agreement between VibraTip™, a 128Hz tuning fork and a 10g monofilament. VibraTip™ is a brand new device, however, and there are no data as yet to correlate VibraTip™ findings with risk of foot injury

Q: How long does VibraTip™ last?
A: About 35 minutes of continuous vibration if the button is held down. In terms of clinical use, if it takes 10 or 20 seconds of vibration to assess a patient, the device should last for several months

Q: Can the battery be replaced?
A: No. VibraTip™ is s sealed unit to optimize hygiene. It is designed to be disposable

Q: How do you clean VibraTip™?
A: The smooth, continuous curved surfaces of VibraTip™ are designed to be easily cleaned by wiping with an alcohol swab

Q: Why doesn’t VibraTip™ provide several different frequencies?
A: The stimulus provided by VibraTip™ is designed to be a set amplitude rather than one or more set frequencies.

Q: How does VibraTip™ compare with the 10g monofilament?
A: These two devices test different things. VibraTip™ tests vibration perception whilst the monofilament tests fine touch. The integrity of both sensory modalities is known to correlate with the presence of neuropathy but only monofilament has been around long enough for the association with risk of foot injury to be confirmed

Q: Our protocols say ‘monofilament’
A: VibraTip™ is very straightforward and takes only a few seconds to use. Using VibraTip™ alongside the monofilament in clinical practice would increase experience and provide reassurance about the integrity of results.

Q: Why use VibraTip™ in preference to a tuning fork?
A: A uniform intensity of vibration can be applied discretely without the pressure, coldness and sound that accompany tuning fork use. VibraTip™ is much quicker to use, more likely to be used (because it is more likely to be available at the point of use) and more hygienic in use.

Q: We use a 10g monofilament. Why should we change?
A: Monofilament and VibraTip™ test different sensory modalities. As it takes only a few seconds, perhaps it would be worth adding VibraTip™ use to your current monofilament protocol to see how the results compare?

Q: Why isn’t VibraTip™ adapted to also test fine touch, temperature and pain sensation?
A: Fine touch is best tested with the gentle application of a fingertip. Temperature is untestable given the time available to carry out neuropathy assessments. Blunt needles for testing pain are single use for hygiene reasons

Q: Where do you keep VibraTip™ when not in use?
A: We are currently working on a lanyard from which VibraTip™ can be released and replaced one-handed

Q: Does VibraTip™ come in different colours?
A: Not yet!

Q: What is the likely cost of VibraTip™?
A: VibraTip™ is likely to retail at about £6.50 each + postage and packing. Prices will be lower if ordered in larger numbers by healthcare trusts or GP practices

Q: Is more information available?
A: ‘VibraTip.com’ & ‘VibraTip.co.uk’ can be found directly or by searching ‘VibraTip’ in Google. The ‘press pack’ pdf contains all of the clinical trial material, instructions for use and a link to a purchase page

Q: How is VibraTip™ supplied?
A: VibraTip™ is supplied in a blister pack with an instruction booklet.

Q: Which is first to go in developing neuropathy, temperature or vibration sense?
A: Some clinicians believe that loss of temperature sensation precedes loss of vibration sense. Temperature sensation is difficult and very time consuming to test.

Q: Which is first to go in developing neuropathy, vibration or fine touch?
A: Loss of vibration perception is believed to precede loss of fine touch

Q: Does pressing harder with VibraTip™ affect performance?
A: If VibraTip™ is heavily applied, the vibration is likely to be damped. VibraTip™ should be squeezed firmly to activate it, but applied very gently to the skin

Q: NICE clinical guideline No.10 recommends 10g monofilament and/or vibration testing (with a calibrated tuning fork) for neuropathy
A: VibraTip™ is a new source of calibrated vibration and its place in fulfilling the guidelines still needs to be determined

Q: How does VibraTip™ compare with a Neurothesiometer?
A: Neurothesiometers provide different amplitudes of vibration (up to 250μm) rather than a set frequency. VibraTip™ provides a single, reference amplitude of vibration. Standard tuning forks (such as 128Hz), provide a standard frequency of vibration, but variable amplitude.

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