Evaluation of the Self-Administered Indicator Plaster Neuropad for the Diagnosis of Neuropathy in Diabetes

Abstract

OBJECTIVE -To evaluate the inter-rater reliability between patient and health care provider of the indicator plaster neuropad (IPN) in the diagnosis of peripheral neuropathy and the feasibility of the IPN.RESEARCH DESIGN AND METHODS -A total of 156 patients with diabetes were examined. At the same visit, the IPN was evaluated by the health care provider. Afterward, the IPN with written instructions for its use and evaluation for self-testing at home were provided together with a questionnaire asking for the easiness of the IPN.RESULTS -Neuropathy was diagnosed in 56.9% of the participants by the health care provider. The k statistic to measure overall agreement between patient and health care provider of the IPN was very good: 0.88 (95% CI 0.85-0.91). The indicated instructions and the IPN were evaluated as easy by the patients.CONCLUSIONS -The high degree of reliability and the easiness of the IPN suggest that it is proper for self-testing for the identification of peripheral neuropathy. Diabetes Care 31:236-237, 2008C hronic peripheral sensorimotor neuropathy is a common complication of diabetes (1). Clinical examination is the mainstay for the diagnosis of peripheral neuropathy and prevention of foot problems (1). Sudomotor dysfunction develops early in the course of peripheral neuropathy (2). Recently, a new test assessing sudomotor dysfunction, the indicator plaster neuropad (IPN), has been introduced for the diagnosis of peripheral neuropathy (3,4). The IPN has a high sensitivity for the diagnosis of peripheral neuropathy (3-5) and excellent reproducibility (6). Another advantage of the IPN is its simplicity. This study evaluated the interrater reliability between patient and health care provider of the IPN in the diagnosis of peripheral neuropathy and the feasibility of the IPN. RESEARCH DESIGN ANDMETHODS -A total of 156 consecutive subjects were recruited from the outpatient diabetes clinic of our hospital (Table 1). Subjects were included if they were able to read and understand the written instructions for the use and evaluation of the IPN. Patients with dyschromasia, with severe visual loss, treated with medications affecting sweating, with known allergy to cobaltium, and with critical limb ischemia were excluded.Participants were assessed for neuropathy at the first visit to the clinic. Diagnosis of neuropathy was based on clinical examination using the neuropathy symptom score and the neuropathy disability score (7). The IPN was applied for 10 min in the sitting position at both feet and evaluated as normal (pink color bilaterally) or abnormal (blue color or any other combinations of colors bilaterally) by the doctor at the same visit. Afterward, the IPN for self-testing at home in the sitting position together with written instructions for its use and evaluation were provided. Additionally, a questionnaire was given asking for the easiness to understand the instructions for the use of the IPN, the easiness to the use the IPN, and the easiness to evaluate the result of the IPN (visual analogue scale...

Association between Foot Temperature and Sudomotor Dysfunction in Type 2 Diabetes

“…Of particular importance, both Neuropad and the handheld infrared thermometer are very easy to use and have been evaluated for patient self-examination. 8,9,14 The present work adds to the body of knowledge that the neuropathic foot is warmer and encourages the future application of temperature measurement in the study of the diabetic foot.…”

Moisture Status of the Skin of the Feet Assessed by the Visual Test Neuropad Correlates With Foot Ulceration in Diabetes

“…Advantages of the Neuropad are its simplicity, wide availability, high performance for the diagnosis of peripheral neuropathy, and high reproducibility (5,12). Moreover, the test can be self-performed and evaluated safely by the patients (13). …”

Useful Application of the Neuropad Test for Assessment of Diabetic Polyneuropathy

“…Tentolouris et al (20) demonstrated that an abnormal Neuropad response correlates with foot ulceration in diabetic subjects and suggest that it may be a screening test for the prediction of foot ulceration. The visual reinforcement of the Neuropad test may make diabetic patients more aware of foot care, in addition to conventional evaluations, because the Neuropad test can be self-performed and is easy to carry out by the patients (21).…”