Evaluation of a self-administered sensory testing tool to identify patients at risk of diabetes-related foot problems.
OBJECTIVE
To study the use of a self-administered sensory testing tool designed to identify individuals at risk for diabetes-related foot problems and determine the inter-rater reliability between patient and provider sensory evaluations.


METHODS
Nine centers in eight states with established foot prevention centers mailed 196 self-screening testing materials to randomly selected patients with diabetes scheduled for follow-up appointments. Patients were instructed to perform a sensory test using a 10-g nylon filament at specified sites on the foot and to complete a brief survey form before their appointment. During the follow-up appointment, providers retested patients using an identical sensory filament at the same sites and completed a provider survey.


RESULTS
Of the patients, 145 kept their appointments and completed the self-screening materials. There were 141 patient and 137 provider surveys that indicated the instructions were clear and easy to use. Sixty-eight percent of the patients reported self-testing without the assistance of another person. Patient and provider sensory test findings disagreed (P = 0.0014) in 18 of 145 cases and fair inter-rater reliability was found (kappa = 0.73). Disagreement in sensory tests was related to patient age (P = 0.012). Sensory loss, previously undetected by providers, was found in 23 case subjects.


CONCLUSIONS
Self-administered sensory tests provide patients an opportunity to share in the responsibility for preventing diabetes-related foot problems but should not replace routine foot evaluation by a provider.
Birke
J A
JA
Foot and Physical Therapy Department, Gillis W. Long Hansen's Disease Center, Carville, LA 70721, USA. jbirke@concentric.net
Rolfsen
R J
RJ
D000367:Age Factors; D000368:Aged; D017719:Diabetic Foot / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011209:Power, Psychological; D015203:Reproducibility of Results; D012307:Risk Factors; D016353:Self-Examination; D012677:Sensation; D012737:Sex Factors