title: Influence of peripheral arterial occlusive disease on the Neuropad(®) test performance in patients with diabetes.
abstract: OBJECTIVE
  The specificity of the Neuropad(®) test to screen for peripheral neuropathy is moderate, but this test has several advantages, such as self-use, educative value and good sensitivity. Use of the Neuropad is usually contra-indicated in the presence of peripheral arterial occlusive disease, a condition associated with skin dryness. The aim of this study was to assess the influence of peripheral arterial occlusive disease on the performance of the Neuropad for screening peripheral neuropathy, and to compare it with the monofilament test.
  
  
  METHODS
  We included 200 patients with diabetes. Peripheral neuropathy was defined by a neuropathy disability score ≥ 6. The Neuropad was determined as normal or abnormal at 10 and 20 min, respectively, and its performance was compared in patients with and without peripheral arterial occlusive disease diagnosed by colour duplex ultrasonography. The performances of the Neuropad and of the monofilament test were compared.
  
  
  RESULTS
  Prevalences of peripheral neuropathy and of peripheral arterial occlusive disease were 15.8 and 44%, respectively. At 10 min, sensitivity and negative predictive value were high (93.8 and 95.1%), while specificity and positive predictive value were poor (23.2 and 18.9%). The Neuropad performance was not significantly different between patients with and without arteriopathy. Between 10 and 20 min, there was significant loss of sensitivity and gain in specificity. The Neuropad at 10 min was more sensitive but less specific than the monofilament test.
  
  
  CONCLUSIONS
  The reliability of the Neuropad is not significantly different in the presence or absence of peripheral arterial occlusive disease.
authors: Diabetes and Metabolic Diseases Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France. caroleaubert@bluewin.ch
authors: C E
authors: CE
authors: Aubert
authors: J
authors: J
authors: Le Doeuff
authors: J
authors: J
authors: Lajou
authors: O
authors: O
authors: Barthelemy
authors: A
authors: A
authors: Hartemann
authors: O
authors: O
authors: Bourron
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D004185:Disability Evaluation; D042241:Early Diagnosis; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007202:Indicators and Reagents / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods*; D011237:Predictive Value of Tests; D011933:Reagent Kits, Diagnostic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012684:Sensory Thresholds
chemical_list: D007202:Indicators and Reagents; D011933:Reagent Kits, Diagnostic