Published online Apr 15, 2023. doi: 10.4239/wjd.v14.i4.435
Peer-review started: November 8, 2022
First decision: November 27, 2022
Revised: December 11, 2022
Accepted: January 9, 2023
Article in press: January 9, 2023
Published online: April 15, 2023
Processing time: 154 Days and 1.1 Hours
Diabetic sensorimotor polyneuropathy is an important risk factor for foot ulceration and amputation. Thus, patients with diabetes should be screened for this disorder according to local guidelines. An obstacle to the diagnosis of this disease may be the lack of unified diagnostic criteria due to the lack of properly validated scales used for assessment.
To validate both sections (A and B) of the Michigan Neuropathy Screening Instrument (MNSI) in Polish (PL) patients with diabetes.
A cross-sectional study using a test (A1, B1) and re-test (A2, B2) formula was performed in 80 patients with diabetes. The gold standard used for neuropathy detection was a nerve conduction study (NCS) which was performed in all participants. Reliability of the MNSI-PL was assessed using the Cronbach’s alpha, Kuder-Richardson formula 20 (KR-20), split-half reliability, the Gottman split-half tests, and correlation between first and second half was accessed. Stability was assessed using an intraclass correlation coefficient (ICC). For external validation, we used simple linear correlation, binomial regression, and agreement between two different tools using a Bland-Altman plot analysis.
The scale was internally consistent (Cronbach’s alpha for the full scale: 0.81 for A and 0.87 for B). MNSI-PL scores in test/retest showed high stability (ICC = 0.73 for A and ICC = 0.97 for B). The statistically important correlations between MNSI-PL and NCS were found for B1, B2, and A1 (P < 0.005). The cut-off points of ≥ 3 for section A (sensitivity of 90%-100%; specificity of 33%-40%) and ≥ 2 for section B (sensitivity of 81%-84%; specificity of 60%-70%) were obtained during neuropathy detection.
The MNSI-PL is a reliable and valid instrument in screening for diabetic neuropathy.
Core Tip: The Michigan Neuropathy Screening Instrument (MNSI) is a collective tool for assessing the peripheral nervous system in patients with diabetes mellitus and is widely used to evaluate patients in many countries. In Poland, the MNSI has not yet been validated, thus is a problem when using it in daily practice and for research purposes. We concluded that the Polish MNSI is a reliable and accurate screening tool for peripheral neuropathy, and we hope that it can be used by our colleagues in their studies. We also proposed cutoff points of both scales for patients and for physicians, hoping that MNSI can be used by other authors from different countries