Person—peripheral neuropathy indicator, code N

Identifying and definitional attributes

• Health, Standard 21/09/2005

Value domain attributes

Representational attributes

Collection and usage attributes

CODE 9    Not stated/inadequately described

This code is not for use in primary data collections.

Data element attributes

Collection and usage attributes

CODE 1   Yes
Record if peripheral neuropathy is present in the person.

CODE 2   No
Record if peripheral neuropathy is not present in the person.

Record whether or not peripheral neuropathy is present determined by clinical judgement following assessment using pinprick and vibration (using perhaps a Biothesiometer) or Monofilament.

Examine for neuropathy by testing reflexes and sensation preferably using tuning fork (standard vibration fork 128 hz), pinprick, 10g monofilament and/or biothesiometer.

The preferred assessment methods are monofilament and biothesiometer. These two non-invasive tests provide more objective and repeatable results than testing sensation with pinprick or a tuning fork, which are very difficult to standardise.

1 The 'Touch-Test' Sensory Evaluation (Semmens-Weinstein Monofilaments) application guidelines:

• Occlude the patient's vision by using a shield or by having the patient look away or close his or her eyes.
• Instruct the patient to respond when a stimulus is felt by saying 'touch' or 'yes'.
• Prepare to administer the stimulus to the foot (dorsal or plantar surface).
• Press the filament of the Touch
• Test at a 90 degree angle against the skin until it bows. Hold in place for approximately 1.5 seconds and then remove.

  To assure the validity of the sensory test findings:

• The patient must not be able to view the administration of the stimuli so that false indications are avoided.
• The nylon filament must be applied at a 90 degree angle against the skin until it bows for approximately 1.5 second before removing.
• If the patient does not feel the filament, then protective pain sensation has been lost.

2 Testing vibration sensation with a biothesiometer - application guidelines:

• The biothesiometer has readings from 0 to 50 volts. It can be made to vibrate at increasing intensity by turning a dial.
• A probe is applied to part of the foot, usually on the big toe.
• The person being tested indicates as soon as he/she can feel the vibration and the reading on the dial at that point is recorded.

The reading is low in young normal individuals (i.e. they are very sensitive to vibration). In older individuals, the biothesiometer reading becomes progressively higher. From experience, it is known that the risk of developing a neuropathic ulcer is much higher if a person has a biothesiometer reading greater than 30-40 volts.

Source and reference attributes

National Diabetes Data Working Group

National Diabetes Outcomes Quality Review Initiative (NDOQRIN) data dictionary

1997 North Coast Medical, INC. San Jose, CA 95125; 800 821 - 9319

Duffy MD, John C and Patout MD, Charles A. 1990. 'Management of the Insensitive Foot in Diabetes: Lessons from Hansen's Disease'. Military Medicine, 155:575-579

Bell- Krotovski OTR, FAOT, FAOTA, Judith and Elizabeth Tomancik LOTR. 1987.The Repeatability of testing with Semmens-Weinstein Monofilaments. 'The Journal of Hand Surgery,' 12A: 155 - 161

Edmonds M, Boulton A, Buckenham T, et al. Report of the Diabetic Foot and Amputation Group. Diabet Med 1996; 13: S27 - 42

Foot Examination -an interactive guide; Aust Prescr 2002; 25:8 - 10

Relational attributes