Disability in Patients with Peripheral Neuropathy Secondary to Diabetes Mellitus Development of an ICF based assessment paradigm and study of factors that influence outcome

Abstract

The prevalence of Diabetes Mellitus (DM) and its complications pose a heavy burden on the disability, health care systems and on the quality of life. Diabetic Peripheral Neuropathy (DPN) is the most common complication and it affects approximately 50% of patients with diabetes. In this scenario, there is a felt need for a comprehensive assessment for DPN which would facilitate its early detection, understand the implications, prevent further complications and help prognosticate. International Classification of Functioning, Disability and Health (ICF) is World Health Organization (WHO) framework for health and disability; the new ICF lends itself to being developed into a globally agreed framework of functioning and health in patients with DPN. While several neuropathy scoring paradigms are available, no systematic framework covering the clinical spectrum is available. We also used the opportunity to study the factors that influence outcome. The Cronbach s Alpha Score of 0.988 showed high reliability and consistency, inter-rater and intra-rater correlated perfectly with Pearson s correlation coefficient of (r=1*) with the ADDiN scale. Analyses of Variance (ANOVA), Pearson s Coefficient, ROC analysis and odds ratio substantially supported our hypothesis that DPN (OR= 1.929) is gt3 times more disabled than DM (OR=0.454). Our study demonstrated that ADDiN was comparable and more comprehensive when compared with the WHODAS, WHOQOL, CGI-Severity score and ONLS as a measure of functioning, disability and health in DPN. The ADDiN was demonstrated to be extremely useful in identifying subjects with hitherto unidentified with health and disability issues, early diagnosis of DPN, disability status assessment and grading, and for purposes of counseling and adequate follow up. As our study has not accounted for some potential confounding factors; diabetic control, severity of the diabetes condition, treatment etc. further research in larger populations will be necessary, before the ADDiN scale can be adopted for widespread use.