The Ipswich Touch Test: a simple and novel method to identify inpatients with diabetes at risk of foot ulceration
Gerry Rayman, Prashanth R Vas, Neil Baker, Charles G Taylor Jr, Catherine Gooday, Amanda I Alder, Mollie Donohoe, Gerry Rayman, Prashanth R Vas, Neil Baker, Charles G Taylor Jr, Catherine Gooday, Amanda I Alder, Mollie Donohoe
Abstract
Objective: To promote foot screening of inpatients with diabetes, we simplified sensory testing to lightly touching the tips of the first, third, and fifth toes (the Ipswich Touch Test [IpTT]).
Research design and methods: Respective performances of the IpTT and 10-g monofilament (MF) were compared with a vibration perception threshold of ≥25 V indicating at-risk feet in 265 individuals. The IpTT and MF were also directly compared.
Results: With ≥2 of 6 insensate areas signifying at-risk feet, sensitivities and specificities, respectively, were IpTT (77 and 90%), MF (81 and 91%); positive predictive values were IpTT (89%), MF (91%); and negative predictive values were IpTT (77%), MF (81%). Directly compared, agreement between the IpTT and MF was almost perfect (κ=0.88, P<0.0001). Interrater agreement for the IpTT was substantial (κ=0.68).
Conclusions: The IpTT performs well against a recognized standard for ulcer prediction. Simple to teach, reliable, without expense, and always at hand, it should encourage uptake of screening and detection of high-risk inpatients requiring foot protection.
References
- Abbott CA, Carrington AL, Ashe H, et al. ; North-West Diabetes Foot Care Study The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med 2002;19:377–384
- Leese GP, Reid F, Green V, et al. Stratification of foot ulcer risk in patients with diabetes: a population-based study. Int J Clin Pract 2006;60:541–545
- Adler AI, Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Smith DG. Risk factors for diabetic peripheral sensory neuropathy. Results of the Seattle Prospective Diabetic Foot Study. Diabetes Care 1997;20:1162–1167
- Rith-Najarian SJ, Stolusky T, Gohdes DM. Identifying diabetic patients at high risk for lower-extremity amputation in a primary health care setting. A prospective evaluation of simple screening criteria. Diabetes Care 1992;15:1386–1389
- Rayman G. The National Diabetes Inpatient Audit Day. A great success and a powerful tool with which to improve inpatient diabetes care. Summary of the paper presented to Diabetes UK APC March 2010 [article online], 2010. Available from Accessed 14 December 2010
- Armstrong DG, Lavery LA, Vela SA, Quebedeaux TL, Fleischli JG. Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration. Arch Intern Med 1998;158:289–292
- Shy ME, Frohman EM, So YT, et al. ; Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Quantitative sensory testing: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2003;60:898–904
- Dros J, Wewerinke A, Bindels PJ, van Weert HC. Accuracy of monofilament testing to diagnose peripheral neuropathy: a systematic review. Ann Fam Med 2009;7:555–558
- Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA 2005;293:217–228
- Young MJ, Breddy JL, Veves A, Boulton AJ. The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. A prospective study. Diabetes Care 1994;17:557–560
- Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159–174
- Diabetes UK. Putting feet first: commissioning specialist services for the management and prevention of diabetic foot disease in hospitals [article online]. Available from Accessed 14 December 2010
Source: PubMed