Emotional response to neuropathy affecting foot self care

NewsBot · Nov 27, 2006

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Patient Interpretation of Neuropathy (PIN) Questionnaire
An instrument for assessment of cognitive and emotional factors associated with foot self-care
Diabetes Care 29:2617-2624, 2006
Loretta Vileikyte, Jeffrey S. Gonzalez, Howard Leventhal, Mark F. Peyrot, Richard R. Rubin, Adam Garrow, Jan S. Ulbrecht, Peter R. Cavanagh, and Andrew J.M. Boulton, FRCP1,2

OBJECTIVE—Using the common-sense model of illness behavior, we developed and validated a self-report instrument for assessment of patients’ cognitive and emotional representations of diabetic peripheral neuropathy (DPN) influencing foot self-care.

RESEARCH DESIGN AND METHODS—The Patient Interpretation of Neuropathy (PIN) questionnaire, generated from discussions with clinicians and interviews with patients with DPN, was administered to patients with DPN attending U.K. (n = 325) and U.S. (n = 170) diabetes centers. Psychometric tests of the PIN questionnaire comprised factor analysis, internal consistency, and test-retest reliability. Partial correlations and multivariate regressions established construct and criterion-related validity. The associations of PIN scales to past foot ulceration and foot self-care behaviors were compared with those using a generic measure of illness perception and emotion, the Revised Illness Perception Questionnaire (IPQ-R), which was adapted to neuropathy.

RESULTS—Factor analysis of the PIN questionnaire produced 11 scales, which explained 69% of item variance. Nine factors measured patients’ common-sense beliefs about DPN and their levels of understanding of DPN-related medical information. Two factors assessed the emotions of worry about potential consequences and anger at practitioners. Most scales demonstrated adequate internal (Cronbach’s = 0.62–0.90) and test-retest reliability (Pearson’s r = 0.51–0.64). Partial correlations between the PIN and IPQ-R scales in corresponding domains were significant but modest (rp = 0.15–0.26). Finally, PIN scales showed significant associations with past foot ulceration and foot self-care behaviors, thereby confirming criterion validity.

CONCLUSIONS—The 39-item PIN questionnaire is a reliable and valid measure of patients’ cognitive and emotional representations of neuropathy affecting foot self-care.
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NewsBot · Apr 29, 2009

Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study.
Vileikyte L, Peyrot M, Gonzalez JS, Rubin RR, Garrow AP, Stickings D, Waterman C, Ulbrecht JS, Cavanagh PR, Boulton AJ.
Diabetologia. 2009 Apr 18. [Epub ahead of print]

AIMS/HYPOTHESIS: The aim of the study was to determine whether diabetic peripheral neuropathy (DPN) is a risk factor for depressive symptoms and examine the potential mechanisms for this relationship.

METHODS: This longitudinal study (9 and 18 month follow-up) of 338 DPN patients (mean age 61 years; 71% male; 73% type 2 diabetes) examined the temporal relationships between DPN severity (mean +/- SD; neuropathy disability score [NDS], 7.4 +/- 2.2; mean vibration perception threshold, 41.5 +/- 9.5 V), DPN somatic experiences (symptoms and foot ulceration), DPN psychosocial consequences (restrictions in activities of daily living [ADL] and social self-perception) and the Hospital Anxiety and Depression subscale measuring depressive symptoms (HADS-D; mean 4.9 +/- 3.7).

RESULTS: Controlling for baseline HADS-D and demographic/disease variables, NDS at baseline significantly predicted increased HADS-D over 18 months. This association was mediated by baseline unsteadiness, which was significantly associated with increased HADS-D. Baseline ADL restrictions significantly predicted increased HADS-D and partly mediated the association between baseline unsteadiness and change in HADS-D. Increased pain, unsteadiness and ADL restrictions from baseline to 9 months each significantly predicted increased HADS-D over 18 months. Change in social self-perception from baseline to 9 months significantly predicted increased HADS-D and partly mediated the relationships of change in unsteadiness and ADL restrictions with change in HADS-D.

CONCLUSIONS/INTERPRETATION: These results confirm that neuropathy is a risk factor for depressive symptoms because it generates pain and unsteadiness. Unsteadiness is the symptom with the strongest association with depression, and is linked to depressive symptoms by perceptions of diminished self-worth as a result of inability to perform social roles.
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Admin2 · Nov 22, 2014

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NewsBot · Jun 8, 2012

From the 2012 ADA Mtg:
Depression and Not Specific Emotional Distress Predicts Diabetic Foot Ulcer Incidence
LORETTA VILEIKYTE, JEFFREY S. GONZALEZ, ANDREW J. BOULTON

Prior diabetic foot ulceration (DFU) does not increase risk for depression. However, depression is associated with increased DFU risk. We re-examined these relationships substituting depression (Hospital and Anxiety Depression Scale; HADS-D) with a measure of foot problem-Specific Emotional Distress (NeuroQoL-SED). Data from an 18-month prospective cohort study of 333 patients with diabetic peripheral neuropathy, DPN (71% male; age 62yrs; 73% type 2 diabetes; Neuropathy Disability Score 7.4) showed that those with prior DFU had significantly (p < .001) greater NeuroQoL-SED (M = 2.70, SD = 1.19) at baseline than those without (M = 2.00, SD = 1.10). This difference persisted (p = .003) in multivariate regression models controlling for demographics, comorbidities, DPN-severity, symptoms and functional impairment, and was enhanced, rather than attenuated, when HADS-D was controlled for (p < .001). However, longitudinal multivariate models showed that NeuroQoL-SED did not predict DFU over time. Controlling for NeuroQoL-SED did not attenuate previously reported association between HADS-D and DFU risk. Item-level analyses showed HADS-D items assessing positive affect were not significantly associated with DFU risk. Only ‘feeling slowed down’ (p = .030) and ‘losing interest in appearance’ (p = .003) were significantly associated with increased risk of DFU. Controlling for DPN-related DFU risk factors and subjective health ratings (general or DPN-specific) did not attenuate the relationship between HADS-D and DFU risk. These results suggest that while prior DFU is associated with increased specific emotional distress and not depression, it is depression, particularly negative affect, that is associated with increased risk for the development of new DFU over time. While the mechanism for this relationship is unclear, it does not appear to be accounted for by confounding with specific emotional distress or with objective or subjective indicators of poor health.
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NewsBot · Feb 7, 2014

Cognitive status and foot self care practice in overweight diabetics, engaged in different levels of physical activity.
Madarshahian F, Hassanabadi M, Koshniat Nikoo M.
J Diabetes Metab Disord. 2014 Feb 4;13(1):31.

BACKGROUND:
Type 2 diabetes along with chronic hyperglycemia may result in cognitive impairment. This can negatively affect the patient's adherence to diabetes treatment. The purpose of this study was to compare the cognitive status and foot self care practice in overweight type 2 diabetic patients who exercised regularly and those who did not.
METHODS:
The comparative study was conducted on 160 consecutive patients from an outpatient diabetes clinic. They were divided into two groups: The active group comprised of 80 patients engaged in regular exercise for at least 15-30 minutes, three times per week during the past 6 months. The control group included 80 patients who had not exercised regularly for the past 12 months, matched for sex, age, education, diabetes duration, hemoglobin A1C and body mass index (BMI: 25-29.9Kg/m2). Data on the patients' demographic information, foot care practice and physical activity habits were gathered using a questionnaire. The Mini Mental Status examination (MMSE) was applied to assess cognitive status.
RESULTS:
MMSE score was significantly higher in the active group. A significant negative correlation was noted between MMSE scores and BMI in the control group (r = -0.2, P = 0.03). A significant difference was noted in the four domains of foot self care practice between the active (4.77 +/- 0.77) and control (4.45 +/- 0.83) groups (P < 0.01).
CONCLUSIONS:
Regular physical activity can help promote cognitive status and foot self care practice in overweight patients with type 2 diabetes.
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NewsBot · Nov 22, 2014

Recognition and management of psychosocial issues in diabetic neuropathy.
Vileikyte L, Gonzalez JS.
Handb Clin Neurol. 2014;126C:195-209

Although psychosocial aspects of diabetic neuropathy (DN) have received far less attention than biological aspects, research conducted over the last decade has begun to illuminate several important pathways between DN and psychosocial outcomes, including depression, anxiety, and self-management of diabetic foot ulcer (DFU)-risk. Growing body of evidence indicates that DN is a risk factor for depression predicting both the severity and increments in depression over time. Whereas painful DN contributes to depression, postural instability is the DN symptom with the strongest, cumulative effect on depression. Furthermore, depression and foot self-care, while having no impact on the development of recurrent diabetic foot ulcers (DFU), play a substantial role in incident first DFU. Patient common sense misconceptions about DFU risks and associated emotional responses play an important role in shaping foot self-care. Depression, and especially DFU-specific emotions, may be linked to DFU chronicity through biological and behavioral pathways that are at present under investigation in several ongoing trials. Integrative approaches that target psychological factors such as anxiety and depression while concurrently optimizing treatment and self-management may therefore be most powerful. Cognitive behavioral therapy-based techniques that are informed by these findings deserve investigation.
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NewsBot · Apr 23, 2015

The role of physical activity and psychological coping strategies in the management of painful diabetic neuropathy–A systematic review of the literature
Ben Davies, Fiona Cramp, Jeremy Gauntlett-Gilbert, David Wynick, Candida S. McCabe
Physiotherapy; Article in Press

Background
Diabetes is rising in prevalence; painful diabetic neuropathy (PDN) is one complication of diabetes. PDN is primarily managed with medication but analgesic failure is common and people remain in pain and distress. It is unclear whether pain management strategies are appropriate for PDN.

Objectives
To establish the effectiveness of physical activity and psychological coping strategies for PDN.

Design
Systematic literature review.

Data sources
Ten online databases.

Eligibility criteria (participants and interventions)
Controlled trials reporting specific results for PDN, investigating, (a) physical activity or (b) psychological coping strategies and measuring pain as an outcome. The search was restricted to published research with no restriction on language or date of publication.

Study appraisal methods
Methodological quality and risk of bias assessed with Cochrane Collaboration and NICE checklist for randomised controlled trials.

Results
Of 1306 titles identified, four studies met the inclusion criteria. Two trials investigated physical activity and two investigated psychological coping interventions. Studies showed pain measures improved or did not worsen compared to controls, but methodological quality was moderate and results need cautious interpretation.

Limitations
The studies were of small sample size and used a diverse range of outcome measures. There is high risk of bias from lack of blinding and attrition at follow up.

Conclusions and implications of key findings
The research literature in this area is sparse and inconsistent, despite the pressing clinical challenge of PDN. Firm conclusions cannot be drawn from the studies included. Further high quality research is required to match treatment provision to patient requirements.
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NewsBot · Jun 20, 2015

Migrants with diabetes believe diabetic foot ulcers being unavoidable and impossible to prevent.
Hjelm, Katarina and Apelqvist, Jan
50th annual meeting of the EUROPEAN DIABETES EPIDEMIOLOGY GROUP.25-28 April 2015. Les Fontaines, Gouvieux-Chantilly, France.Study group of the European Association for the Study of Diabetes (EASD), Paris, France

Background: Since type 2 diabetes is developing into a pandemic, particularly affecting migrants in industrializing countries, the prevalence of diabetes complications is expected to increase. Diabetic foot disorders are the predominant source of complications and are serious and costly but highly preventable particularly by self-care. Health-related behavior, including self care and health care seeking, is guided by beliefs about health/illness but has not previously been studied in different migrant groups. We aim to describe beliefs about health/illness in foreign-born persons with diabetic foot ulcers that might affect self-care and health care seeking and to study whether there are dissimilarities related to origin. ‘

Material and methods: Qualitative descriptive study. Semi-structured interviews with 26 persons, aged 38-86 years, whereof 13 born in European and 13 in non European countries, all except one in the Middle East, being residents in Sweden between 7-60 years (Md 18 yrs).

Results: Most believed foot ulcers being unavoidable and problematic to detect, and mainly caused by internal factors such as diabetes, sometimes combined with external factors as inappropriate foot wear, hot water, or bare foot walking. Perceived health had deteriorated after onset of the foot problems due to immobility and pain. Middle Easterners differed as they discussed the importance to adapt to the will of Allah, leading to even poorer quality of life and view of future health. They described more foot problems and perceived religion (Muslim) with washing rituals of the feet being of importance for health. They were less often regularly monitored than European migrants. Economy affected health, more so in Europeans, due to expenses for medications and shoes. Many described limited activity in self-care, few had searched help for their foot problems and if so solely among professionals and had limited knowledge about the influence of glycaemic control on diabetes/foot status.

Conclusions: Foreign-born persons perceived foot ulcers being impossible to prevent, experienced problems with detection, and had limited knowledge about self-care. Dissimilarities in beliefs related to origin were found that negatively affected self-care of the feet why it is important to assess individual beliefs and plan care and education accordingly.
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NewsBot · Jul 25, 2016

Impact of neuropathy on the adherence to diabetes-related self-care activities: a cross-sectional study.
Timar B et al
Patient Prefer Adherence. 2016 Jul 1;10:1169-75. doi: 10.2147/PPA.S107621

PURPOSE:
The purpose of this study was to evaluate the impact of the presence and severity of neuropathy and depression on the patient's adherence to diabetes-related self-care activities (DRSCA) in a cohort of patients with type 2 diabetes mellitus (T2DM).
PATIENTS AND METHODS:
In this cross-sectional, noninterventional study, 198 patients with T2DM were enrolled according to a population-based, consecutive-case enrollment principle. In all patients, the adherence to DRSCA was evaluated using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire; a higher SDSCA score is associated with a better adherence. The presence and severity of neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI) and the severity of depression using the Patient Health Questionnaire-9 (PHQ-9).
RESULTS:
The presence of neuropathy was associated with a decreased SDSCA score (26 points vs 37 points; P<0.001), an increased severe depression prevalence (24.7% vs 4.3%; P<0.001), and an increased PHQ-9 score (12 points vs 7 points; P<0.001). The MNSI score was reverse correlated with SDSCA score (r=-0.527; P<0.001) and positively correlated with PHQ-9 score (r=0.495; P<0.001). The reverse correlation between MNSI score and SDSCA score was present for all the subcomponents of SDSCA questionnaire (diet, exercise, glycemic monitoring, and foot care).
CONCLUSION:
The presence of neuropathy is associated with decreases in the quality of adherence to DRSCA in patients with T2DM and with increases in the symptomatology of depression. The significant, negative association between the severity of T2DM and the quality of disease self-management points to a possible loop-type relationship between these two components, being possible a reciprocal augmentation with negative consequences on the global management of the disease.
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NewsBot · May 3, 2018

Illness Perception as a Predictor of Foot Care Behavior Among People With Type 2 Diabetes Mellitus in Indonesia
Sofyan Indrayana, MSN, RN, Su-Er Guo, PhD, RN, Ching-Lan Lin, PhD, RN, ...
Journal of Transcultural Nursing April 26, 2018

Introduction: Illness perception may contribute to foot care behavior because people with type 2 diabetes mellitus (T2DM) in Indonesia may have different beliefs that influence their foot care behaviors. This study aimed to determine the relationships among foot care knowledge, illness perception, local beliefs, and foot care behaviors in people with T2DM in Indonesia. Methods: Cross-sectional study with a convenience sampling technique was used to recruit 200 people with T2DM from the Outpatient Department of Islamic Hospital. The Foot Care Knowledge, Brief Illness Perception, Local Beliefs, and Foot Self-Care Behavior questionnaires were administered. Results: The predictors of foot care were having a family member or friend with diabetic foot ulcer (p = .001), diabetes mellitus duration (p = .026), foot care knowledge (p < .001), consequences (p < .001), treatment control (p < .001), and local beliefs (p = .017). Discussion: Health care providers may cultivate a spiritual approach, providing success stories to create positive images of the disease’s outcomes and increase patients’ confidence to control the disease
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NewsBot · Dec 6, 2022

Neuropathy-and foot-ulcer specific quality of life instrument (NeuroQoL): Translation, cross-cultural adaptation and content validation in Hindi
AakanshaSarafa et al
Foot and Ankle Surgery; 5 December 2022

BACKGROUND
Neuropathy-and foot ulcer-specific quality of life instrument (NeuroQoL) is not available in Hindi language which is one of the most spoken languages in the world. Hence, we aimed to translate, cross-culturally adapt and content validate NeuroQoL into Hindi language (NeuroQoL-H).

METHODS
NeuroQoL is translated and cross-culturally adapted into Hindi language (NeuroQoL-H) using the guidelines proposed by Beaton and colleagues. Both item and scale levels content validity index (I-CVI & S-CVI) were reported for the validation and pretesting was performed with, n=51 patients with diabetes. Floor and ceiling effects were reported.

RESULT
Total score of content validated and pretested, NeuroQoL-H with, n=51 patients with diabetes is, 60 (36,109). For all the items in NeuroQoL-H, I-CVI > 0.9 and S-CVI = 0.95. The floor effort is (24%) while the ceiling effect is (1%).

CONCLUSION
NeuroQoL-H scale is a valid outcome measure among Hindi speaking patients with diabetes.
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