Rotterdam Diabetic Foot Study Test Battery

NewsBot · Jan 20, 2020

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Item reduction of the 39-item Rotterdam Diabetic Foot Study Test Battery using decision tree modeling.
Rinkel WD et al
Diabetes Metab Res Rev. 2020 Jan 19

AIMS:
Pedal sensory loss due to diabetes-related neuropathy can be graded by testing static- and moving two-point discrimination (S2PD, M2PD), static one-point discrimination (S1PD, e.g. 10 g monofilament) and vibration sense, and are included in the Rotterdam Diabetic Foot Study Test Battery. The aim of this study is to investigate if decision tree modeling is able to reduce the number of tests needed in estimating pedal sensation.

METHODS:
39-item RDF Study Test Battery (RDF-39) scores were collected from the prospective RDF-study and included baseline (n=416), first follow-up (n=364) and second follow-up (n=135) measurements, supplemented with cross-sectional control data from a previous study (n=196). Decision tree analysis was used to predict total RDF-39 scores using individual test item data. The tree was developed using baseline RDF Study data and validated in follow-up and control data. Spearman correlation coefficients assessed the reliability between the decision tree and original RDF-39.

RESULTS:
The tree reduced the number of items from 39 to 3 in estimating the RDF-39 sum score. M2PD (hallux), S2PD (first dorsal web, fifth toe), vibration sense (interphalangeal joint) and S1PD (first dorsal web, fifth toe) measurements proved to be predictive. The correlation coefficients to original scores were high (0.76 to 0.91).

CONCLUSIONS:
The decision tree was successful at reducing the number RDF Test Battery items to only 3, with high correlation coefficients to the scores of the full test battery. The findings of this study aids medical decision-making by time-efficiently estimating pedal sensory status with fewer tests needed
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NewsBot · Apr 25, 2021

A new application of the Rotterdam Diabetic Foot Study Test Battery: grading pedal sensory loss to predict the risk of foot ulceration
Willem D. Rinkel et al
April 23, 2021

Aims
To assess the relationship between the degree of loss of foot sensation at baseline and incidence of foot ulceration (DFU).
Methods
Diabetic patients (n=416) participating in the observational Rotterdam Diabetic Foot (RDF) Study were followed prospectively (median 955.5 days (IQR, 841.5-1121)). Subjects underwent sensory testing of the feet (39-item RDF Study Test Battery) at baseline and were assessed regarding incident DFU. Seven groups of incremental degree of sensory loss were distinguished, according to the RDF-39 sum score. Kaplan-Meier and regression analyses were used to determine the independent hazard of baseline variables for new DFU.
Results
40 participants developed DFUs. The mean incident rate of new-onset ulceration from study start was 4.5 (95%CI: 3.3 to 6.1) per 100 person-years, which increased significantly from 0 to 67.70 in the seven groups (p<0.0005). Predictors for DFUs were higher RDF-39 score (aHR: 1.173, p<0.0005) and kidney function (aHR: 1.022, p=0.016). Prior DFU suggests increased mortality risk.
Conclusions
The degree of sensory loss at baseline was associated with progression to DFU during follow-up. Grading the loss of sensation using the RDF Study Test Battery may result in a more precise risk stratification compared to the use of the 10 g monofilament according to current guidelines.
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