The Ipswich Touch Test for diabetic neuropathy

NewsBot · Mar 29, 2014

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The Ipswich Touch Test: a simple and novel method to screen patients with diabetes at home for increased risk of foot ulceration.
Sharma S, Kerry C, Atkins H, Rayman G.
Diabet Med. 2014 Mar 26.

AIMS:
The Ipswich Touch Test is a novel method to detect subjects with diabetes with loss of foot sensation and is simple, safe, quick, and easy to perform and teach. This study determines whether it can be used by relatives and/or carers to detect reduced foot sensation in the setting of the patient's home.
METHODS:
The test involves lightly and briefly (1-2 s) touching the tips of the first, third and fifth toes of both feet with the index finger. Reduced foot sensation was defined as ≥ 2 insensate areas. Patients due to attend clinic over a 4-week period were invited by post. The invitation contained detailed instructions and a sheet for recording the results. The findings were compared with those obtained in clinic using the 10-g monofilament at the same six sites.
RESULTS:
Of 331 patients (174 males), 25.1% (n = 83) had ≥ 2 insensate areas to 10-g monofilament testing. Compared with this, the Ipswich Touch Test at home had a sensitivity of 78.3% and a specificity of 93.9%. The predictive values of detecting 'at-risk' feet were positive at 81.2% and negative at 92.8%. The likelihood ratios were positive at 12.9 and negative at 0.23.
CONCLUSIONS:
With clearly written instructions, this simple test can be used by non-professionals to accurately assess for loss of protective sensation. We believe that the Ipswich Touch Test may also be a useful educational adjunct to improve awareness of diabetes foot disease in patients and relatives alike and empower them to seek appropriate care if sensation was found to be abnormal.
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Admin2 · Mar 30, 2014

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NewsBot · Nov 22, 2014

Utilizing the Ipswich Touch Test to simplify screening methods for identifying the risk of foot ulceration among diabetics: The Saudi experience
Amal Madanat, Eman Sheshah, EL-Badry Badawy, Ameera Abbas, Anas AL-Bakheet
Primary Care Diabetes; Articles in Press

Highlights
•IpTT was sensitive and specific in detecting feet at risk compared to VPT ≥ 25 V.
•IpTT was highly specific in detecting the risk of foot ulceration compared to NDS ≥ 6.
•IpTT was highly specific compared to10-g MF test and showed substantial agreement.
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Our study demonstrates that Ipswich Touch Test is reliable and comparable to established standardized tests that identify the risk of foot ulceration among Saudi patients with diabetes mellitus. The simplicity of the test will assist in overcoming the barriers to screen for and detect the risk of foot ulceration.
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NewsBot · Feb 18, 2015

The Ipswich Touch Test at home had 78% sensitivity and 94% specificity for detecting loss of foot sensation.
O'Loughlin A, Dinneen SF.
Ann Intern Med. 2015 Feb 17;162(4):JC10. doi: 10.7326/ACPJC-2015-162-4-010.

NewsBot · Apr 6, 2020

Accuracy of Ipswich Touch Test (IpTT) to detect small fiber neuropathy and large fiber neuropathy as a risk factor of diabetic foot ulcers in public health centers
Ita SulistianiBasir et al
Enfermería Clínica Volume 30, Supplement 2, March 2020, Pages 308-312

Objective
This study was to determine the accuracy of using Ipswich Touch Test (IpTT) in detecting neuropathy in patients with small fiber and large fiber neuropathy.

Method
This was a cross sectional multisite study approach. The number of samples in this study were one hundred participants. The data collection process in this study was performed by assessing nerve sensation in the legs with IpTT technique compared to the Golden Standard for Small Fiber Neuropathy and Large Fiber Neuropathy. The Golden Standard is used for the examination of Small Fiber Neuropathy, Pinprick, and for large Fiber Neuropathy using Monofilament, Tuning Fork 128 Hz, and Ankle Reflex.

Results
We found sensitivity of IpTT against Pin prick test was 80.0%, with specificity 88.0% in detection small fiber neuropathy. Meanwhile, sensitivity of IpTT to detect large fiber neuropathy in comparison with Monofilament (80.0%), Tuning Fork 128 Hz (40.0%), and Ankle Reflex (20.0%).

Conclusion
There is no difference between the IpTT against the golden standard small fiber neuropathy large fiber neuropathy.
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NewsBot · Apr 10, 2020

Is it possible to substitute the monofilament test for the Ipswich Touch Test in screening for peripheral diabetic neuropathy?
Dutra LMA et al
Diabetol Metab Syndr. 2020 Mar 31;12:27.

BACKGROUND:
This study aimed to assess the agreement and efficacy of the Ipswich Touch Test compared to the monofilament test in individuals with type 2 diabetes.

MATERIALS AND METHODS:
A cross-sectional and analytical study was conducted. The inclusion criteria were patients with type II diabetes (n = 250) who did not present ulcers or amputation in either foot. The exclusion criteria were as follows: patients who presented sequelae of cerebrovascular disease or other neurological pathologies, as well as diagnoses of malignancy, alcohol abuse, liver cirrhosis, hepatitis B, AIDS, hypothyroidism, chronic kidney disease or lupus erythaematosus, as these clinical conditions could influence or bias the results (Won and Park in Endocrinol Metab 31:230-238, 2016). Sensitivity, specificity, predictive values, likelihood ratios, and Kappa index were calculated. Other factors assessed were glycated haemoglobin and body mass index.

RESULTS:
Most of the participants were female (71.2%), and glycated haemoglobin (HbA1c) was greater than 7% in 54.4% of the patients. The mean age was 59.43 years, and the mean time since diagnosis was 12.38 years. The Kappa index was 0.819 (p < 0.001), and the Ipswich Touch Test had a sensitivity of 83.33%, a specificity of 97.66%, a positive predictive value of 85.71%, a negative predictive value of 97.21%, a positive likelihood ratio of 30.19%, and a negative likelihood ratio of 0.17%. The level of significance was 5% in this study.

CONCLUSION:
The Ipswich Touch Test resented good agreement and efficacy compared to the gold standard-the 10 g monofilament test.
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NewsBot · Jul 5, 2020

A review of the current evidence on the sensitivity and specificity of the Ipswich touch test for the screening of loss of protective sensation in patients with diabetes mellitus
Arnold Hu, Beatrice Koh & Melissa- Raye Teo
Diabetology International (2020)

Aims
To evaluate the sensitivity and specificity of the Ipswich touch test for the screening of loss of protective sensation in patients with diabetes mellitus based on the current literature.

Methods
Three electronic databases were searched for eligible studies that investigated the sensitivity and specificity of the Ipswich touch test. Methodological quality was assessed using the QUADAS-2 tool.

Results
Five studies that reported the sensitivity and specificity of the Ipswich touch test were included. When compared to the 10 g monofilament, the sensitivity ranges from 51 to 83.3% and the specificity ranges from 96.4 to 98%. When compared to the vibration perception test ≥25 V, Ipswich touch test sensitivity ranges from 76 to 100% and specificity ranges from 90 to 96.6%.

Conclusions
The Ipswich touch test has a high specificity in screening for loss of protective sensation in the feet of patients with diabetes mellitus. It is a useful test to be included in diabetic foot screenings, especially when other sensory tools are not available. However, more rigorous studies need to be conducted as there is currently only a limited pool of research evidence to substantiate it as a screening tool for loss of protective sensation in the diabetic foot.
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NewsBot · Oct 5, 2021

Application of the Ipswich Touch Test for diabetic peripheral neuropathy screening: a systematic review and meta-analysis
Nan Zhao et al
BMJ Open. 2021 Oct 4

Objective: Diabetic peripheral neuropathy (DPN) is one of the most important risk factors of diabetic foot ulcers, and early screening and treatment of DPN are crucial. The Ipswich Touch Test (IPTT) is a new method for screening for DPN and, compared with traditional methods, is more simple to operate and requires no equipment. However, the screening accuracy of IPTT in patients with DPN has not been well characterised. We aim to conduct a systematic review and meta-analysis to characterise the sensitivity and specificity of IPTT compared with traditional methods and to understand the potential screening value of IPTT.

Design: Systematic review and meta-analysis.

Data sources: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature Database up to 16 April 2020.

Methods: Stata V.15.1 software was used for analysis, and the screening value of IPTT in DPN was described using 10 g monofilament (10g-MF), neuropathy disability scores (NDS), Pin prick, 128 Hz tuning fork, and ankle reflex as reference standards. Sensitivity, specificity and other measures of accuracy of IPTT for screening DPN were pooled based on a quality effects model. The protocol was registered with PROSPERO (42020168420).

Results: Of the 441 records retrieved, 7 studies were evaluated for the screening value of IPTT. Five studies with 10g-MF as the reference standard were included in the meta-analysis, and the pooled sensitivity and specificity were 0.77 (95％CI 0.69-0.84) and 0.96(95％CI 0.93-0.98), respectively, and the area under curve was 0.897. Compared with vibration perception threshold, IPTT showed a sensitivity between 0.76 and 1, and a specificity between 0.90 and 0.97. Compared with NDS, IPTT showed a sensitivity between 0.53 and 1, and a specificity between 0.90 and 0.97. Compared with Pin prick, IPTT showed a sensitivity and specificity of 0.8 and 0.88, respectively. Compared with 128 Hz tuning fork, IPTT showed a sensitivity and specificity of 0.4 and 0.27, respectively. Compared with ankle reflex, IPTT had a sensitivity of 0.2 and a specificity of 0.97.

Conclusions: IPTT shows a high degree of agreement with other commonly used screening tools for DPN screening. It can be used clinically, especially in remote areas and in primary medical institutions, and by self-monitoring patients. More high-quality studies are needed to assess and promote more effective screening practices.
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NewsBot · May 19, 2022

Application Of The Ipswich Touch Test (IPTT) Method To Detect Diabetic Neuropathy (Penerapan Metode Ipswich Touch Test Untuk Mendeteksi Neuropati Diabetik)
Gita Cahyani, Ta'adi Samsuri, Anna Jumatul
Source

Neuropathy is the classic and most common complication of DM. One of the early detection of diabetic sensory neuropathy is the Ipswich Touch Test. This study aims to analyze, compile and examine the results of published research articles containing the application of the IpTT method in detecting diabetic neuropathy. Desain of this research is a literature review. Article searches were carried out comprehensively through national and international indexed research journals databases such as Pubmed, Elsevier Clinical Key, and Google Scholar. who met the inclusion and exclusion criteria. The research articles obtained were 6 articles, then all the articles obtained were synthesized and combined. The results of the analysis of six journals, there are five research journals with cross-sectional study and systematic review methods, stated that the IpTT examination is significant for detecting diabetic neuropathy, which is evidenced by having a sensitivity ranging from 51-83.3% and a specificity of 90-96, 6% which means it has higher accuracy than the monofilament test. Meanwhile, another journal that uses a cross-sectional study states that the results are not significant/there is no difference between the IpTT examination and the monofilament test, this is because the researchers did not characterize DM respondents in their research. In general, five of the six journals recommend that the IpTT examination can be a reliable method, does not require special costs or tools, and is easy to apply in primary health care and in inpatient care for early detection of diabetic neuropathy.
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NewsBot · May 9, 2023

Comparing the Ipswich Touch Test (IpTT) and 10gm-SMWF (10-gm Semmes–Weinstein mono-filament) in Indian population subset with type 2 diabetes mellitus to detect diabetes neuropathy
Sivasubramaniyam Senthilkumar, Ramesh Dasarathan, Pushkar Pazhani, Archana Gaur & Varatharajan Sakthivadivel
Irish Journal of Medical Science (1971 -) (2023)

Background
Diabetic neuropathy diagnosis involves invasive procedures like nerve biopsy and nerve conduction studies which are seldom available at rural health centers. The Ipswich Touch Test (IpTT) is one test that can be performed by the caregiver and it’s simple to perform.

Aim
This study was aimed to compare the validity of the IpTT and 10gm-SMWF (10-gm Semmes–Weinstein mono-filament) test with the vibration perception threshold (VPT) using biothesiometer.

Methods
Two hundred patients with type 2 diabetes, between the age of 30 and 50 years, were included in the study. The neuropathy assessment was performed by biothesiometer, 10gm-SMWF test, and IpTT. Taking VPT(> 25 V) as the gold standard; the sensitivity and specificity of IpTT and 10gm-SMWF are calculated and compared to each other.

Results
On comparing with the VPT, the 10gm-SMWF test had a sensitivity of 94.7% and specificity of 85.7%, and the IpTT had a sensitivity of 91.9% and specificity of 85.7%. 10gm-SMWF test (Kappa value 0.733) had better agreement with VPT than IpTT (Kappa value 0.675). On Spearman’s correlation, the 10gm-SMWF test and the IpTT had r values of 0.738 and 0.686 respectively (P = 0.000).

Conclusion
10gm-SMWFis a better test to diagnose neuropathy than the IpTT; but in the absence of 10gm-SMWFs, the IpTT is an ideal alternative. IpTT can be performed in a bedside or chairside setting in the absence of a professional health care provider who can screen patients for neuropathy and alert the physician of an impending complication where amputation can be avoided.
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