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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
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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.
Re: Emotional response to neuropathy affecting foot self care
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]
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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.
Emotional response to neuropathy affecting foot self care
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