Patient Interpretation of Neuropathy (PIN) Questionnaire

Abstract

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 PatientInterpretation 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 ϭ 325) and U.S. (n ϭ 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 ␣ ϭ 0.62-0.90) and test-retest reliability (Pearson's r ϭ 0.51-0.64). Partial correlations between the PIN and IPQ-R scales in corresponding domains were significant but modest (r p ϭ 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. Diabetes Care 29:2617-2624, 2006F oot ulceration and amputations cause an extensive burden on individuals with diabetes, the health care system, and society (1). Yet diabetic foot ulcer-related morbidity could be substantially reduced, as a significant proportion of foot ulcers could be prevented by patients' active engagement in foot self-care (2). Causal pathways to foot ulceration are well defined, with diabetic peripheral neuropathy (DPN), the key risk factor, predisposing to foot ulceration through mechanisms that are either extrinsic to the foot (e.g., unperceived trauma) or intrinsic to the foot (e.g., DPN contributing to foot deformities and high pressure areas) (3,4). Therefore, it seems plausible that a series of relatively simple foot self-care actions should be effective in minimizing the impact of neuropathic risk factors and thereby reducing the incidence of insensate foot ulcers. Published guidelines on diabetic foot self-care define two types of such behaviors: engagement in preventive foot self-care (e.g., having feet measured when buying a new pair of shoes) and avoidance of behaviors which, although appropriate for people w...

Patients' perspectives on foot complications in type 2 diabetes: a qualitative study

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