Reproducibility of ACT, A simple-self-administered sCreening Tool for diabetic peripheral neuropathy.

INTRODUCTION

Diabetic Peripheral Neuropathy (DPN) is associated with pain and increased risk of foot ulceration and lower-limb amputation. Most people remain undiagnosed due to the lack of a simple, rapid, and reliable screening tool suitable for primary care. We evaluated the reproducibility of a short, self-administered screening tool (ACT) for DPN compared with the Michigan Neuropathy Screening Instrument Questionnaire (MNSIq) and examination (MNSIe).

METHODS

In this observational study, 126 adults with type 1 or type 2 diabetes were recruited from an outpatient endocrinology clinic. Participants completed the ACTquestionnaire (q) + examination (e) which can be summed to create a totalq + e score of 0-20, and MNSIq + e at baseline and after 14 days. Reproducibility was assessed using intraclass correlation coefficients (ICC) for continuous scores and Cohen's kappa (κ) for categorical reproducibility.

RESULTS

ACTq + e demonstrated good reproducibility with an ICC = 0.85 (ICC = 0.78 for ACTq; ICC = 0.88 for ACTe) which was comparable to ICC = 0.82 for MNSIq; ICC = 0.75 for MNSIe; ICC = 0.85 for MNSIq + e. Dichotomized classification of the overall ACT showed strong repeatability with κ = 0.83 (κ = 0.61 ACTq and moderate-to-strong repeatability for ACTe with κ = 0.78). Symptoms showed variable agreement, with the strongest reproducibility for burning and pins-and-needles sensations. The sensory examination components of ACTe demonstrated strong agreement (κ = 0.81).

DISCUSSION: The overall ACT tool demonstrated good 14-day reproducibility compared to the overall MNSIq + e. The brevity, self-administered format, and minimal reliance on clinician expertise, support the utility of ACT as a practical screening instrument for DPN in busy, resource-limited clinical settings.