28 Aug 2018
As part of its ongoing Neuropad guidance development, the UK National Institute of Health and Care Excellence (NICE) commissioned an Adoption Scoping Report. In the report, NICE asked NHS clinicians who were familiar with the Neuropad test what they thought of it. Amongst the comments received, the principal findings were as follows:
‘Contributors thought that sweat production is a good marker of diabetic peripheral neuropathy. All reported that Neuropad could be used as part of a comprehensive foot assessment and in conjunction with sensory testing.’
Contributors went on to say that: ‘Neuropad may be particularly useful for people with cognitive issues or in those with a language barrier as other methods of sensory testing require a level of understanding and communication from the patient.’ That ‘older people or those with mobility issues may benefit from screening using this test as it can easily be applied at home.’ And ‘one contributor suggested that use of Neuropad should be prioritised in high risk people within a diabetic foot clinic.’
The reported benefits of Neuropad testing were summarized as follow:
- ‘Easy to use and interpret with little training requirements. Provides an objective [rather than a subjective] result.’
- ‘Can be carried out easily where the person resides rather than requiring patients to attend a healthcare setting.’
- The visual nature of this test may have high educational value for people with diabetes and help them to appreciate there is a problem and therefore motivate them to make changes to their lifestyle and foot care regimen.’
- ‘May be used as an early screening test to prompt referral for comprehensive foot assessment. This test may detect a problem before any visual problems are apparent.’
- ‘The visual nature of this test may have high educational value for people with diabetes and help them to appreciate there is a problem and therefore motivate them to make changes to their lifestyle and foot care regimen.’
- ‘Sensory testing can be difficult to carry out and there is a lot of subjectivity involved. This test offers a simple objective adjunct test to the foot assessment process.’
Of particular significance is that ‘One contributor’s NHS Trust has reconfigured their diabetes screening clinics to reduce capacity required. Here people attend an annual eye screening assessment which is followed by a foot assessment/examination (including application of Neuropad) and required blood tests. This reduces the number of appointments attended from 3 to 1. Attendance is reported to be high for these clinics as people are more motivated to look after their eyes. Previous to the reconfiguration, this contributor reported that 20% of people with diabetes had not had their feet looked at/assessed at all.’ And that ‘Feedback from people with diabetes has been that they like this test and that it aids their understanding and acceptance of the fact that they may have diabetic peripheral neuropathy.’