Is the Modified Neuropathy Disability Score (NDS) Screening Tool A Useful Predictor of Foot Ulcer Risk in Adults with Diabetes?

Background: The modified Neuropathy Disability Score (NDS) is a simple and inexpensive tool used for the detection of diabetic peripheral neuropathy in podiatric practice. However, it is unclear if the intraepidermal nerve fiber density test (IENFD) is needed for confirmatory results.

Purpose:  The aim of the study was to validate the modified neuropathy disability score (NDS) screening tool for early detection of foot neuropathy in adult patients with type 2 diabetes. The intraepidermal nerve fiber density (IENFD) test was used as the gold standard.

Methods: Participants were 15 adult patients with type 2 diabetes recruited from a local podiatric clinic. Data collected from each participant included (1) a demographic questionnaire, (2) a modified neuropathy disability score (NDS) and (3) intraepidermal nerve fiber density test used as a confirmatory for diagnosing peripheral neuropathy in patients with diabetes. The study was approved by an institutional review board (IRB #); each participant provided a written informed consent prior to enrollment in the study.

Results: The mean age of participants was 61.6 ± 11.39 years. Majority of the participants were females (60%) and Caucasian (70%). The average duration of illness was 9.1 ± 5.43 years. Participants’ overall NDS mean score was 7 (range: 6-8). Frequently reported neurological deficits were abnormal vibration perception (100%), abnormal temperature perception (70%) and absent Achilles reflex (70%) as measured by the NDS. The mean values of vibration perception threshold and epidermal nerve fiber density were 13.4 ± 2.98 (seconds) and 5.52 ± 5.83 (fibers/mm) respectively.

Conclusions and Implications: Foot care nurses and health care providers can use the modified NDS screening tool to identify patients at risk for insensate foot ulceration, and provide preventive education and podiatric care.