A New Simple SCreening Tool for Painful Diabetic Neuropathy (ACT) in Ecuador

Area of Science:

• Neurology
• Diabetology
• Pain Management

Background:

• Diabetic painful neuropathy significantly impacts quality of life and is often undiagnosed.
• Existing neuropathic pain (NP) questionnaires can be impractical in busy clinical environments.
• A concise, patient-led screening tool, the Assessment of Chronic Pain (ACT), was developed to address these limitations.

Purpose of the Study:

• To evaluate the screening validity and psychometric properties of the ACT tool.
• To compare the diagnostic utility of ACT against the DN4 questionnaire as the reference standard.
• To assess ACT's performance in identifying painful diabetic peripheral neuropathy (DPN).

Main Methods:

• An observational study was conducted with 300 diabetic patients at a tertiary outpatient clinic in Ecuador.
• Participants completed the ACT, DN4, and Michigan Neuropathy Screening Instrument (MNSI) questionnaires.
• Screening validity metrics including sensitivity, specificity, and ROC curve analysis were calculated for ACT using DN4 as the criterion.

Main Results:

• The optimal cut-off score for the total ACT (questionnaire + examination) was ≥6 items, yielding an Area Under the ROC Curve of 0.836.
• ACT demonstrated a sensitivity of 80.0% and specificity of 75.7% for detecting painful DPN.
• The ACT tool had moderate internal consistency (Cronbach's alpha = 0.65) and was well-received by patients and clinicians, with a completion time comparable to DN4.

Conclusions:

• The ACT tool is a rapid and effective screening method for identifying neuropathic pain in clinical settings.
• ACT exhibits acceptable sensitivity and specificity when compared to the DN4 questionnaire.
• The brevity and patient self-administration of ACT make it a promising tool for integration into busy outpatient workflows to enhance DPN diagnosis.