The Ipswich Touch Test – screening for neuropathy at home

Summary

The Ipswich Touch Test (IpTT) is a novel test for neuropathy that is simple, safe and easily taught. The test involves lightly and briefly (1-2 seconds) touching the tips of the first, third and fifth toes of both feet with the index finger to detect a loss in sensation, and can be performed by patients and relatives alike in the comfort of their own home. 

When used at home, the IpTT had a sensitivity of 78.3 per cent and specificity of 93.9 per cent. The likelihood that a positive test meant a person had neuropathy was 81.2 per cent, while the likelihood that a negative test meant someone didn’t have neuropathy was 92.8 per cent. 

With clearly written instructions, this is a simple test can be used by non-professionals to assess for loss of protective sensation accurately. In addition, the test also serves as educational tool to teach patients and relatives about diabetes foot disease, with 96.8 per cent of respondents claiming their awareness levels increased.

Challenge

Diabetes can lead to disease of the foot in up to 40 per cent of patients. These complications include damage to the nerves (diabetes neuropathy) and damage to the large blood vessels that serve the limbs (peripheral arterial disease) and can affect anyone with diabetes. 

Current data suggests that amputation rates are set to rise, from over 5,000 in 2009/10 to more than 7,000 in 2014/15 in England. Amputation is not only devastating; it is expensive. In England it is estimated that nearly £700m is spent each year on foot ulcers and amputations and account for every £1 in £150 spent by the NHS in healthcare. However, 80 per cent of amputations are preventable by a variety of healthcare initiatives which include annual foot checks to screen for nerve damage, educating patients about foot care and improving standards of diabetes care delivery. 

Given these statistics, the Ipswich Hospital NHS Trust set wanted to devise a project to involve the person with diabetes and their relatives in foot care by having them undertake the examination at home using the novel Ipswich Touch Test (IpTT). This test simply involves touching the toes with the index finger and has been shown in the clinic setting to be effective in detecting loss of sensation with a high degree of sensitivity and specificity comparable to existing screening techniques. 

The project was designed to determine whether the test when done at home is sufficiently sensitive and specific in detecting neuropathy, whether patients and relatives find it an acceptable thing for them to be doing and whether it improves their awareness of diabetes foot disease. This project was carried out between September and December 2011 at The Ipswich Hospital NHS Trust.

Objectives

The project “The Ipswich Touch Test – screening for neuropathy at home” involves relatives and friends examining the feet of their diabetes patients using the Ipswich Touch test based on written instructions. We hope to determine: 

  • Whether the IpTT is an effective means to screen for diabetes neuropathy at home
  • Whether it can serve as an educational tool to improve awareness of diabetes foot disease and empower patients and their relatives to be more involved in their foot care 
  • Whether people with diabetes, their friends and/or relatives find their involvement in foot examination acceptable.

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QiC Diabetes Winner 2012
Best early detection and prevention initiative
The Ipswich Touch Test – screening for neuropathy at home
by The Ipswich Hospital NHS Trust

Contacts

Dr Sanjeev Sharma

Job title:
Clinical Research Fellow in Diabetes
Place of work:
The Ipswich Hospital NHS Trust
Email:
sahjeev.sharma2@nhs.net

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