Abstract
Background: Metabolic syndrome polyneuropathy (MSP), sensory peripheral neuropathy associated with diabetes or prediabetic metabolic syndrome affects more than 10% of Americans over 40 years old. Screening exam measures commonly used in primary care (PC), such as 10 gram monofilament testing measure loss of protective sensation and predict development of foot ulcers and infection, but are not sensitive enough to detect early sensory loss. The Utah Early Neuropathy Scale (UENS) is a 2-minute exam scale focused on sensory loss to pin sensation in the foot that has been validated for early neuropathy screening. Objectives: To examine reliability of the UENS when performed by medical assistants in a PC setting. Methods: PC medical assistants were trained to perform the UENS, then screened consenting primary care patients selected by best practice alert (BPA) for age >40 and BMI > 30 with 3 neuropathy-focused questions and the UENS. A blinded neurologist (JRS), performed UENS and a brief exam at the same visit to examine reliability. Results: 135 patients meeting BPA criteria were screened with UENS. Of these, 18% had a UENS score >4, suggesting neuropathy. Intraclass correlation coefficient for 20 comparison UENS exams was 86%. Sub-scores for pin sensation, strength and joint position sense were highly coherent, while vibration sense proved less reliable. Pin (37.9%), vibration (34.8%) and deep tendon reflex (23.4%) sub scores contributed the most to total UENS score overall, with pin sub score most likely to contribute to UENS scores 4-8 (44%). Discussion: UENS can be performed reliably by medical assistants in a primary care setting, and is a sensitive screening modality for MSP. Pin and vibration contribute the bulk of UENS score points in patients with mild neuropathy, suggesting that a simplified UENS could be used in PC screening. Disclosure S.C. Foster-Palmer: None. J. Singleton: None. C. Revere: None. R.L. Marcus: None. M. Shakeri: None. A. Castillo: None. S. Shafi: None. Funding University of Utah Health
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