Interrater reliability of sensory testing in patients with diabetic neuropathy
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Background: Peripheral neuropathy, occurring in 30-50% of diabetic patients, is the main risk factor for foot ulceration. In order to detect diabetic neuropathy, the continuous and dichotomous 39-item and the dichotomous 13-item Rotterdam Diabetic Foot Study test batteries (RDF-39-C, RDF-39-D, RDF-13-D) were developed. This study examined the interrater reliability of these test batteries in patients with diabetic neuropathy. Methods: Interrater reliability of the 39-item test batteries was determined across one pair of raters, whereas reliability of the RDF-13-D was examined across two pairs of raters. Interrater agreement rates (IRA) and intraclass coefficients (ICC) were calculated to assess reliability. Results: Sixty-five patients with diabetes and symptomatic neuropathy were included. Interrater agreement was found to be acceptable for the RDF-39-C test battery but low for the RDF-39-D (IRA = 84.6% and 73.3%, respectively). Regarding the RDF-13-D, agreement rates ranged from 64.3% for one pair of raters to 81.4% for the other pair of raters. ICCs were all above .80, indicating high correlation. Conclusion: The results demonstrate that the continuous version of the RDF-39 test battery is reliable across different clinicians, but when measured dichotomously it is not. The level of interrater agreement of the 13-item RDF test battery is dependent on the pair of raters. Though raters do not always agree on the absolute total scores of both dichotomous test batteries, the results indicate that their ratings are highly consistent. Standardised training across clinicians may be important to improve reliability.