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Meta-Analysis
. 2021 Oct 4;11(10):e046966.
doi: 10.1136/bmjopen-2020-046966.

Application of the Ipswich Touch Test for diabetic peripheral neuropathy screening: a systematic review and meta-analysis

Nan Zhao  1   2 , Jingcan Xu  3   2   4 , Qiuhong Zhou  1   4 , Xinyi Li  5 , Jiarui Chen  2   5 , Jing Zhou  1 , Feng Zhou  1   6 , Jinghong Liang  7
Affiliations
Meta-Analysis

Application of the Ipswich Touch Test for diabetic peripheral neuropathy screening: a systematic review and meta-analysis

Nan Zhao et al. BMJ Open. .

Abstract

Objective: Diabetic peripheral neuropathy (DPN) is one of the most important risk factors of diabetic foot ulcers, and early screening and treatment of DPN are crucial. The Ipswich Touch Test (IPTT) is a new method for screening for DPN and, compared with traditional methods, is more simple to operate and requires no equipment. However, the screening accuracy of IPTT in patients with DPN has not been well characterised. We aim to conduct a systematic review and meta-analysis to characterise the sensitivity and specificity of IPTT compared with traditional methods and to understand the potential screening value of IPTT.

Design: Systematic review and meta-analysis.

Data sources: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature Database up to 16 April 2020.

Methods: Stata V.15.1 software was used for analysis, and the screening value of IPTT in DPN was described using 10 g monofilament (10g-MF), neuropathy disability scores (NDS), Pin prick, 128 Hz tuning fork, and ankle reflex as reference standards. Sensitivity, specificity and other measures of accuracy of IPTT for screening DPN were pooled based on a quality effects model. The protocol was registered with PROSPERO (42020168420).

Results: Of the 441 records retrieved, 7 studies were evaluated for the screening value of IPTT. Five studies with 10g-MF as the reference standard were included in the meta-analysis, and the pooled sensitivity and specificity were 0.77 (95％CI 0.69-0.84) and 0.96(95％CI 0.93-0.98), respectively, and the area under curve was 0.897. Compared with vibration perception threshold, IPTT showed a sensitivity between 0.76 and 1, and a specificity between 0.90 and 0.97. Compared with NDS, IPTT showed a sensitivity between 0.53 and 1, and a specificity between 0.90 and 0.97. Compared with Pin prick, IPTT showed a sensitivity and specificity of 0.8 and 0.88, respectively. Compared with 128 Hz tuning fork, IPTT showed a sensitivity and specificity of 0.4 and 0.27, respectively. Compared with ankle reflex, IPTT had a sensitivity of 0.2 and a specificity of 0.97.

Conclusions: IPTT shows a high degree of agreement with other commonly used screening tools for DPN screening. It can be used clinically, especially in remote areas and in primary medical institutions, and by self-monitoring patients. More high-quality studies are needed to assess and promote more effective screening practices.

Prospero registration number: Registration Number is CRD (42020168420).

Keywords: diabetic foot; diabetic neuropathy; public health.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.
Figure 2
Figure 2
Quality assessment of the included studies.
Figure 3
Figure 3
Sensitivity and specificity of Ipswich Touch Test (IPTT) in the diagnosis of diabetic peripheral neuropathy (DPN).
Figure 4
Figure 4
Doi plot and Luis Furuya-Kanamori (LFK) index.
See this image and copyright information in PMC

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