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Thursday, May 24, 2012

Inlow's 60-Second Diabetic Foot Screen Tool

Inlow's 60-Second Diabetic Foot Screen Tool is used by clinicians to help assess susceptibly to ulceration in diabetics. The non-invasive 60 second screening tool was developed in Canada and consists of a mono-filament device and accompanying checklist. The frequency of assessment is determined by the initial and subsequent assessment scores. The higher the score, the more frequent the assessment. The quick but thorough assessment covers all important areas. The first part of the assessment involves the condition of the skin and nails; footwear; and foot deformity such as Charcot’s Deformity, bunions and or history of previous amputations. Next, the temperature of the foot is recorded. By touching the feet, a comparison is made of the temperature of both feet. The range of motion of the great toe is assessed. Next comes testing with the mono-filament tool. 10 sites on the foot are touched with the mono-filament and the client’s ability to feel the touch is rated. The client is also asked whether they feel numbness, tingling, or burning in the feet. The pedal pulses are felt. The presence of dependent rubor (redness when the feet are down; pallor when they are elevated) and erythema (reddened areas of the skin) complete the assessment. A reliability study published recently in Adv Skin Wound Care. 2012 Jun;25(6):261-266, found Inlow's 60-Second Diabetic Foot Screen Tool had excellent interrater and intrarater reliability and provided preliminary information about predictive validity. The convenience sample of 69 persons with diabetes was recruited: n = 26 from an acute care setting (dialysis) and n = 43 from long-term-care (LTC) setting. The screening tool was administered by 2 assessors independently to determine interrater reliability and later the same day by one of the assessors to determine intrarater reliability. Occurrence of foot ulcers or amputation was noted 1 to 5 months later to determine predictive validity. Reliability is reported per setting using the intraclass correlation coefficient (2.1) and 95% confidence intervals. Intrarater reliability: LTC 0.96 (0.93-0.98) right foot, 0.97 (0.95-0.98) left foot; dialysis 1.00 right and 1.00 left foot. Interrater reliability: LTC 0.92 (0.86-0.96) right foot, 0.93 (0.87-0.96) left foot; dialysis 0.83 (0.65-0.92) right foot and left foot. Predictive validity: Two subjects had events-1 ulcer and 1 amputation-that were associated with high Inlow's screening tool scores.

Reference
Murphy CA, Laforet K, Da Rosa P, Tabamo F, Woodbury MG. 2012 Reliability and Predictive Validity of Inlow's 60-Second Diabetic Foot Screen Tool. Adv Skin Wound Care. 2012 Jun;25(6):261-266.

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