Introduction: Loss of sensation due to diabetes-related neuropathy often leads to diabetic foot ulceration. Several test instruments are used to assess sensation, such as static and moving 2-point discrimination (S2PD, M2PD), monofilaments, and tuning forks. Methods: Mokken scale analysis was applied to the Rotterdam Diabetic Foot Study data to select hierarchies of tests to construct measurement scales. Results: We developed 39-item and 31-item scales to measure loss of sensation for research purposes and a 13-item scale for clinical practice. All instruments were strongly scalable and reliable. The 39 items can be classified into 5 hierarchically ordered core clusters: S2PD, M2PD, vibration sense, monofilaments, and prior ulcer or amputation. Discussion: Guided by the presented scales, clinicians may better classify the grade of sensory loss in diabetic patients’ feet. Thus, a more personalized approach concerning individual recommendations, intervention strategies, and patient information may be applied.

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Keywords diabetic sensorimotor polyneuropathy, early detection, grading loss of sensation, medical decisionmaking, neuropathy, psychometrics, risk stratification, scale development
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Journal Muscle & Nerve
Rinkel, W.D, Aziz, M.H. (M. Hosein), van Neck, J.W, Castro Cabezas, M, van der Ark, L.A, & Coert, J.H. (2019). Development of grading scales of pedal sensory loss using Mokken scale analysis on the Rotterdam Diabetic Foot Study Test Battery data. Muscle & Nerve. doi:10.1002/mus.26628