Development of grading scales of pedal sensory loss using Mokken scale analysis on the Rotterdam Diabetic Foot Study Test Battery data

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.