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Patient Interpretation of Neuropathy (PIN) Questionnaire

An instrument for assessment of cognitive and emotional factors associated with foot self-care

¹ University of Manchester, Manchester, U.K.
² University of Miami, Miami, Florida
³ Rutgers University, New Brunswick, New Jersey
⁴ Loyola College, Baltimore, Maryland
⁵ The Johns Hopkins University, Baltimore, Maryland
⁶ Penn State University, State College, Pennsylvania

Address correspondence and reprint requests to Dr. Loretta Vileikyte, Department of Medicine, University of Manchester, Oxford Road, Manchester M13 WL9, U.K. E-mail: lvileikyte{at}med.miami.edu

OBJECTIVE—Using the common-sense model of illness behavior, we developed and validated a self-report instrument for assessment of patients’ cognitive and emotional representations of diabetic peripheral neuropathy (DPN) influencing foot self-care.

RESEARCH DESIGN AND METHODS—The Patient Interpretation of Neuropathy (PIN) questionnaire, generated from discussions with clinicians and interviews with patients with DPN, was administered to patients with DPN attending U.K. (n = 325) and U.S. (n = 170) diabetes centers. Psychometric tests of the PIN questionnaire comprised factor analysis, internal consistency, and test-retest reliability. Partial correlations and multivariate regressions established construct and criterion-related validity. The associations of PIN scales to past foot ulceration and foot self-care behaviors were compared with those using a generic measure of illness perception and emotion, the Revised Illness Perception Questionnaire (IPQ-R), which was adapted to neuropathy.

RESULTS—Factor analysis of the PIN questionnaire produced 11 scales, which explained 69% of item variance. Nine factors measured patients’ common-sense beliefs about DPN and their levels of understanding of DPN-related medical information. Two factors assessed the emotions of worry about potential consequences and anger at practitioners. Most scales demonstrated adequate internal (Cronbach’s = 0.62–0.90) and test-retest reliability (Pearson’s r = 0.51–0.64). Partial correlations between the PIN and IPQ-R scales in corresponding domains were significant but modest (r_p = 0.15–0.26). Finally, PIN scales showed significant associations with past foot ulceration and foot self-care behaviors, thereby confirming criterion validity.

CONCLUSIONS—The 39-item PIN questionnaire is a reliable and valid measure of patients’ cognitive and emotional representations of neuropathy affecting foot self-care.

Abbreviations: CSM, common-sense model of illness behavior • DPN, diabetic peripheral neuropathy • IPQ-R, Revised Illness Perception Questionnaire • PIN questionnaire, Patient Interpretation of Neuropathy questionnaire

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