Validation and Cross-cultural Adaptation and Reliability ofthe Turkish Version of the Michigan Neuropathy ScreeningInstrument in the Eastern Anatolia Region of Turkey

Aim: Distal symmetric polyneuropathy is a common complication causing foot ulcers and amputations in diabetic patients. TheMichigan Neuropathy Screening Instrument (MNSI) is one of the screening methods of diabetic neuropathy, which also providesa comprehensive foot evaluation. The aim of this study was to evaluate the validation, cross-cultural adaptation, and reliability ofTurkish Version of the MNSI in the Eastern Anatolia region of Turkey.Materials and Methods: One hundred twenty-six patients with diabetes mellitus were randomly assigned to the study. Thequestionnaire section of the MNSI was completed by the patients, and the physical examination section was evaluated by healthprofessionals. Nerve conduction studies were performed to 123 patients as the gold standard for diabetic neuropathy. All nerveconduction studies and patients were evaluated by a neurologist.Results: The inter-rater agreement of questionnaire section [ICC: 0.957 (95% CI: 0.940-0.969), p<0.001] and physical examinationsection [ICC: 0.917 (95% CI: 0.884-0.941), p<0.001] were excellent. The intra-rater agreement of the questionnaire section [ICC: 0.880(95% CI: 0.833-0.914), p<0.001] and physical examination section [ICC: 0.920 (95% Cl: 0.889-0.943), p<0.001] showed a high stability.The area under curve (AUC) for the questionnaire section and physical examination section of the MNSI were 0.588 (p=0.205) and0.880 (p<0.001), respectively. The optimum cut-off value of the physical examination section determined using both Youden’s indexand Index of Union as >3, with the sensitivity of 76.2%, specificity of 91.2%, positive predictive value of 64%, negative predictive valueof 94.9%. Conclusion: The physical examination section of Turkish version of the MNSI is valid and reliable.