Análise comparativa do teste de sensibilidade do monofilamento e do Ipswich Test em pés de paciente com diabetes
Tipo
TCC
Data de publicação
2025-06-05
Periódico
Citações (Scopus)
Autores
Friederich, Beatriz
Shiobara, Julia Akemi
Shiobara, Julia Akemi
Orientador
Zella, Maria Augusta Karas
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Introdução: O Diabetes Mellitus tem alta prevalência no Brasil e pode levar a complicações como a neuropatia diabética. O rastreamento dessa complicação é essencial, mas limitado pela disponibilidade de instrumentos como o monofilamento de 10g. O Ipswich Test é uma alternativa para identificação precoce do risco de ulceração nos pés diabéticos. Objetivos: Comparar o Teste do Monofilamento de 10g e o Ipswich Test quanto à sensibilidade, especificidade e eficácia no rastreio da neuropatia periférica em pacientes com diabetes. Buscar identificar pacientes em risco, conscientizá-los e propor intervenções educativas para prevenção de complicações. Metodologia: Estudo descritivo e intervencionista, com abordagem qualitativa e quantitativa, realizado entre outubro de 2024 e fevereiro de 2025 no Hospital Evangélico Mackenzie do Paraná. Participaram pacientes internados com diagnóstico de diabetes, avaliados por meio de questionário, escore de sintomas neuropáticos e exame físico. A sensibilidade protetora foi testada com o monofilamento de 10g, diapasão, palito e Ipswich Test, aplicados em pontos padronizados dos pés. Resultados: A amostra foi composta por 92 pacientes, com idade média de 65 anos e predominância de diabetes tipo 2. Em relação ao exame do pé, somente 30,4% haviam sido previamente submetidos ao exame dos pés por profissionais de saúde, e 47,8% relataram sintomas compatíveis com neuropatia periférica, como fadiga, câimbras e prurido. O Teste do Monofilamento apresentou sensibilidade de 61,36% e menor especificidade, enquanto o Ipswich Test demonstrou especificidade superior (79,15%) e sensibilidade de 43,18%. O Ipswich Test também esteve associado à presença de sintomas neuropáticos (p=0,02), com quase três vezes mais chance de detecção em pacientes sintomáticos. Conclusão: Há falhas importantes no rastreio da neuropatia periférica diabética. Apesar de o Ipswich Test ter demonstrado menor sensibilidade, sua maior especificidade e facilidade de aplicação o tornam uma ferramenta viável em contextos com poucos recursos. A comparação com o Teste do Monofilamento reforça a utilidade de ambos os métodos, que se complementam na prática clínica. Os resultados ressaltam a necessidade de capacitação dos profissionais de saúde e de rastreios regulares, especialmente na atenção primária, visando detecção precoce, estratificação de risco e redução das complicações do diabetes.
Introduction: Diabetes Mellitus has a high prevalence in Brazil and can lead to complications such as diabetic neuropathy. Screening for this complication is essential but limited by the availability of tools such as the 10g monofilament. The Ipswich Test offers an alternative for the early identification of the risk of foot ulceration in diabetic patients. Objectives: To compare the 10g Monofilament Test and the Ipswich Test in terms of sensitivity, specificity, and effectiveness in screening for peripheral neuropathy in diabetic patients. To identify patients at risk, raise awareness, and propose educational interventions for the prevention of complications. Methodology: This is a descriptive and interventional study with both qualitative and quantitative approaches, conducted between October 2024 and February 2025 at the Mackenzie Evangelical Hospital of Paraná. Hospitalized patients diagnosed with diabetes participated and were assessed through a questionnaire, neuropathic symptom score, and physical examination. Protective sensation was tested using the 10g monofilament, tuning fork, stick, and Ipswich Test, applied to standardized points on the feet. Results: The sample consisted of 92 patients, with a mean age of 65 years and a predominance of type 2 diabetes. A total of 30.4% had previously undergone foot examinations by healthcare professionals, and 47.8% reported symptoms consistent with peripheral neuropathy, such as fatigue, cramps, and itching. The Monofilament Test showed a sensitivity of 61,36% and lower specificity, while the Ipswich Test demonstrated higher specificity (79.15%) and sensitivity of 43.18%. The Ipswich Test was also associated with the presence of neuropathic symptoms (p=0.02), with nearly three times the likelihood of detection in symptomatic patients. Conclusion: There are significant gaps in the screening of diabetic peripheral neuropathy. Although the Ipswich Test demonstrated lower sensitivity, its higher specificity and ease of application make it a viable tool in resource-limited settings. The comparison with the Monofilament Test reinforces the usefulness of both methods, which complement each other in clinical practice. The results highlight the need for healthcare professional training and regular screening, especially in primary care, aiming for early detection, risk stratification, and reduction of diabetes-related complications.
Introduction: Diabetes Mellitus has a high prevalence in Brazil and can lead to complications such as diabetic neuropathy. Screening for this complication is essential but limited by the availability of tools such as the 10g monofilament. The Ipswich Test offers an alternative for the early identification of the risk of foot ulceration in diabetic patients. Objectives: To compare the 10g Monofilament Test and the Ipswich Test in terms of sensitivity, specificity, and effectiveness in screening for peripheral neuropathy in diabetic patients. To identify patients at risk, raise awareness, and propose educational interventions for the prevention of complications. Methodology: This is a descriptive and interventional study with both qualitative and quantitative approaches, conducted between October 2024 and February 2025 at the Mackenzie Evangelical Hospital of Paraná. Hospitalized patients diagnosed with diabetes participated and were assessed through a questionnaire, neuropathic symptom score, and physical examination. Protective sensation was tested using the 10g monofilament, tuning fork, stick, and Ipswich Test, applied to standardized points on the feet. Results: The sample consisted of 92 patients, with a mean age of 65 years and a predominance of type 2 diabetes. A total of 30.4% had previously undergone foot examinations by healthcare professionals, and 47.8% reported symptoms consistent with peripheral neuropathy, such as fatigue, cramps, and itching. The Monofilament Test showed a sensitivity of 61,36% and lower specificity, while the Ipswich Test demonstrated higher specificity (79.15%) and sensitivity of 43.18%. The Ipswich Test was also associated with the presence of neuropathic symptoms (p=0.02), with nearly three times the likelihood of detection in symptomatic patients. Conclusion: There are significant gaps in the screening of diabetic peripheral neuropathy. Although the Ipswich Test demonstrated lower sensitivity, its higher specificity and ease of application make it a viable tool in resource-limited settings. The comparison with the Monofilament Test reinforces the usefulness of both methods, which complement each other in clinical practice. The results highlight the need for healthcare professional training and regular screening, especially in primary care, aiming for early detection, risk stratification, and reduction of diabetes-related complications.
Descrição
Palavras-chave
diabetes Mellitus. , neuropatia diabética , pé diabético , diabetes Mellitus , diabetic neuropathies , diabetic foot