Translation, Validation, and Diagnostic Performance of the Michigan Neuropathy Screening Instrument (MNSI) in Bangla

Abstract

Backgrounds and Aims: Diabetic peripheral neuropathy (DPN) can result in foot ulcers and ultimately limb amputation. The Michigan Neuropathy Screening Instrument (MNSI) is a recommended screening tool for DPN. However, it must be appropriately translated and validated before use in new linguistic and cultural contexts. The study aimed to translate the MNSI into Bangla and assess its validity and applicability among Bangladeshi Diabetic patients. Methods: A cross-sectional study was conducted to develop Bangla version of the MNSI questionnaire (MNSIq-Bl) following ISPOR Task Force recommendations. The translation process included reconciliation, expert committee review, and pilot testing among 20 purposively selected patients with diagnosed diabetes mellitus. Validation was performed among purposively selected 50 diabetic patients attending outpatient Department of Endocrinology, Dhaka Medical College, adhering to the inclusion and exclusion criteria between July 2018 and June 2019. Cut-off values for the MNSIq-Bl and MNSIe (questionnaire and physical examination) scores were recommended compared with the result of the Nerve Conduction Study (NCS). Ethical clearance (MIU-DMC/ECC/2019/42, dated February 6, 2019) from the due authority and informed written consent were obtained from the respondents before data collection. Results: Strong inter-interviewer reliability was observed for both MNSIq-Bl (r = 0.977) and MNSIe (r = 0.923), with significance at p < 0.001. Cronbach's α for MNSIq-Bl (excluding Items 4 and 10) ranged from 0.7 to 0.8, indicating acceptable internal consistency. The area under the curve (AUC) for MNSIq-Bl was 0.850 at a cut-off score of ≥ 2.5 with 68% sensitivity and 75% specificity. For MNSIe, the AUC was 0.918 at a cut-off score of ≥ 0.5, with 90% sensitivity and 75% specificity. Conclusion: The Bangla version of MNSI (MNSI-Bl) is a valid and reliable tool for screening diabetic peripheral neuropathy among Bangla-speaking patients, demonstrating good diagnostic performance.