1. Anxiety affects Disability and Quality of Life in patients with Painful Diabetic Neuropathy.*
Charlotte C.M. Geelen1,2, Marielle E Goossens2, Sophie Schmitz2, Joop P van den Bergh3,4, Rob J Smeets2,5, Jeanine A Verbunt1,2
1 Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
2 Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
3 Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
4 Department of Internal Medicine, Research School NUTRIM, Maastricht University, Maastricht, The Netherlands
5 Libra Rehabilitation and Audiology, Eindhoven, The Netherlands
Introduction
Painful Diabetic Neuropathy (PDN) is a complex and multi-dimensional condition, potentially having a major negative impact on daily life, both physically and mentally. Patients with PDN often suffer from enhanced levels of anxiety, fears and depression [1,2].
A qualitative study by our group identified several fears related to diabetes and pain, such as fear of hypoglycaemia, fear of (increased) pain, fear of total exhaustion, fear of physical injury, fear of falling, fear of loss of identity and fear of negative evaluation [3].
To further quantify these fears, we identified available questionnaires that match these self-reported fears, each measuring one specific element of diabetes-related fear or pain-related fear.
The aim of the current study was to investigate which of these fears are associated with disability and QoL. Furthermore, we aimed to identify which of these fears are most strongly associated with disability and a decreased QoL.
Results
In patients with PDN:
In univariate analysis, corrected for age, gender, insulin treatment, duration of complaints and pain intensity:
All fears were independently associated with QoL and disability.
In multivariate analyses, corrected for age, gender, insulin treatment, duration of complaints and pain intensity:
Fear of falling, fear of hypoglycemia and fear of fatigue were associated with QoL.
Fear of falling was associated with disability.
Pain intensity was associated with QoL and disability.
Male gender was associated with disability.
Results
Patients
154 patients (96 male, 58 female)
Age: 65.7 ± 6.6 years.
Insulin treatment: 100 (65%).
Duration of complaints: 72.3 ± 57.6 months
Pain Intensity (VAS): 4.8 ± 2.0.
Stepwise backward regression analyses of fears and Quality of Life
TSF; Tampa Scale for Fatigue, HFS; Hypoglycaemia Fear Survey, FES-I; Falls Efficacy Scale International.
* = statistically significant, defined as p< 0.05
2. Stepwise backward regression analyses of fears and Disability
FES-I; Falls Efficacy Scale International.
Conclusion & Take Home Message
In patients with PDN, anxiety is associated with decreased QoL and increased disability. More specific, fear of falling, fear of hypoglycaemia and fear of fatigue seem to play a role in these associations.
Unraveling specific fears enables us to identify targets for behavioral interventions that aim to improve psychosocial well-being and improve levels of physical activity in patients with PDN.
Methods
Inclusion
Patients with DM type 2, aged > 18 years who suffer from peripheral polyneuropathy (Diabetic Neuropathy Symptom Score, DNS ≥ 1) and neuropathic pain in the feet (Douleur Neuropathique 4, DN4 ≥ 4) for at least three months.
Measures
Disability: Pain Disability Index (PDI)
Quality of Life: Norfolk Quality of Life – Diabetic Neuropathy
(QOL-DN)
Fear of Hypoglycaemia: Hypoglycaemia Fear Survey (HFS)
Kinesiophobia: Tampa Scale of Kinesiophobia (TSK)
Fear of Pain: Pain Anxiety Symptom Scale (PASS-20)
Fear of Falling: Falls Efficacy Scale-I (FES-I)
Fear of Fatigue: Tampa Scale of Fatigue (TSF)
Fear of Negative Evaluation: Brief Fear of Negative Evaluation
Scale (BFNE).
Statistical analyses
Univariate analyses to assess the association of each fear questionnaire
individually with QoL and disability respectively.
Stepwise backward regression to assess which fear is most strongly
associated with QoL and disability respectively.
All analyses were corrected for age, gender, insulin treatment, duration of
complaints and pain intensity.
Standardized Beta
P-value R2
Age
-0.059
0.328
0.602
Gender
0.006
0.914
Insulin Treatment
0.001
0.987
Duration of complaints
0.113
0.074
Pain Intensity
0.253
0.000*
Fear of Fatigue (TSF)
0.134
0.045*
Fear of Hypoglycaemia (HFS)
0.216
0.003*
Fear of Falling (FES-I)
0.385
Acknowledgement
This work was partially funded by Diabetes Fonds Nederland (Dutch Diabetic Foundation). Grant number
Standardized Beta
P-value R2
Age
0.012
0.845
0.523
Gender
-0.135
0.025*
Insulin Treatment
0.056
0.351
Duration of complaints
0.058
0.364
Pain Intensity
0.283
0.000*
Fear of Falling (FES-I)
0.540
References
* Geelen et al, in preparation
[1] Geelen et al, J Peripher Nerv Syst. June 2016. 
[2] Vileikyte L. et al., (2005) Diabetes Care, 28 (10) :
[3] Kanera I. et a., (2016) Submitted.
Adelante Centre of Expertise in
Rehabilitation and Audiology
P.O. Box 88
6430 AB Hoensbroek
The Netherlands
Maastricht University Department of Rehabilitation Medicine P.O. Box MD Maastricht
The Netherlands
Correspondence to:
C.C.M. Geelen, MD