The psychometric properties of the Turkish version of the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT)

doi:10.1016/j.ejon.2017.10.001

European Journal of Oncology Nursing

Volume 31, December 2017, Pages 84-89

https://doi.org/10.1016/j.ejon.2017.10.001 Get rights and content

Highlights

•
Peripheral neuropathy emerges as a common adverse effect of chemotherapeutic drugs.
•
Peripheral neuropaty symptoms should be comprehensively addressed in order to effectively manage.
•
There is a need for comprehensive assesment tools.
•
Therefore, our study was designed to test the Turkish validity and reliability of the CIPNAT.
•
As a result of this study, CIPNAT was found to be a valid and reliable assesment tool.

Abstract

Purpose

Chemotherapy-induced peripheral neuropathy is a common treatment-related adverse effect. It adversely affects the quality of life. Therefore, it is important to evaluate symptoms. The purpose of this study was to evaluate the validity and reliability of Chemotherapy-Induced Peripheral Neuropathy Assessment Tool in Turkish patients.

Methods

A convenience sample of 327 patients, being treated with peripheral neurotoxic chemotherapeutic agents were asked to fill in the questionnaire. The data was evaluated using SPSS 21 (SPSS Inc., Chicago IL, USA) statistical software. The verification of the structure obtained with CFA was provided by AMOS 21.0. Psychometric testing included internal consistency reliability (Cronbach's alpha coefficient and item-total correlations), test-retest reliability, validity (exploratory factor analysis, confirmatory factor analysis and concurrent validity).

Results

The Cronbach alpha value of the scale was 0.97. The test-retest reliability results were significantly high. The CIPNAT significantly correlated with the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy. The model was validated by confirmatory factor analysis (χ2/sd = 2.74, GFI = 0.95, AGFI = 0.92, CFI = 0.98, RMSEA = 0.07, and RMR = 0.009).

Conclusions

The Turkish version of the CINAT was found to be reliable and valid with Turkish patients receiving chemotherapy. Use of the CIPNAT may lead to a better understanding of symptom. The CIPNAT can be used in future nursing research and practice as an assessment tool for peripheral neuropathy in patients with cancer who undergo chemotherapy.

Introduction

Peripheral neuropathy is one of the most common adverse effects of chemotherapy on the neurological system (Kannarkat et al., 2008). The pathophysiology of peripheral neuropathy has not yet been explained in depth. Peripheral neuropathy is an adverse effect that occurs due to distortion in the electrical activity of neurons, caused by chemotherapy which damages the peripheral nerve fiber (Arıkan and Kurt, 2014). This adverse effect is characterized by a decrease in motor skills, sensory dysfunctions, loss in deep tendon reflexes, muscle weakness, and peripheral nerve involvement. The incidence rate of peripheral neuropathy varies, depending upon the varied chemotherapy protocols, drug dosages, and the duration of the post-treatment period. Peripheral neuropathy emerges as a common adverse effect of chemotherapeutic drugs such as taxanes, vinca alkaloids, platinum compounds, bortezomib and thalidomide (Miltenburg and Boogerd, 2014, Costa et al., 2015, Staff et al., 2017). As a result of a meta-analysis for fluorouracil/leucovorin/oksaliplatin, the chemotherapy protocols, the rate of peripheral neuropathy incidence was found to be 3.8–68% (Chen et al., 2010). In the meta-analysis study conducted by Seretny et al. (2014), the peripheral neuropathy prevalence was found to be 68.1% in the first month, 60.6% in the third month and 30% after the third month.

It is fair to say that peripheral neuropathy will affect more people due to the new cancer cases which are increasing daily, and due to the new chemotherapy treatments. Sensory, motor and autonomic symptoms are being observed as a result of peripheral neuropathy. These symptoms include pain, formication, low reflex levels, weakness, distortion in walking and balance, constipation, urinary retention, sexual dysfunction and so on (Arıkan and Kurt, 2014). Symptoms generally start at the finger tips and advance from the distal to proximal. Affected areas display stocking and glove distribution (Kannarkat et al., 2008, Tofthagen, 2010, Tofthagen et al., 2013). Patients suffer from paresthesia and weakness, and may sustain injuries due to a loss of balance; their daily lives are negatively affected (Tofthagen, 2010). It is fair to say that these symptoms which weaken the functional abilities of the patients also decrease the patients' quality of life. Mols et al. (2013) demonstrated in a study conducted with colorectal cancer patients that there was a negative relationship between the peripheral neuropathy and quality of life, and that peripheral neuropathy negatively affected the quality of life.

Therefore, these symptoms should be comprehensively addressed in order to effectively manage them (Binner et al., 2011, Lavoie Smith et al., 2011). In addition to sufficient knowledge and skills, valid and reliable measurement tools that can objectively evaluate a symptom are also needed for comprehensive evaluation. Studies in the literature demonstrate that various scales have been developed to evaluate chemotherapy-induced peripheral neuropathy (Chaudhry et al., 1994, Lavoie Smith et al., 2011, Tofthagen et al., 2011). In the systematic review study that was done, it was reported that there are 20 different measurement tools were used in the evaluation of the peripheral neuropathy resulting from chemotherapy (Haryani et al., 2017).

The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire for Chemotherapy-Induced Peripheral Neuropathy is used in Turkey to evaluate chemotherapy-induced peripheral neuropathy (Postma et al., 2005, Ünsüz, 2015). The symptoms of peripheral neuropathy associated with chemotherapy and the effect of functional limitations that was caused by this problem on the life of patients are evaluated by this tool. The Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT), unlike the EORTC QLQ-CIPN 20, demonstrates the status of negative effect on patients daily life activities together with the frequency, severity, and emotional distress levels of symptoms. That the CIPNAT is a measurement tool to be used in evaluation of neuropathy resulting from chemotherapy was reported in literature, and it is used for evaluation (Chu et al., 2015, Kim et al., 2015). It was reported that it can be used as a patient self report scale in evaluation of peripheral neuropathy resulting from oxaliplatin (Chu et al., 2015). The use of this measurement tool contributes to the detailed evaluation of patients in terms of peripheral neuropathy. Therefore, our study was designed to test the Turkish validity and reliability of the CIPNAT. We believe that, as a result of this validity and reliability study of the CIPNAT, patients will be examined in a more detailed manner, and this tool will be used in oncology nursing in Turkey. Moreover, when evaluations are performed with objective measurement tools, the results will provide a basis for studies to be conducted on the findings.

Section snippets

Study design and participants

This methodological study was conducted on the validity and reliability of the Turkish adaptation of the “Chemotherapy-Induced Peripheral Neuropathy Assessment Tool”. The data was derived from 327 patients receiving chemotherapy at the Outpatient Chemotherapy Units of two University Hospitals between June 2015 and January 2016. Of the 400 patient invited to participate in the study, 330 agreed to do so and returned the questionnaire, giving in a response rate of 82.5%. There patients did not

Participant characteristics

Patients’ descriptive characteristics data are shown in Table 1. The mean age of the participants was 56.81 ± 11.50. Of the patients, 53.5% were females, 92.7% were married, almost half of them (49.5%) were elementary school graduates, and the majority of them (87.8%) were not working. Common diagnoses included breast (26.9%), lung (22.0%) and colorectal cancers (12.5%). The mean diagnosis duration for the patients was 14.62 ± 22.66 months, and the stage of illness of the 34.9% was stage IV.

The

Discussion

Due to the limited numbers of the studies in which CIPNAT was used, discussion of the data was performed via the findings of validity and reliability. Validity and reliability are the main characteristics of a measurement tool. Reliability is the capability of a measurement tool to provide sensitive, consistent and decisive results. Internal consistency reliability is considered for the evaluation of the reliability. The internal consistency should be proved. It should be proved that all sub

Conclusion

CIPNAT is a sufficient, valid and reliable tool that can be used for the comprehensive evaluation of peripheral neuropathy in Turkish cancer patients. The fact that there is a different evaluation tool to be used for the evaluation of chemotherapy-induced peripheral neuropathy ensures more choices. A complete and comprehensive evaluation can be performed when the presence of symptoms is determined with objective measurement tools. Explaining a symptom in a detailed way will be instructive in

Note

We received statistical counseling from Statistical Workshop (Oğuzhan Çicek).

Conflict of interest

None.

References (32)

M.L. Chen et al.
A meta-analysis of chemotherapy regimen fluorouracil/leucovorin/oxaliplatin compared with fluorouracil/leucovorin in treating advanced colorectal cancer
Surg. Oncol.
(2010)
N.C. Miltenburg et al.
Complications of treatment chemotherapy-induced neuropathy: a comprehensive survey
Cancer Treat. Rev.
(2014)
T.J. Postma et al.
The development of an EORTC quality of life questionnaire to assess chemotherapy-induced peripheral neuropathy: the QLQ-CIPN20
Eur. J. Cancer
(2005)
M. Seretny et al.
Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis
Pain
(2014)
A. Akgül
Tıbbi Araştırmalarda Istatistiksel Analiz Teknikleri (Statistical Analysis Methods for Medical Studies)
(1997)
K. Arıkan et al.
Periferal nöropati (Peripheral neuropathy)
M. Binner et al.
Chemotherapy-ınduced peripheral neuropathy: assessment of oncology nurses' knowledge and practice
Oncol. Nurs. Forum
(2011)
Ş. Büyüköztürk
Faktör analizi: temel kavramlar ve ölçek geliştirmede kullanımı (factor analysis: basic concepts and using scale development)
Eğitim Yönetimi Derg.
(2002)
V. Chaudhry et al.
Peripheral neuropathy from taxol and cisplatin combination chemotherapy: Clinical and electrophysiological studies
Ann. Neurology
(1994)
S.H. Chu et al.
Properties of the measures to assess oxaliplatin-induced peripheral neuropathy: a literature review
J. Korean Acad. Nurs.
(2015)

D.A. Cole

Utility of confirmatory factor analysis in test validation research

J. Consult. Clin. Psychol.

(1987)

T.C. Costa et al.

Chemotherapy-induced peripheral neuropathies: an integrative review of the literature

Rev. Esc. Enferm. Usp.

(2015)

Ö. Çokluk et al.

Sosyal Bilimler Için Çok Değişkenli Istatistik: SPSS Ve Lisrel Uygulamaları (A Statistics with Multiple Variables for the Social Sciences: SPSS and Lisrel Practices)

(2012)

M.N. Esin

Veri toplama yöntem ve araçları & veri toplama araçlarının güvenirlik ve geçerliği (Data collection methods and tools & reliability and validity of data collection tools)

S. Gözüm et al.

Kültürlerarası ölçek uyarlaması için rehber II: psikometrik özellikler ve kültürlerarası karşılaştırma (Guide II for transcultural scale adaptation: psychometric properties and transcultural comparison)

Hemşirelik Araştırma Derg.

(2003)

D. Harrington

Confirmatory Factor Analysis

(2009)

Cited by (12)

Peripheral neuropathy and lifestyle factors in women with breast cancer receiving taxane-based chemotherapy: Pathway analysis
2023, European Journal of Oncology Nursing
Peripheral neuropathy adversely affects the treatment process of cancer, and thus it is important to reveal the factors leading to peripheral neuropathy and to take the necessary precautions to avoid it. This study was conducted to investigate the relationship between chemotherapy-induced peripheral neuropathy (CIPN) and lifestyle factors (nutrition, physical activity and sleep quality).
This descriptive and correlational study was conducted with 108 individuals who were treated in the chemotherapy unit of a hospital between April 2021 and April 2022 in Turkey. Data were collected using the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT), the International Physical Activity Questionnaire (IPAQ), the Mini Nutritional Assessment Test (MNA), and the sleep level Visual Analog Scale. Number, percentages, means, and standard deviations were calculated, and multiple linear regression analysis and path analysis were conducted to analyze the data.
The results indicate that the total MET score significantly and positively predicted the sleep scale score (β = 0.24, p < 0.01), while it negatively and significantly predicted the CIPNAT score (β = −0.30, p < 0.001). In addition, both the MNA screening score and the sleep scale score significantly and negatively predicted the CIPNAT score (β = −0.25, p < 0.01, β = −0.29, p < 0.001, respectively).
Lifestyle factors (exercise, nutrition, sleep) were found to have an effect on peripheral neuropathy. It is thought that increasing the level of exercise improves sleep quality, and regular nutrition, quality sleep and increased physical activity may be effective in reducing peripheral neuropathy.
Clinical and biochemical markers in CIPN: A reappraisal
2021, Revue Neurologique
Citation Excerpt :
The Rasch built overall disability scale for CIPN (CIPN R-ODS) consists of 28 items examining patients’ capability to accomplish specific tasks as measure of functional impairment [136]. The Chemotherapy-induced Neurotoxicity Questionnaire (CINQ) [137] and the Chemotherapy-induced peripheral neuropathy assessment tool (CIPNAT) [138] also embrace the evaluation of severity of CIPN symptoms and their impact on daily activities with adequate reliability and validity [139–141]. Other scales have addressed CIPN symptoms occurring in specific chemotherapies.
The increased survival of cancer patients has raised growing public health concern on associated long-term consequences of antineoplastic treatment. Chemotherapy-induced peripheral neuropathy (CIPN) is a primarily sensory polyneuropathy, which may be accompanied by pain, autonomic disturbances, and motor deficit. About 70% of treated cancer patients might develop CIPN during or after the completion of chemotherapy, and in most of them such complication persists after six months from the treatment. The definition of the potential risk of development and resolution of CIPN according to a clinical and biochemical profile would be certainly fundamental to tailor chemotherapy regimen and dosage on individual susceptibility. In recent years, patient-reported and clinician-related tools along with quality of life instruments have been featured as primary outcomes in clinical setting and randomized trials. New studies on metabolomics markers are further pursuing accurate and easily accessible indicators of peripheral nerve damage. The aim of this review is to outline the strengths and pitfalls of current knowledge on CIPN, and to provide a framework for future potential developments of standardized protocols involving clinical and biochemical markers for CIPN assessment and monitoring.
Validation of the Arabic Version of the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool
2020, Pain Management Nursing
Citation Excerpt :
These possibilities should be taken into consideration in future studies. The results of this study provide more evidence for the reliability and validity of the Arabic version of CIPNAT, which is consistent with other versions of the tool in terms of its reliability (Kutlutürkan et al., 2017; Tofthagen et al., 2011). The correlation matrix showed two strong correlations between the items “Picking up objects” and “Holding onto objects” (0.79), as well as between “Participating in hobbies or leisure activities” and “Exercising” (0.78), which suggests item redundancy (Streiner, 2003).
Chemotherapy-induced peripheral neuropathy results in multidimensional neurological and muscular symptoms, which interfere with the patients’ daily life.
Examine the psychometric properties of the Arabic version of the chemotherapy-induced peripheral neuropathy assessment tool (CIPNAT) among adult cancer patients.
A descriptive study design was used. A convenience sample of 210 patients was assigned to two groups: 135 who received chemotherapies of known neurotoxic potential and 75 who served as a comparison group. Translation and back-translation considering cross-cultural issues to produce the Arabic version of CIPNAT was used. Test–retest and internal consistency reliability were used to test the reliability of the tool, whereas for the validity, content and construct validity were assessed.
Test–retest scores for the overall scale (r = 0.98, p = < .001), for the symptom experience subscale (r = 0.97, p = <.001), and for the interference subscale (r = 0.96, p = < .001) all showed evidence of reliability. Cronbach α coefficients were 0.97, 0.96, and 0.95 for the total scores, symptoms experience, and interference scales, respectively. Items to total correlation ranged from moderate to strong (0.55-0.81). The Content Validity Index was 0.83. The data support the evidence of discriminant validity, as significant differences were found between the groups with regard to symptom experience (t = 8.51, p = < .001), interference (t = 5.60, p = <.001), and total score (t = 7.88, p = < .001).
The Arabic version of CIPNAT showed adequate reliability and validity to screen for chemotherapy-induced peripheral neuropathy symptoms and their interference in Arab countries. Further studies are needed to evaluate concurrent validity.
The preliminary effects of henna on chemotherapy-induced peripheral neuropathy in women receiving oxaliplatin-based treatment: A parallel-group, randomized, controlled pilot trial
2020, European Journal of Oncology Nursing
Citation Excerpt :
This form, which was developed by the investigators by reviewing the relevant literature, consisted of questions regarding sociodemographic characteristics (age, marital status, number of children, educational status, and working status), diagnosis and disease characteristics such as the severity of CIPN based on CTCAE v3.0. The validity and reliability of the Turkish version of the scale, which was originally developed by Tofthagen et al. (2011), was conducted by Kutlutürkan et al. (2017). The tool is composed of two sections.
Chemotherapy-induced peripheral neuropathy (CIPN) may frequently occur in patients receiving oxaliplatin-based treatment. The aim of the present parallel-group, randomized, controlled pilot trial was to investigate the effect of henna on CIPN in women receiving oxaliplatin-based treatment.
Sixty female patients receiving oxaliplatin-based treatment were randomly divided into two groups, i.e., one intervention group (n = 30) where henna was applied topically and one control group (n = 30) that received routine treatment and care. Women in the intervention group were provided a pack of henna prepared by the investigators following each treatment course (2nd, 3rd, and 4th courses) and were instructed to apply the henna on their palms, fingers, and soles. The chemotherapy-induced peripheral neuropathy assessment tool (CIPNAT) was completed by women subsequent to the 2nd (baseline), 3rd, and 4th courses of treatment.
The intragroup assessment performed for the intervention group revealed that the total CIPNAT score significantly declined in the intervention group (p < 0.05). The score changes by time in the intervention and control groups were in favour of the intervention group, and the effect size for group × time interaction was η² = 0.169. Similarly, regarding the symptoms intervention section of the tool, a positive change by time in the intervention group was observed, and the effect size concerning this change was large, i.e., η² = 0.284.
The present study results showed that henna application on hands and feet has a beneficial effect on peripheral neuropathy. Applying henna is a promising approach in CIPN management.
Reliability and Validity of the Turkish Version of Chemotherapy-induced Peripheral Neuropathy Assessment Tool for Breast Cancer Patients Receiving Taxane Chemotherapy
2018, Asia-Pacific Journal of Oncology Nursing
Citation Excerpt :
The literature suggests that factors with positive values exceeding 0.32 should be included.18,20 Kutlutürkan et al. reported factor powers of 0.498 and 0.948,12 consistent with our factor powers of 0.553–0.937. These powers explain 66.6% of the variance in a single factor.
The aim was to evaluate the reliability and the validity of the Turkish version of the chemotherapy-induced peripheral neuropathy assessment tool (CIPNAT) in cancer patients using taxane.
This methodological study was carried out to evaluate the validity and the reliability of the CIPNAT. The sample cohort comprised 430 breast cancer patients who were administered taxane, a chemotherapeutic agent, between April and December 2017. Data were collected by the CIPNAT and by a demographic data form. The CIPNAT content reliability was checked after completing it in Turkish. Validity was tested after the translation as well. Cronbach's alpha and test–retest reliability were utilized for reliability analyses.
Cronbach's alpha value was 0.87 in this study. The test–retest reliability ranged between 0.90 and 0.96 for all items. No difference existed between the means of test and retest scores of the CIPNAT. A statistically significant positive relationship materialized between the item's test and retest scores. There were statistically significant positive relationships among all levels of the CIPNAT. Factor analysis resulted in a size value higher than 1 and explained 66% of total variation. These results show that the Turkish version of the CIPNAT is a valid and reliable scale in Turkish society.
This study showed that the CIPNAT in Turkey is a reliable and valid tool to evaluate taxane chemotherapy in breast cancer patients.
Determination of the Influence of Peripheral Neuropathy Symptoms on Quality of Life in Breast Cancer Patients: A Cross-Sectional Study with Four Follow-Ups
2023, Florence Nightingale Journal of Nursing

View all citing articles on Scopus

^☆: This study was presented as a poster at EONS 10 congress (17-18 October 2016, Dublin, Ireland).

View full text

The psychometric properties of the Turkish version of the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT)☆

Highlights

Abstract

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Study design and participants

Participant characteristics

Discussion

Conclusion

Note

Conflict of interest

Surg. Oncol.

Cancer Treat. Rev.

Eur. J. Cancer

Pain

Tıbbi Araştırmalarda Istatistiksel Analiz Teknikleri (Statistical Analysis Methods for Medical Studies)

Periferal nöropati (Peripheral neuropathy)

Chemotherapy-ınduced peripheral neuropathy: assessment of oncology nurses' knowledge and practice

Oncol. Nurs. Forum

Faktör analizi: temel kavramlar ve ölçek geliştirmede kullanımı (factor analysis: basic concepts and using scale development)

Eğitim Yönetimi Derg.

Peripheral neuropathy from taxol and cisplatin combination chemotherapy: Clinical and electrophysiological studies

Ann. Neurology

Properties of the measures to assess oxaliplatin-induced peripheral neuropathy: a literature review

J. Korean Acad. Nurs.