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Vol. 22. Num. 3.
Pages 175-254 (01 May 2018)
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Vol. 22. Num. 3.
Pages 175-254 (01 May 2018)
Original Research
DOI: 10.1016/j.bjpt.2017.10.004
Cross-cultural adaptation and measurement properties of the Brazilian Version of the Michigan Neuropathy Screening Instrument
Cristina D. Sartora,b,
Corresponding author

Corresponding author at: Rua Cipotânea, 51, Cidade Universitária, CEP 05360-160, São Paulo, SP, Brazil.
, Mariana D. Oliveiraa, Victoria Camposa, Jane S.S.P. Ferreiraa, Isabel C.N. Saccoa
a Universidade de Sao Paulo (USP), School of Medicine, Physical Therapy, Speech and Occupational Therapy Department, São Paulo, SP, Brazil
b Universidade Ibirapuera, São Paulo, SP, Brazil

  • Translation and cross-cultural adaptation of the MNSI into Brazilian Portuguese were performed.

  • Excellent reliability and internal consistency, as well as good agreement, were observed.

  • The results indicate reasonable construct validity and excellent association between the MNSI and Neuropathy Disability Score.

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Figures (2)
Tables (2)
Table 1. Sociodemographic, anthropometric and clinical characteristics (mean (SD)) of patients evaluated in the pre-test phase and in the measurement properties phase.
Table 2. Final translated version to Brazilian Portuguese of the Michigan Neuropathy Screening Instrument.
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The Michigan Neuropathy Screening Instrument is an easy-to-use questionnaire aimed at screening and detecting diabetic polyneuropathy.


To translate and cross-culturally adapt the MNSI to Brazilian Portuguese and evaluate its measurement properties.


Two bilingual translators translated from English into Brazilian Portuguese and made a synthetic version. The synthetic version was back translated into English. A committee of specialists and the translator checked the cultural adaptations and developed a pre-final questionnaire in Brazilian Portuguese (prefinal version). In pretesting, the prefinal version was applied to a sample of 34 subjects in which each subject was interviewed to determine whether they understood each item. For the later assessment of measurement properties, 84 subjects were assessed.


A final Brazilian Portuguese version of the instrument was produced after obtaining 80% agreement (SEM<0.01%) among diabetic patients and specialists. We obtained excellent intra-rater reliability (ICC3,1=0.90), inter-rater reliability (ICC2,1=0.90) and within-subject reliability ICC3,1=0.80, excellent internal consistency (Cronbach's alpha>0.92), reasonable construct validity for the association between the MNSI and Neuropathy Symptom Score (r=0.46, p<0.05) and excellent association between the MNSI and Neuropathy Disability Score (r=0.79, p<0.05). We did not detect floor and ceiling effects (<9.5% of patients with maximum scores).


The Brazilian Portuguese version of the MNSI is suitable for application in the Brazilian diabetic population and is a reliable tool for the screening and detection of DPN. The MNSI can be used both in clinical practice and also for research purposes.

Diabetes mellitus
Diabetic polyneuropathies
Measurement properties


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