Leg symptoms, the ankle-brachial index, and walking ability in patients with peripheral arterial disease

AbstractOBJECTIVE: To determine how functional status and walking ability are related to both severity of lower extremity peripheral arterial disease (PAD) and PAD-related leg symptoms. DESIGN: Cross-sectional study. SETTING: Academic medical center. PARTICIPANTS: Patients aged 55 years and older diagnosed with PAD in a blood flow laboratory of general medicine practice (n=147). Randomly selected control patients without PAD were identified in a general medicine practice (n=67). MEASUREMENTS: Severity of PAD was measured with the ankle-brachial index (ABI). All patients were categorized according to whether they had (1) no exertional leg symptoms; (2) classic intermittent claudication; (3) exertional leg symptoms that also begin at rest (pain at rest), or (4) exertional leg symptoms other than intermittent claudication or pain at rest (atypical exertional leg symptoms). Participants completed the 36-Item Short-Form Health Survey (SF-36) and the Walking Impairment Questionnaire (WIQ). The WIQ quantifies patient-reported walking speed, walking distance, and stairclimbing ability, respectively, on a scale of 0 to 100 (100=best). MAIN RESULTS: In multivariate analyses patients with atypical exertional leg symptoms, intermittent claudication, and pain at rest, respectively, had progressively poorer scores for walking distance, walking speed, and stair climbing. The ABI was measurably and independently associated with walking distance (regression coefficient=2.87/0.1 ABI unit, p=.002) and walking speed (regression coefficient=2.09/0.1 ABI unit, p=.015) scores. Among PAD patients only, pain at rest was associated independently with all WIQ scores and six SF-36 domains, while ABI was an independent predictor of WIQ distance score. CONCLUSIONS: Both PAD-related leg symptoms and ABI predict patient-perceived walking ability in PAD.

[1]  J. Ware SF-36 health survey: Manual and interpretation guide , 2003 .

[2]  G. A. Rose The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. , 1962, Bulletin of the World Health Organization.

[3]  David A. Belsley,et al.  Regression Analysis and its Application: A Data-Oriented Approach.@@@Applied Linear Regression.@@@Regression Diagnostics: Identifying Influential Data and Sources of Collinearity , 1981 .

[4]  E. Barrett-Connor,et al.  TABLE 1 Prevalence of PAD by traditional assessment : intermittent claudication and pulse palpation % Claudication % Pulse abnormalities Rose Femoral Posterior Dorsalis n Rose , 2005 .

[5]  J. Regensteiner,et al.  Functional Benefits of Peripheral Vascular Bypass Surgery for Patients with Intermittent Claudication , 1993 .

[6]  J. Regensteiner,et al.  Functional Benefits of Peripheral Vascular Bypass Surgery for Patients with Intermittent Claudication , 1993, Angiology.

[7]  J. Regensteiner,et al.  Clinical trials for claudication. Assessment of exercise performance, functional status, and clinical end points. Vascular Clinical Trialists. , 1995, Circulation.

[8]  Linda P. Fried,et al.  The Women's Health and Aging Study: Health and Social Characteristics of Older Women with Disability , 1995 .

[9]  E. Youngstrom,et al.  Depression and disability in Parkinson's disease. , 1996, The Journal of neuropsychiatry and clinical neurosciences.

[10]  J. Polak,et al.  Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group. , 1993, Circulation.

[11]  R. Langer,et al.  The Correlation between Symptoms and Non-Invasive Test Results in Patients Referred for Peripheral Arterial Disease Testing , 1996, Vascular medicine.

[12]  R. Hamman,et al.  Effect of diagnostic criteria on the prevalence of peripheral arterial disease. The San Luis Valley Diabetes Study. , 1995, Circulation.

[13]  L. Kuller,et al.  Morbidity and mortality in hypertensive adults with a low ankle/arm blood pressure index. , 1993, JAMA.

[14]  J. Feinglass,et al.  Effect of lower extremity blood pressure on physical functioning in patients who have intermittent claudication. The Chicago Claudication Outcomes Research Group. , 1996, Journal of vascular surgery.

[15]  B. Pasternack,et al.  Premenopausal estradiol levels and the risk of breast cancer: a new method of controlling for day of the menstrual cycle. , 1994, American journal of epidemiology.

[16]  P. Wolf,et al.  The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. , 1994, American journal of public health.

[17]  L. Fried,et al.  Self‐Reported Causes of Physical Disability in Older People: The Cardiovascular Health Study , 1994, Journal of the American Geriatrics Society.

[18]  R. Langer,et al.  Screening for peripheral arterial disease: the sensitivity, specificity, and predictive value of noninvasive tests in a defined population. , 1994, American journal of epidemiology.

[19]  A. Lee,et al.  Use of ankle brachial pressure index to predict cardiovascular events and death: a cohort study , 1996, BMJ.

[20]  R. Fitzpatrick,et al.  Self-reported functioning and well-being in patients with Parkinson's disease: comparison of the short-form health survey (SF-36) and the Parkinson's Disease Questionnaire (PDQ-39) , 1995, Age and ageing.

[21]  T. Louis,et al.  Chronic conditions that lead to functional limitation in the elderly. , 1994, Journal of gerontology.