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Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication
Published on: December 11, 2013
Effect of lower extremity blood pressure on physical functioning in patients who have intermittent claudication. The
J Feinglass1, W J McCarthy, R Slavensky
1Division of General Internal Medicine, Northwestern University Medical School, Chicago, IL 60611, USA.
Insights
Lower extremity blood flow, measured by ankle-brachial index (ABI), significantly impacts walking ability in peripheral artery disease patients. Improving ABI enhances physical functioning and walking distance, guiding treatment decisions.
Area of Science:
- Vascular Surgery
- Peripheral Artery Disease
- Biomedical Engineering
Background:
- Patient perceptions of walking impairment influence treatment recommendations for peripheral bypass and angioplasty.
- The direct relationship between lower extremity blood flow and physical functioning in claudication patients remains understudied.
Purpose of the Study:
- To investigate the association between ankle-brachial index (ABI) and physical functioning in patients with peripheral artery disease (PAD).
- To determine the predictive value of ABI on walking impairment scores in claudication patients.
Main Methods:
- Prospective study of 555 PAD patients with abnormal ABI, excluding those with prior revascularization or severe symptoms.
- Patients completed the SF36 Health Survey and Peripheral Arterial Disease Walking Impairment Questionnaire (WIQ).
- Stepwise multiple regression analysis assessed the relationship between ABI, physical functioning (PF), and WIQ scores, controlling for covariates.
Main Results:
- ABI showed modest but significant univariate correlations with both SF36 physical functioning (PF) and WIQ community walking distance scores.
- ABI was a significant predictor of PF and WIQ scores in multiple regression analysis.
- Positive predictors of PF included high-school graduation and male sex; negative predictors included comorbid conditions like heart, lung, and cerebrovascular disease, arthritis, and back pain.
Conclusions:
- A 0.3 improvement in ABI is associated with significant gains in physical functioning and walking distance.
- Careful patient selection, considering ABI, baseline function, and comorbidities, can optimize functional benefits from interventional therapy.
- Rigorous functional evaluation is crucial for surgeons when recommending interventional management for claudication.
Purpose:
Claudication patients' perceptions of walking impairment often influence recommendations for peripheral bypass and angioplasty. The actual relationship between lower extremity blood flow and physical functioning, however, has rarely been explicitly studied.
Methods:
Patients were enrolled at a visit to one of 16 vascular surgery offices and clinics that participated in a prospective outcomes study. A total of 555 patients (445 men and 110 women) with an abnormal ankle-brachial index (ABI), none of whom had had previous leg revascularization or symptoms of rest pain, skin ulcers, or gangrene, completed the SF36 Health Survey and the Peripheral Arterial Disease Walking Impairment Questionnaire (WIQ). Stepwise multiple regression analysis was used to test the statistical significance and strength of association between patients' ABI level and SF36 physical functioning (PF) and WIQ community walking distance scores, controlled for sociodemographic characteristics and the presence and severity of comorbid conditions.
Results:
Univariate correlations with ABI were modest but significant (PF score, r = 0.12, p = 0.004; WIQ distance score, r = 0.18, p < 0.001). ABI was a very significant predictor of both PF (b = 18.8; p = 0.001) and WIQ scores (b = 0.33; p < 0.0001) in the multiple regression analysis. Other positive predictors of PF scores were high-school graduation and male sex. Negative predictors of PF scores were heart, lung, and cerebrovascular disease; knee arthritis and chronic back pain; and enrollment at a Veterans Administration clinic rather than a private community or academic office.
Conclusion:
Cross-sectional findings indicate that a 0.3 improvement in ABI is associated with an average improvement of 5.6% in PF or 10.3% in WIQ distance score. However, proper selection of individual candidates for interventional therapy, that is, those patients who have lower ABIs, lower initial functioning, and fewer disabling comorbidities would be predicted to produce a much greater functional benefit. Surgeons should make a rigorous functional evaluation when recommending interventional management of claudication.
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