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Claudication distance is poorly estimated and inappropriately measured
C J Watson1, D Phillips, L Hands
1University of Oxford, Nuffield Department of Surgery, John Radcliffe Hospital, UK.
Insights
Patient-reported claudication distance is unreliable for assessing disability in peripheral arterial disease. Objective walking tests are needed for accurate handicap evaluation and treatment decisions.
Area of Science:
- Vascular Surgery
- Clinical Assessment
- Patient Outcomes
Background:
- Claudication distance is the primary metric for lower-limb occlusive arterial disease disability.
- The accuracy of claudication distance as a surrogate for patient handicap requires evaluation.
Purpose of the Study:
- To assess the accuracy of patient-estimated claudication distance.
- To compare patient-reported distances with objective walking test results.
Main Methods:
- Prospective study of 70 patients with intermittent claudication at a vascular clinic.
- Patients estimated claudication and maximum walking distances.
- Objective measurements via patient-controlled corridor and fixed-speed treadmill walks.
Main Results:
- Patient-reported claudication distance showed poor correlation with medical records.
- No correlation found between estimated and objectively measured walking distances.
- Patients walked further at self-selected speeds (corridor) than at slower, fixed speeds (treadmill).
Conclusions:
- Claudication distance is inaccurately estimated, reported, and measured, limiting its clinical value.
- Current methods of assessing claudication distance are unreliable for treatment decisions.
- Objective handicap assessment is crucial for rational management of peripheral arterial disease.
Background:
Claudication distance is the commonest measure of the disability caused by lower-limb occlusive arterial disease. The accuracy of claudication distance as a surrogate for handicap has been assessed.
Methods:
Seventy patients who attended a specialist vascular clinic with intermittent claudication were studied prospectively. Patients were asked to estimate their claudication distance and maximum walking distance before undergoing both a patient-controlled corridor walk and a fixed-speed treadmill walk.
Results:
The claudication distance reported by patients bore little relation to the distance recorded in the medical correspondence. There was no correlation between the estimated distance and the actual distance walked on either a patient-controlled corridor walk or a fixed-speed treadmill walk. Most patients were able to walk substantially further at their own speed on the corridor than on the treadmill at a slower speed.
Conclusion:
Claudication distance is spuriously estimated, inaccurately reported, falsely recorded, inappropriately measured and usually misinterpreted. It is of little value in judging the need for treatment. Objective measures of the handicap caused by the disability of reduced walking distance are required if rational management decisions are to be made.