No abstract

WHAT THIS PAPER ADDS In patients with peripheral artery disease, the Walking Estimated Limitation Calculated by History (WELCH) questionnaire score correlates with the maximum treadmill walking time. Changes in WELCH score tend to decrease more than the objective changes in walking impairment, particularly with a longer a testeretest interval. After revascularisation, a shortlived "honeymoon" (overestimation of the objectively measured change on the treadmill) is observed. For long testeretest intervals, self reported worsening according to the WELCH score should probably be confirmed on the treadmill before a decision to revascularise is taken. Whether other questionnaires estimating walking impairment face the same issue remains to be determined. Objective: Determining the maximum walking time (MWT) using the treadmill test is the gold standard method for evaluating walking capacity and treatment effect in patients with peripheral arterial disease (PAD). However, self reported functional disability is important when assessing quality of life. Changes in the Walking Estimated Limitation Calculated by History (WELCH) questionnaire scores were compared with the MWT. Methods: A cross sectional study was performed in patients with intermittent claudication. The treadmill test (3.2 km/h; 10% gradient) and WELCH questionnaire were administered to all patients for objective evaluation of walking capacity. Given the log normal distribution of these parameters in patients with PAD, a log transformation was applied to the WELCH score (LnW) and maximum walking time (LnT). The responsiveness of the WELCH score was determined using mean changes and correlation coefficients of LnW and LnT changes. The effect of time on the "estimated minus real" (E À R) changes (LnW À change minus LnT À change) was assessed after categorisation of patients into various testeretest intervals. Patients who underwent lower limb revascularisation between the two tests and those who underwent medical treatment only were analysed. Results: Correlation coefficients between LnW and LnT for tests 1 and 2 were r ¼ 0.514 and r ¼ 0.503, respectively (p < .001, for both). Correlation for LnW change vs. LnT change was 0.384 (p < .001). E À R was positive only early after surgery. E À R was negative for all testeretest intervals >1 year in revascularised and non-revascularised patients. Conclusion: Changes in WELCH scores correlated with changes observed on the treadmill in patients with intermittent claudication. For long testeretest intervals, WELCH changes tended to overestimate the worsening of walking impairment as compared with the measured difference observed in both revascularised and non-revascularised patients. A shortlived "honeymoon" (overestimation of the benefit for the shortest testeretest interval) was observed only in revascularised patients.

BACKGROUND: Epidemiological, imaging, and anatomical studies suggest an association between proximal arterial atherosclerosis and development of low back pain (LBP). OBJECTIVES: We aimed to define (1) the frequency and (2) factors associated with exercise-induced proximal ischemia (EIPI) in individuals with LBP and (3) develop a clinical screening scale. DESIGN: Monocentric cross-sectional study. PARTICIPANTS: All patients with history of ongoing LBP referred to our exercise investigation laboratory for exercise transcutaneous oximetry (ex-tcPO 2 ) between January 2011 and December 2017 (n = 542; mean age, 65.4 ± 10.9; 83.9% men). MAIN MEASURES: EIPI was defined as a decrease from rest of oxygen pressure (DROP) below − 15 mmHg on the lumbar and/or buttock probes. Ex-tcPO 2 is a reliable validated tool for diagnosing EIPI in comparison with arteriography and computed tomography angiography. Ex-tcPO 2 was performed on a treadmill until symptom manifestation or exhaustion. Clinical data were collected using interview questionnaires, medical file review, and clinical examination. KEY RESULTS: EIPI was diagnosed in 282 patients (52%). Age ≤ 70 years (OR, 2.22; 95% CI, 1.35-3.57; p = 0.002), a history of proximal revascularization (OR, 2.64; 95% CI, 1.50-4.65; p = 0.001), use of antiplatelet medication (OR, 1.71; 95% CI, 0.96-3.06; p = 0.069), a relationship between exercise and LBP (OR, 2.61; 95% CI, 1.49-4.57; p = 0.001), and an abnormal ankle to brachial index (OR, 2.87; 95% CI, 1.77-4.66; p < 0.0001) were identified as EIPI predictors. Using these items, we developed a screening scale that showed an area under the receiver operating characteristics curve of .756. At a score of ≥ 3, the sensitivity, specificity, and accuracy for EIPI were 84%, 55%, and 71%, respectively. CONCLUSIONS: EIPI was common among our patients with LBP undergoing ex-TcPO 2 . Our screening scale could help better select the patients who require angiography.