Cross-cultural adaptation and validation of the Peripheral Artery Questionnaire: Korean version for patients with peripheral vascular diseases

Abstract

Peripheral artery disease (PAD) results from luminal narrowing and stiffening of the arteries supplying the lower limbs, most often due to systemic atherosclerotic disease. Its prevalence is high, and is associated with a high risk for fatal and non-fatal cardiovascular events (death, myocardial infarction and cerebral vascular accident). 1 Accordingly, guidelines and performance measures have been developed for PAD to support aggressive treatment of its risk factors, including hypertension and hyperlipidemia. Diagnosing PAD is very important, as the incidence of acute cardiovascular events is two to three times higher in patients with PAD as compared with people having no atherosclerosis of their peripheral arteries. 2,3 Despite its prevalence and cardiovascular risk implications, only 25% of PAD patients are recognized and treated. 4 Although the majority of PAD patients are asymptomatic, the disease often progresses to cause symptoms that can impact patients' functioning and quality of life. Intermittent claudication is the cardinal symptom of PAD and is a primary treatment target for afflicted patients. It occurs as a result of reduced blood flow to lower extremity skeletal muscle during exercise. The incidence of symptomatic PAD increases with age, affecting 22% of patients with PAD, and the cardiovascular risk factors mentioned contribute to the progression of PAD. 5 AbstractThe Peripheral Artery Questionnaire (PAQ), as developed in US English, is a validated scale to evaluate the health status of patients with peripheral artery disease (PAD). The aim of this study was to translate the PAQ into Korean and to evaluate its reliability and validity. A multi-step process of forward-translation, reconciliation, consultation with the developer, back-translation and proofreading was conducted. The test-retest reliability was evaluated at a 2-week interval using the intra-class correlation coefficient (ICC). The validity was assessed by identifying associations between Korean PAQ (KPAQ) scores and Korean Health Assessment Questionnaire (KHAQ) scores. A total of 100 PAD patients were enrolled: 63 without and 37 with severe claudication. The reliability of the KPAQ was adequate, with an ICC of 0.71. There were strong correlations between KPAQ's subscales. Cronbach's alpha for the summary score was 0.94, indicating good internal consistency and congruence with the original US version. The validity was supported by a significant correlation between the total KHAQ score and KPAQ physical function, stability, symptom, social limitation and quality of life scores (r = -0.24 to -0.90; p < 0.001) as well as between the KHAQ walking subscale and the KPAQ physical function score (r = -0.55, p < 0.001). Our results indicate that the KPAQ is a reliable, valid instrument to evaluate the health status of Korean patients with PAD.

Correlation between Patient-Reported Symptoms and Ankle-Brachial Index after Revascularization for Peripheral Arterial Disease

“…Traditionally, patient-reported symptom measures and objective functional performance have been included as clinical trial end points [14,15,16,17,18,19]. Among the instruments for the assessment of patients’ symptoms, previous studies suggest that the PAQ is more sensitive to changes in patients’ health status than generic instruments, such as the EuroQol 5 Dimensions (EQ5D) [14], the health associated questionnaire (HAQ) [6], and EuroQol-Visual Analogue Scale (EQ VAS) [15]. According to our previous study, the reliability of the Korean version of PAQ was adequate with an intra-class correlation coefficient of 0.71, and Cronbach’s alpha for the summary score was 0.94, indicating good internal consistency and congruence with the original English version [6].…”

“…Among the instruments for the assessment of patients’ symptoms, previous studies suggest that the PAQ is more sensitive to changes in patients’ health status than generic instruments, such as the EuroQol 5 Dimensions (EQ5D) [14], the health associated questionnaire (HAQ) [6], and EuroQol-Visual Analogue Scale (EQ VAS) [15]. According to our previous study, the reliability of the Korean version of PAQ was adequate with an intra-class correlation coefficient of 0.71, and Cronbach’s alpha for the summary score was 0.94, indicating good internal consistency and congruence with the original English version [6]. Recent trials have also assessed intermittent claudication-related symptoms and functional impairment using the Walking Impairment Questionnaire (WIQ) and PAQ [16].…”

“…The Peripheral Artery Questionnaire (PAQ) was developed to measure the health status of PAD patients based on their symptoms, functional status, and QoL [5]. We have previously translated and validated a Korean version of the PAQ in Korean PAD patients and demonstrated that PAQ scores strongly correlate with ABI [6,7]. Thus, screening programs using the PAQ in conjunction with ABI may improve the ability to detect PAD patients when assessing individuals with suspicious lower-limb symptoms.…”

The efficacy and safety of the herbal medicine geonchildan for patients with active rheumatoid arthritis: study protocol for a randomized, double-blind, placebo-controlled, parallel pilot trial

“…It is a disease-specific health status instrument for RA. In this study, we will use the KHAQ, which has undergone a cross-cultural adaptation and confirmation process [19, 20]. The KHAQ consists of 20 questions divided into eight areas: (1) dressing and grooming, (2) rising, (3) eating, (4) walking, (5) hygiene, (6) reaching out, (7) holding hands, and (8) activities.…”

“…The KHAQ consists of 20 questions divided into eight areas: (1) dressing and grooming, (2) rising, (3) eating, (4) walking, (5) hygiene, (6) reaching out, (7) holding hands, and (8) activities. A high score signifies that the disability in daily living activities is severe [20]. …”