Nurses’ and patients’ experiences and preferences of the ankle-brachial pressure index and multi-site photoplethysmography for the diagnosis of peripheral arterial disease: A qualitative study

Abstract

Peripheral arterial disease is a global health problem, affecting around 20% of people aged over 60 years. Whilst ankle-brachial pressure index (ABPI) is regularly used for diagnosis, it has a number of limitations, which have presented a need for alternative methods of diagnosis. Multi-site photoplethysmography (MPPG) is one such method, but evidence of acceptability of both methods is lacking. This study aims to describe and compare preferences and experiences amongst nurses and patients of ABPI and MPPG use in primary care. We used qualitative research methods in the context of a clinical diagnostic study comparing ABPI with MPPG. Use of ABPI and MPPG by 13 nurses were observed with 51 patients across general practice surgeries in North-East England in 2015/16. Follow-up semi-structured interviews were conducted with 12 nurses and 27 patients. Data were thematically analysed. Two major themes were identified: (1) device preferences; (2) test discomfort and anxiety. There was a compelling preference for MPPG due to ease of use, speed of the test, patient comfort, and perceived device accuracy/objectivity. However some patients struggled to identify a preference, describing ambivalence to medical testing. ABPI was deemed uncomfortable and painful, particularly when the blood pressure cuff was inflated at the lower limbs. There was also evidence of anxiety amongst patients when their foot pulses were not identified using ABPI. Whilst ABPI is a non-invasive and routine procedure it was associated with a number of drawbacks in clinical practice. Nurses required considerable dexterity to employ the test, and it resulted in anxiety amongst some patients. Conversely, MPPG was deemed to be easier and quicker to use, and perceived to be less subjective. Should diagnostic accuracy and cost be comparable to ABPI, then the findings of this study suggest MPPG would be preferable to ABPI for patients as well as nurses.

Prospective Assessment of the Diagnostic Accuracy of Multi-site Photoplethysmography Pulse Measurements for Diagnosis of Peripheral Artery Disease in Primary Care

“…We have previously reported a qualitative study which demonstrates that users perceived MPPG to be quicker and easier to use than ABPI, 48 and like ABPI it is safe. An updated version of the MPPG device includes automatic gain control, ECG with conventional electrodes and real-time pulse analysis; 32 we expect these will reduce its test failure rate.…”

“…We have previously shown that healthcare professionals prefer MPPG to ABPI. 48 We plan further developments to the MPPG technology, making it fully portable and plan further studies to investigate its economic case and its utility in subgroups, for example, diabetes and AF. MPPG offers promise the potential for rapid and accessible PAD assessments in primary care.…”

Are portable ankle brachial pressure index measurement devices suitable for hypertension screening?

“…Traditionally, ABPI is measured using a handheld continuous-wave Doppler instrument [ 6 ] to guide the user in accurately determining the systolic BP. However, this method is time consuming and requires a skilled operator [ 7 ].…”

Diagnostic Accuracy of Ankle-Brachial Pressure Index Compared with Doppler Arterial Waveforms for Detecting Peripheral Arterial Disease: A Systematic Review

“…6 Although the ABPI is the primary noninvasive diagnostic tool, 7 it has several limitations; primarily, it is timeconsuming, with a mandatory 10-minute rest period before testing. 9 Further, it may not detect mild or moderate disease because occlusion may be masked by a rich collateral vascular network. 10 Increased arterial calcification will artificially increase the ABPI, leading to an underestimation of PAD in those with diabetes mellitus, renal disease, advanced age, or connective tissue disease.…”

“…Although the ABPI is the primary noninvasive diagnostic tool, 7 it has several limitations; primarily, it is time-consuming, with a mandatory 10-minute rest period before testing 9 . Further, it may not detect mild or moderate disease because occlusion may be masked by a rich collateral vascular network 10 .…”