Reliability of Ankle-Brachial Index Measurements

Abstract

An ankle-brachial index (ABI) is determined by comparing blood pressures of the extremities. No study that compared the blood pressure measurements obtained by standard or vascular cuffs was found. This study investigated the reliability of ABI measures using standard and vascular pressure cuffs. Two raters measured 480 systolic blood pressures of 10 healthy participants using standard and vascular cuffs. Intrarater reliability for standard cuffs was weak (intraclass correlation coeffi cient [ICC] ϭ 0.42-0.63) and moderate to strong for vascular cuffs (ICC ϭ 0.70-0.87). Interrater reliability was moderate to strong for both standard and vascular cuffs (ICC ϭ 0.83-0.96). Reliability of ABI measures with vascular cuffs was moderate to strong. The results of this study suggest and recommend the vascular cuff for accurate measures to determine reliable ABI values. If a standard cuff is used, the blood pressure should be measured twice and averaged for the ABI calculation.

Systematic review of associations between concomitant rheumatoid arthritis and peripheral arterial disease, health-related quality of life and functional capacity

“…Notably, studies either implemented manual Doppler [ 24 , 30 , 33 , 38 ], sphygmomanometric methods [ 29 ], or automated oscillometry [ 30 , 31 ] in deriving ABPI scores. Manual methodological approaches in ascertaining ABPI posit a degree of observer bias [ 45 ]. ABPI score inaccuracies may have been present since the observer must measure ankle and brachial pressures simultaneously rather than successively [ 45 ].…”

“…Manual methodological approaches in ascertaining ABPI posit a degree of observer bias [ 45 ]. ABPI score inaccuracies may have been present since the observer must measure ankle and brachial pressures simultaneously rather than successively [ 45 ]. Despite reducing the risk of observer bias, no evidence was found validating automated oscillometry in an RA population.…”

The reliability of the ankle brachial index: a systematic review

“…Eleven studies reported participants' gender, with more men ( n = 416, 56.4%) overall than women, whilst gender was unreported in four studies [12, 46, 49, 50]. Most of the studies included predominantly older participants (age range (41–92 years) [12, 13, 16, 47–49, 51, 53–55, 57], however two studies recruited only younger adults (age range 22–30 years) [46, 56], one study included 18–80 year olds [52] and one study did not report participants' ages [50]. The majority of studies [12, 47–51, 55, 57] included only participants with suspected PAD, or risk factors for atherosclerosis; three studied a mixed population including those without risk factors or clinical indicators of PAD [13, 16, 52]; two studies included only participants with diabetes [53, 54], and two studies included only healthy individuals [46, 56].…”

“…There was little consistency in the training and qualifications of the raters used, with experience ranging from students [46, 47] to experienced vascular technicians and/or vascular specialist doctors [12, 13, 48, 54, 57]. Six studies did not state the background of the personnel performing the test [49, 51–53, 55, 56]. The majority of the studies used Doppler and manual sphygmomanometer to measure systolic blood pressures; [12, 13, 16, 46–49, 51–53, 56] however three studies used an automated device to obtain some or all of the pressure readings [54, 55, 57] and one study did not report the method used [50].…”

“…Six studies did not state the background of the personnel performing the test [49, 51–53, 55, 56]. The majority of the studies used Doppler and manual sphygmomanometer to measure systolic blood pressures; [12, 13, 16, 46–49, 51–53, 56] however three studies used an automated device to obtain some or all of the pressure readings [54, 55, 57] and one study did not report the method used [50]. The reported pre‐measurement rest time varied from five minutes [55] to 15 min [48], with seven studies not reporting a period of rest before testing commenced [44, 47, 49, 50, 52–54].…”