Changes in functional status after treatment of critical limb ischemia.

OBJECTIVE: This study evaluated changes in functional status with the Academic Medical Center Linear Disability Score (ALDS) and in quality of life with the Vascular Quality of Life Questionnaire (VascuQol) in patients treated for critical limb ischemia (CLI). METHODS: We conducted a prospective observational cohort study in a single academic center that included consecutive patients with CLI who presented between May 2007 and May 2010. The ALDS and VascuQol questionnaires were administered before treatment (baseline) and after treatment at 6 and 12 months of follow-up. Changes in functional status (ALDS) and quality of life (VascuQol) scores after 6 and 12 months, compared with baseline, were tested with the appropriate statistical tests, with significance set at P < .05. RESULTS: The study included 150 patients, 96 (64%) were men, and mean (± standard deviation) age was 68.1 (± 12.4) years. The primary treatment was endovascular in 98 (65.3%), surgical in 36 (24%), conservative in 11 (7.3%), or a major amputation in five (3.3%). The ALDS was completed by 112 patients after 12 months. At that time, the median ALDS score had increased by 10 points (median, 83; range, 12-89; P = .001) in patients who achieved limb salvage, which corresponds with more difficult outdoor and indoor activities. In patients with a major amputation, the median ALDS score decreased by 14 points (median, 55; range, 16-89; P = .117) after 12 months, which corresponds with domestic activities only. VascuQol scores improved significantly in all separate domains for the limb salvage group (P < .001). All VascuQol scores, except for the activity and social domains, increased significantly after amputation. CONCLUSIONS: Our study confirms the clinical validity of the ALDS in patients treated for CLI and shows that it is a valuable and sophisticated instrument to measure changes in functional status in these patients.

The relationship of walking distances estimated by the patient, on the corridor and on a treadmill, and the Walking Impairment Questionnaire in intermittent claudication.

OBJECTIVE: Physicians and patients consider the limited walking distance and perceived disability when they make decisions regarding (invasive) treatment of intermittent claudication (IC). We investigated the relationship between walking distances estimated by the patient, on the corridor and on a treadmill, and the Walking Impairment Questionnaire (WIQ) in patients with IC due to peripheral arterial disease. METHODS: This was a single-center, prospective observational cohort study at a vascular laboratory in a university hospital in the Netherlands. The study consisted of 60 patients (41 male) with a median age of 64 years (range, 44-86 years) with IC and a walking distance ≤ 250 m on a standardized treadmill test. Main outcome measures were differences and Spearman rank correlations between pain-free walking distance, maximum walking distance (MWD) estimated by the patient, on the corridor and on a standardized treadmill test, and their correlation with the WIQ. RESULTS: The median patients' estimated, corridor, and treadmill MWD were 200, 200, and 123, respectively (P < .05). Although the median patients' estimated and corridor MWD were not significantly different, there was a difference on an individual basis. The correlation between the patients' estimated and corridor MWD was moderate (r = 0.61; 95% confidence interval [CI], 0.42-0.75). The correlation between patients' estimated and treadmill MWD was weak (r = 0.39; 95%, CI 0.15-0.58). Respective correlations for the pain-free walking distance were comparable. The patients' estimated MWD was moderately correlated with WIQ total score (r = 0.63; 95%, CI 0.45-0.76) and strongly correlated with WIQ distance score (r = 0.81; 95% CI, 0.69-0.88). The correlation between the corridor MWD and WIQ distance score was moderate (r = 0.59; 95% CI, 0.40-0.74). CONCLUSIONS: Patients' estimated walking distances and on a treadmill do not reflect walking distances in daily life. Instruments that take into account the perceived walking impairment, such as the WIQ, may help to better guide and evaluate treatment decisions.

Validation of the Dutch version of the VascuQol questionnaire and the Amsterdam Linear Disability Score in patients with intermittent claudication.

PURPOSE: To assess the reliability and validity of the Dutch version of the vascular quality of life questionnaire (VascuQol) and the AMC Linear Disability Score (ALDS) in patients with stable intermittent claudication (IC). METHODS: During a 5-month period we performed a prospective study in which we included every patient with stable IC, who visited our vascular surgery outpatient clinic and consented to participate. Forty consecutive patients filled in the Dutch VascuQol, the ALDS, and Short Form-36 (SF-36). Twenty patients filled in the same questionnaires after 4 weeks. Internal reliability consistencies were expressed as Cronbach's α. Test-retest reliability was expressed as intraclass correlation coefficients (ICC). Construct validity was expressed as Spearman rho correlations between SF-36 and relevant domains of Dutch VascuQol and the ALDS. RESULTS: Internal reliability consistencies were, respectively, good and excellent for the total scores of VascuQol, SF-36, and ALDS (Cronbach's α. 0.87, 0.89, and 0.92). Test-retest reliability was excellent for the total VascuQol scores [ICC 0.91 (95% CI, 0.78-0.96)], and for the ALDS [ICC 0.90 (95% CI, 0.76-0.96)]. Spearman correlations between VascuQol, ALDS, and SF-36 domains varied from r = 0.34-0.79. CONCLUSION: The Dutch VascuQol is a valid and reliable questionnaire for assessment of Qol in patients with IC. This study confirms the good clinimetric properties of the ALDS for assessing disability in patients with IC.