Abstract
Cutaneous microcirculatory impairments are associated with skin injury to the foot. Post-Occlusive reactive hyperemia (PORH) is one of the quick and easy methods to assess microcirculatory function. However, there are variations in the protocols currently used. Hence, this study aimed to systematically investigate the reproducibility of PORH protocols with minimal occlusion time in the foot. Post-Occlusive reactive hyperemia was measured using 12 different protocols (three occlusion times, two occlusion sites and with or without temperature control) in 25 healthy adults. Each of the 12 different protocols was repeated three times, and the intraclass correlation coefficient (ICC) was calculated. Intraclass correlation coefficient showed that that ankle level occlusion produced moderate to excellent reproducibility for most PORH measures. In the right foot, 30- and 60-s ankle level occlusion without temperature control showed ICC of >0.40 for all parameters except the area of hyperemia (ICC=-0.36) and biological zero to peak flow percent change (ICC=-0.46). In the left foot, 30-s ankle level occlusion without temperature control showed ICC of >0.40 for all parameters except time to latency (ICC=0.29), after hyperemia (ICC=0.37), and max (ICC=-0.01), and area of hyperemia (ICC=-0.36). But the 60-s protocol showed ICC>0.40 for all except time to max (ICC=0.38). In the hallux protocols, all three 10-, 30-, and 60-s protocols without temperature control showed moderate to excellent reproducibility (ICC>0.40). In most cases, the temporal and area under the perfusion-time curve parameters showed poor reproducibility. Post-Occlusive reactive hyperemia can be tested efficiently with a minimal occlusion time of 10s with hallux occlusion and 30s with ankle occlusion in the foot. This can suggest that microcirculatory assessment is feasible in routine practice and can potentially be included for routine assessment of foot in people with diabetes.
Highlights
For long the peripheral vascular function assessments have relied on macrocirculatory measures such as Ankle Brachial Index (ABI) and Toe Brachial Index (TBI)
Even assessment of peripheral vascular function in at-risk individuals for complications such as foot ulcers, clinical decisions, and risk stratification are based on guidelines that have been traditionally limited to measures such as ABI and TBI 1–5
Various provocation tests are used to assess the cutaneous microcirculatory responses such as heat provocation, cold provocation, postural changes and application of pressure stimuli [9,10,11]. One such test is Post Occlusive Reactive Hyperemia (PORH), which is the transient increase in blood flow in the organ or tissue that occurs following a brief period of arterial occlusion [12,13]
Summary
For long the peripheral vascular function assessments have relied on macrocirculatory measures such as Ankle Brachial Index (ABI) and Toe Brachial Index (TBI). Even assessment of peripheral vascular function in at-risk individuals for complications such as foot ulcers, clinical decisions, and risk stratification are based on guidelines that have been traditionally limited to measures such as ABI and TBI 1–5. Various provocation tests are used to assess the cutaneous microcirculatory responses such as heat provocation, cold provocation, postural changes and application of pressure stimuli [9,10,11]. One such test is Post Occlusive Reactive Hyperemia (PORH), which is the transient increase in blood flow in the organ or tissue that occurs following a brief period of arterial occlusion [12,13].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
