Abstract
BackgroundThe ankle brachial index (ABI) is an objective diagnostic tool that is widely used for the diagnosis of peripheral arterial disease. Despite its usefulness, it is evident within the literature that many practitioners forgo using this screening tool due to limiting factors such as time. There is also no recommended technique for ABI measurement. The purpose of this study is to investigate the perceptions of the use of ABI clinically among Western Australian podiatrists.MethodsThis study was a cross sectional survey which evaluated the perceptions of the ABI amongst registered podiatrists in Western Australia. The study sample was obtained from the register of podiatrists listed with the Podiatrists Registration Board of Western Australia. Podiatrists were contacted by telephone and invited to participate in a telephone questionnaire. Chi-square tests were performed to determine if there was a statistically significant relationship between use of the ABI and podiatrists’ profile which included: sector of employment; geographical location; and length of time in practice.ResultsThere is a statistically significant relationship (p=0.004) between podiatrists’ profile and the use of ABI, with higher usage in the tertiary hospital setting than in private practice. Length of time spent in practice had no significant impact on ABI usage (p=0.098). Time constraints and lack of equipment were key limiting factors to performing the ABI, and no preferred technique was indicated.ConclusionWestern Australian podiatrists agree that the ABI is a useful tool for lower limb vascular assessment, however, various factors influence uptake in the clinical setting. This study suggests that a podiatrists’ profile has a significant influence on the use of the ABI, which may be attributed to different patient types across the various settings. The influence of time spent in practice on ABI usage may be attributed to differences in clinical training and awareness of lower limb pathology over time. The authors recommend publication of ‘best practice’ guidelines to ABI performance, as well as further education and financial rebates from health organizations to facilitate increased utility of the ABI based on the findings of this study.
Highlights
The ankle brachial index (ABI) is an objective diagnostic tool that is widely used for the diagnosis of peripheral arterial disease
Responses to this study indicated that geographical area had no impact on a practitioners’ use of the ABI, with 50 out of 78 (64.1%) podiatrists practicing in the metropolitan area and 16 out of 27 (59.2%) podiatrists practicing in rural Western Australia indicating use of the ABI
This higher rate to uptake may be explained by the fact that podiatrists are more aware of the value of the ABI due to the nature of podiatry practice which is focused on lower extremity pathology
Summary
The ankle brachial index (ABI) is an objective diagnostic tool that is widely used for the diagnosis of peripheral arterial disease. The ABI provides an indication of the functional status of circulation in the lower extremity by calculating the ratio of the ankle and brachial systolic blood pressures [1,4]. It is obtained by a simple and non-invasive procedure involving measurement of a patient’s systolic blood pressures at both dorsalis pedis (DP) and tibialis posterior (TP) arteries in both feet as well as the brachial artery in both arms [1]. Previous studies have identified a sensitivity of 95% and specificity of at least 99% when compared against angiography [2,6] This has led to the American Heart Association acknowledging the ABI as having 90% sensitivity and 98% specificity for the detection of stenosis of arteries in the lower limb [1,2,7,8]. The ABI is considered a key diagnostic test in the Trans-Atlantic inter-society consensus for the management of PAD [6]
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