Abstract
BackgroundThe Ankle Brachial Index is a useful clinical test for establishing blood supply to the foot. However, there are limitations to this method when conducted on people with diabetes. As an alternative to the Ankle Brachial Index, measuring Toe Systolic Pressures and the Toe Brachial Index have been recommended to assess the arterial blood supply to the foot. This study aimed to determine the intra and inter-rater reliability of the measurement of Toe Systolic Pressure and the Toe Brachial Index in patients with diabetes using a manual measurement system.MethodsThis was a repeated measures, reliability study. Three raters measured Toe Systolic Pressure and the Toe Brachial Index in thirty participants with diabetes. Measurement sessions occurred on two occasions, one week apart, using a manual photoplethysmography unit (Hadeco Smartdop 45) and a standardised measurement protocol.ResultsThe mean intra-class correlation for intra-rater reliability for toe systolic pressures was 0.87 (95% LOA: -25.97 to 26.06 mmHg) and the mean intra-class correlation for Toe Brachial Indices was 0.75 (95% LOA: -0.22 to 0.28). The intra-class correlation for inter-rater reliability was 0.88 for toe systolic pressures (95% LOA: -22.91 to 29.17.mmHg) and 0.77 for Toe Brachial Indices (95% LOA: -0.21 to 0.22).ConclusionDespite the reasonable intra-class correlation results, the range of error (95% LOA) was broad. This raises questions regarding the reliability of using a manual sphygmomanometer and PPG for the Toe Systolic Pressure and Toe Brachial Indice.
Highlights
The Ankle Brachial Index is a useful clinical test for establishing blood supply to the foot
The prevalence of diabetes is increasing with peripheral arterial collusive disease (PAOD) being a common condition in this population [1,2,3,4]
The Ankle Brachial Index (ABI) is a very useful clinical test to assess the arterial blood supply to the foot, but there are limitations to this method when conducted on people with diabetes [8,15,16]
Summary
The Ankle Brachial Index is a useful clinical test for establishing blood supply to the foot. As an alternative to the Ankle Brachial Index, measuring Toe Systolic Pressures and the Toe Brachial Index have been recommended to assess the arterial blood supply to the foot. The prevalence of diabetes is increasing with peripheral arterial collusive disease (PAOD) being a common condition in this population [1,2,3,4]. The ABI is a very useful clinical test to assess the arterial blood supply to the foot, but there are limitations to this method when conducted on people with diabetes [8,15,16]. Known as Mönckeberg’s sclerosis, causes the hardening and incompressibility of arteries which can affect the accuracy of ABIs [17,18]. In addition Mönckeberg’s sclerosis is highly prevalent in autonotmic neuropathy and chronic renal insufficiency [19]
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