Abstract
BackgroundHand held Doppler examination is a frequently used non-invasive vascular assessment utilised by podiatrists. Despite this, the reliability of hand-held Doppler has not been thoroughly investigated. Given the importance of Doppler in completing a vascular assessment of the lower limb, it is essential to determine the reliability of the interpretation of this testing method in practicing podiatrists.MethodsThis was a multi-centre inter and intra-rater reliability study. Four podiatrists (the raters) participated in this study, two public and two private practitioners. Three aspects of Doppler use were examined; (i) use of Doppler (i.e., technique and interpretation), (ii) interpretation of Doppler audio sounds, and (iii) interpretation of visual Doppler waveforms (i.e., tracings). Participants meeting current guidelines for vascular screening attended two testing sessions, 1 week apart at either the private practice (n = 32), or the public practice (n = 31). To assess use of Doppler, the raters evaluated the Doppler waveforms that they collected, rating them as mono-phasic or multi-phasic. To assess Doppler audio sounds and visual Doppler waveforms, raters were required to evaluate 30 audio recordings of Doppler sounds and 30 waveform tracings, respectively, that were previously recorded and chosen at random by the researchers. Cohen’s kappa (κ) statistics were used to calculate inter and intra-rater reliability using SPSS version 19.ResultsUse of Doppler demonstrated the lowest reliability for both pairs of clinicians (inter-rater reliability κ 0.20 to 0.24 and intra-rater reliability κ 0.27 to 0.42). The public podiatrists showed higher reliability in audio interpretation (inter-tester reliability κ 0.61, intra-tester reliability κ 1.00) compared to the private podiatrists (inter-tester reliability κ 0.31, intra-tester reliability κ 0.53). Evaluation of Doppler waveform tracings demonstrated highest reliability, with inter-rater reliability ranging from κ 0.77 to 0.90 and intra-rater reliability from κ 0.81 to 1.00.ConclusionsThere is a need for ongoing education for podiatrists using Doppler in clinical practice, as the reliability for the clinical use of the Doppler was low. This indicates that technique could be an issue. There is also a need to further evaluate if hand-held Doppler equipment, using the examinations that we evaluated, is suitable for use in the contexts examined in this study.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-015-0097-2) contains supplementary material, which is available to authorized users.
Highlights
Hand held Doppler examination is a frequently used non-invasive vascular assessment utilised by podiatrists
Our results demonstrate that the reliability of Doppler use with classification of waveforms was generally poor
As podiatrists are required to do both simultaneously in clinical practice, our results suggest that further training in Doppler use including concurrent interpretation of visual and audio waveforms, is required for this to be an effective component of noninvasive vascular assessment
Summary
Hand held Doppler examination is a frequently used non-invasive vascular assessment utilised by podiatrists. Given the importance of Doppler in completing a vascular assessment of the lower limb, it is essential to determine the reliability of the interpretation of this testing method in practicing podiatrists. Peripheral arterial disease (PAD) is associated with cardiovascular morbidity and mortality [1] and the development of lower limb wounds, gangrene and amputation. Current recommendations indicate routine lower limb vascular screening is required for those over the age of 65 years, or over 50 years with diabetes or a history of smoking [5]. Podiatrists are in an ideal position to carry out vascular screening on a regular basis, as people who are older and have diabetes frequently seek podiatric care [6].
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