Walking Impairment Questionnaire Distance Score Research Articles

Gujarati translation, validity and reliability of Walking Impairment Questionnaire in people with intermittent claudication due to peripheral artery disease

IntroductionThe Walking Impairment Questionnaire (WIQ) is a common and easy-to-use assessment of walking incapacity in people with claudication due to peripheral artery disease (PAD). It has four subscales: pain severity, walking distance, walking speed, and ability to climb stairs. It has not been translated into Gujarati, which limits its use in Indian subjects. AimThis study aims to translate and assess the validity and reliability of a Gujarati version of WIQ. Materials and MethodsThis study had three phases: 1. Forward and backward translation and Cultural adaptation of WIQ into the Gujarati language by two independent translators, 2. Face and content validation by six clinical reviewers and 10 participants with PAD and Type II diabetes, 3. Concurrent and construct validity, test-retest reliability, and internal consistency of Gujarati, the WIQ was assessed on 160 participants with PAD and Type II diabetes who had a mean Ankle Brachial Index (standard deviation) <0.40 (0.1). The concurrent and construct validity of the WIQ was analyzed by correlating the WIQ distance and speed score with 6-minute walk distance (6MWD) and speed and WIQ total score with the Medical Outcome Study Questionnaire Short Form 36 (SF-36) score using Pearson's correlation coefficient. Test-retest reliability was analyzed using an intraclass correlation coefficient (ICC) with a seven-day interval between two questionnaire applications. Internal consistency of the total WIQ score was determined using Cronbach's alpha. ResultsFollowing translation, the Gujarati WIQ was considered acceptable and understandable by people with PAD. There was excellent correlation between the WIQ distance score and 6-minute walk test distance (r = 0.95, P < .05)) , the WIQ speed score and 6-minute walk test speed score (r = 0.89, P < .05)) and the Gujarati WIQ total score and total score of physical functioning domain of SF- 36 (r = 0.99, P < .05). There was excellent test-retest reliability over 7 days for total WIQ score (ICC = 0.94). The Cronbach's alpha for internal consistency of 0.97 for total WIQ score were excellent. This demonstrates the sufficient homogeneity of the total questionnaire. ConclusionThe Gujarati version of the WIQ is reliable and valid and can be used to assess self-reported walking impairment in Gujarati-speaking people with PAD and Type II Diabetes.

Study Design, Rationale, and Methodology for Promote Weight Loss in Patients With Peripheral Artery Disease Who Also Have Obesity: The PROVE Trial.

Background Overweight and obesity are associated with adverse functional outcomes in people with peripheral artery disease (PAD). The effects of weight loss in people with overweight/obesity and PAD are unknown. Methods The PROVE (Promote Weight Loss in Obese PAD Patients to Prevent Mobility Loss) Trial is a multicentered randomized clinical trial with the primary aim of testing whether a behavioral intervention designed to help participants with PAD lose weight and walk for exercise improves 6-minute walk distance at 12-month follow-up, compared with walking exercise alone. A total of 212 participants with PAD and body mass index ≥25 kg/m2 will be randomized. Interventions are delivered using a Group Mediated Cognitive Behavioral intervention model, a smartphone application, and individual telephone coaching. The primary outcome is 12-month change in 6-minute walk distance. Secondary outcomes include total minutes of walking exercise/wk at 12-month follow-up and 12-month change in accelerometer-measured physical activity, the Walking Impairment Questionnaire distance score, and the Patient-Reported Outcomes Measurement Information System mobility questionnaire. Tertiary outcomes include 12-month changes in perceived exertional effort at the end of the 6-minute walk, diet quality, and the Short Physical Performance Battery. Exploratory outcomes include changes in gastrocnemius muscle biopsy measures of mitochondrial cytochrome C oxidase activity, mitochondrial biogenesis, capillary density, and inflammatory markers. Conclusions The PROVE randomized clinical trial will evaluate the effects of exercise with an intervention of coaching and a smartphone application designed to achieve weight loss, compared with exercise alone, on walking performance in people with PAD and overweight/obesity. Results will inform optimal treatment for the growing number of patients with PAD who have overweight/obesity. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04228978.

Perceived Versus Objective Change in Walking Ability in Peripheral Artery Disease: Results from 3 Randomized Clinical Trials of Exercise Therapy.

BackgroundIn people with lower‐extremity peripheral artery disease, the effects of exercise on patient‐reported outcomes remain unclear.Methods and ResultsFour hundred four people with peripheral artery disease in 3 clinical trials were randomized to exercise (N=205) or a control group (N=199) and completed the 6‐minute walk and the Walking Impairment Questionnaire distance score (score 0–100, 100=best) at baseline and 6‐month follow‐up. Compared with the control group, exercise improved 6‐minute walk distance by +39.8 m (95% CI, 26.8–52.8, P<0.001) and the Walking Impairment Questionnaire distance score by +7.3 (95% CI, 2.4–12.1, P=0.003). In all, 2828 individual Walking Impairment Questionnaire distance score questions were completed at baseline and follow‐up. Among participants who perceived no change in ability to walk 1 or more distances between baseline and follow‐up, 6‐minute walk improved in the exercise group and declined in the control group (+26.8 versus −6.5 m, P<0.001). Among participants who perceived that their walking ability worsened for 1 or more distances between baseline and follow‐up, the 6‐minute walk improved in the exercise group and declined in the control group (+18.4 versus –27.3 m, P<0.001). Among participants who reported worsening calf symptoms at follow‐up, the exercise group improved and the control group declined (+28.9 versus −12.5 m, P<0.01).ConclusionsIn 3 randomized trials, exercise significantly improved the 6‐minute walk distance in people with peripheral artery disease, but many participants randomized to exercise reported no change or decline in walking ability. These findings suggest a significant discrepancy in objectively measured walking improvement relative to perceived walking improvement in people with peripheral artery disease.Registration Informationclinicaltrials.gov. Identifiers: NCT 00106327, NCT 01408901.

Satisfaction and Acceptability of Telemonitored Home-Based Exercise in Patients With Intermittent Claudication: Pragmatic Observational Pilot Study.

BackgroundCurrent guidelines recommend supervised exercise training (SET) as a first-line treatment in patients with intermittent claudication (IC). SET has been shown to be more effective than home-based exercise therapy (HBET). However, the lack of available SET programs hampers broad SET implementation in clinical practice.ObjectiveThe aim of this study is to assess patient satisfaction and acceptability of a structured HBET program using wearable technology and elastic band resistance exercises.MethodsA total of 20 patients with IC (Rutherford 1-3) with internet access and currently not engaged in structured exercise training were recruited in a pragmatic observational pilot study. Participants were instructed to complete 3 walking sessions and 2 elastic band resistance exercise sessions per week in their home environment during a 4-week period. Patient satisfaction and acceptability were assessed using a 5-point Likert scale questionnaire (1-2=very unsatisfied, 3=neutral, and 4-5=very satisfied) evaluating the materials and intervention content. Secondary outcomes were evaluated at baseline and at completion of the 4-week intervention and included maximal walking distance (MWD) and pain-free walking distance (PFWD), physical fitness, and patient-reported outcomes on quality of life, walking capacity, levels of kinesiophobia, and self-efficacy. Statistically significant changes were tested using paired t tests or Wilcoxon signed-rank tests.ResultsAll patients (15 men, 5 women; mean age 64.6, SD 10.6 years; range 41-81 years) completed the 4-week intervention and were highly satisfied with the program (mean overall score 4.5, SD 0.5). Patients’ questionnaire responses documented willingness to recommend the exercise program to other patients (mean 4.5, SD 0.5; median 4.5) and preference for continuing the intervention (mean 4.3, SD 0.5; median 4). Furthermore, participants endorsed the use of the sports watches to track walking sessions (mean 4.25, SD 0.6; median 4), felt safe (mean 4.4, SD 0.6; median 4), and appreciated personal feedback (mean 4.55, SD 0.5; median 5) and flexibility of training (mean 4.1, SD 0.7; median 4). Resistance training was not preferred over walking training (mean 2.65, SD 0.8; median 3). In addition, PFWD (+89 m; P=.001), MWD (+58 m; P=.03), Walking Impairment Questionnaire distance score (+0.18; P=.01), activity-related scores (+0.54; P<.001), and total quality of life (+0.36; P=.009) improved following the intervention. Other patient-related outcomes, physical fitness, and physical activity remained to be statistically unaltered.ConclusionsPatients with IC were satisfied and accepted technology to monitor and guide HBET, with observed short-term effectiveness regarding walking capacity and quality of life. However, elastic band resistance exercises as a part of HBET were not preferred over progressive walking.Trial RegistrationClinicalTrials.gov NCT04043546; https://clinicaltrials.gov/ct2/show/NCT04043546

Association between meeting daily step count goals with ambulatory function and quality of life in patients with claudication

ObjectiveTo determine (a) whether patients with peripheral artery disease (PAD) who walked at least 7000 and 10,000 steps/day had better ambulatory function and health-related quality of life (HRQoL) than patients who walked less than 7000 steps/day, and (b) whether differences in ambulatory function and HRQoL in patients grouped according to these daily step count criteria persisted after adjusting for covariates. MethodsTwo hundred forty-eight patients were assessed on their daily ambulatory activity for 1 week with a step activity monitor, and were grouped according to daily step count targets. Patients who took fewer than 7000 steps/day were included in group 1 (n = 153), those who took 7000 to 9999 steps/day were included in group 2 (n = 57), and patients who took at least 10,000 steps/day were included in group 3 (n = 38). Primary outcomes were the 6-minute walk distance (6MWD) and Walking Impairment Questionnaire (WIQ) distance score, which is a disease-specific measurement of HRQoL. Patients were further characterized on demographic variables, comorbid conditions, and cardiovascular risk factors. ResultsThe groups were significantly different on ankle-brachial index (P = .02), and on the prevalence of hypertension (P = .04), diabetes (P < .01), abdominal obesity (P < .01), arthritis (P = .04), and chronic obstructive pulmonary disease (P < .01). Thus, these variables served as covariates in adjusted analyses, along with age, weight, and sex. The 6MWD (mean ± standard deviation) was significantly different among the groups in unadjusted (P < .01) and adjusted (P < .01) analyses (group 1, 313 ± 90 m; group 2, 378 ± 84 m; and group 3, 414 ± 77 m), with groups 2 and 3 having a higher 6MWD than group 1 (P < .01). The WIQ distance score was significantly different among the groups in unadjusted (P < .01) and adjusted (P < .01) analyses (group 1, 30 ± 30%; group 2, 45 ± 35%; and group 3, 47 ± 34%), with groups 2 and 3 having higher WIQ distance scores than group 1 (P < .01). ConclusionsPatients with PAD who walked more than 7000 and 10,000 steps/day had greater ambulatory function and HRQoL than patients who walked fewer than 7000 steps/day. Second, the greater ambulatory function and HRQoL associated with walking 7000 and 10,000 steps/day persisted after adjusting for covariates. This study provides preliminary evidence that patients with PAD who walk more than 7000 steps/day have better ambulatory function and HRQoL than patients below this threshold.

Abstract 14421: Association Between Meeting Daily Step Count Goals With Ambulatory Function and Quality of Life in Patients With Claudication

Introduction: The aims were to determine (a) whether patients with peripheral artery disease (PAD) who walked at least 7,000 and 10,000 steps/day had better ambulatory function and health-related quality of life (HRQoL) than patients who walked less than 7,000 steps/day, and (b) whether these group differences persisted after adjusting for covariates. Hypothesis: Patients who walk at least 7,000 steps/day have significantly better ambulatory function, as measured by greater 6-minute walk distance (6MWD), and better HRQoL, as measured by a higher distance score on the Walking Impairment Questionnaire (WIQ), than patients who walked less than 7,000 steps/day, and that patients who walked more than 10,000 steps/day would have the best values. Furthermore, group differences in the primary outcomes would persist after adjustment for covariates. Methods: Two hundred forty-eight patients were assessed on their daily activity for one week with a step activity monitor, and were grouped according to daily step counts as follows: Group 1 (&lt;7,000 steps/day; n=153), Group 2 (7,000-9,999 steps/day; n=57), Group 3 (&gt;10,000 steps/day; n=38). Primary outcomes were 6MWD and WIQ distance score, which is a disease-specific measurement of HRQoL. Results: Groups were different (p&lt;0.05) on ankle/brachial index, and on prevalence of hypertension, diabetes, abdominal obesity, arthritis, and chronic obstructive pulmonary disease. Thus, these variables served as covariates in adjusted analyses, along with age, weight, and sex. 6MWD (mean±SD) was significantly different among the groups in unadjusted (p&lt;0.01) and adjusted (p&lt;0.01) analyses (Group 1=313±90 m, Group 2=378±84 m, Group 3=414±77 m), with Groups 2 and 3 having higher 6MWD than Group 1 (p&lt;0.01). Similar results were found for the WIQ distance score (Group 1=30±30%, Group 2=45±35%, Group 3=47±34%; p&lt;0.01). Conclusions: PAD patients who walked more than 7,000 and 10,000 steps/day had greater ambulatory function and HRQoL than patients who walked fewer than 7,000 steps/day, and this finding persisted after adjusting for covariates. The clinical significance is that PAD patients should be encouraged to walk more than 7,000 steps/day because this target is associated with greater ambulatory function and HRQoL

Meaningful change in 6-minute walk in people with peripheral artery disease

ObjectiveThe 6-minute walk test is a common outcome measure in clinical trials of people with lower extremity peripheral artery disease (PAD). However, what constitutes a meaningful change in the 6-minute walk distance has not been well defined for people with PAD. The present study related the change in the 6-minute walk distance to the degree of participant-reported improvement or decline in the 6-minute walk distance to define a meaningful change in the 6-minute walk distance for those with PAD. MethodsParticipants with PAD from three observational longitudinal studies completed the walking impairment questionnaire (WIQ) distance score and 6-minute walk at baseline and 1 year later. The WIQ distance score measures participants' perceived difficulty walking seven different distances without stopping (ranging from walking around the home to walking 5 blocks) on a 0 to 4 Likert scale, with 0 representing an inability to walk the distance and 4 representing no difficulty. The mean changes in the 6-minute walk distance corresponding to the participants' report of no change, 1-unit change, or 2-unit change, respectively, in the Likert scale score between the baseline and 1-year follow-up measures were calculated for each WIQ distance. ResultsA total of 777 participants with PAD (mean age, 71.2 ± 8.8 years; mean baseline 6-minute walk distance, 350.1 ± 118.1 meters) completed 5439 questions about their difficulty walking each WIQ distance at baseline and follow-up. Participants with PAD who reported no change in their difficulty in walking each WIQ distance between baseline and follow-up had a decline of 7.2 meters (95% confidence interval [CI], −11.6 to −2.8 meters) in the 6-minute walk test. Relative to those reporting no change in difficulty walking, the participants reporting 1- and 2-point improvements in walking ability showed 6-minute walk distance improvements of 7.8 meters (95% CI, −0.3 to 15.9 meters) and 20.1 meters (95% CI, 1.1-39.2 meters), respectively. Relative to those reporting no change in walking difficulty, those reporting 1- and 2-point declines in perceived walking difficulty showed declines of −11.2 meters (95% CI, −19.0 to −3.4 meters) and −23.8 meters (95% CI, −37.4 to −10.3 meters) in the 6-minute walk distance. ConclusionsAmong people with PAD, ∼8- and ∼20-meter improvements in the 6-minute walk distance represent small and large improvements in walking ability, respectively. People with PAD who reported no change in their ability to walk distances over 1 year simultaneously declined by a mean of 7 meters in the 6-minute walk test. These findings will be useful for interpreting the results from randomized trials of interventions to improve the walking performance of people with PAD.

Diabetes Impairs Walking Capacity And Autonomic Function In Patients With Peripheral Artery Disease

Diabetes is a high prevalent comorbid condition in patients with peripheral arterial disease (PAD). Previous studies showed that diabetes impair physical function in PAD patients. However, whether cardiovascular function is also affected by diabetes is unknown. PURPOSE: To compare walking capacity and cardiovascular function in PAD patients with and without diabetes. A total of 80 patients (n=41 non-diabetic and n=39 diabetic) with PAD were recruited. Six-minute walk test (total walking capacity), 4-meter test, walking impairment questionnaire (WIQ) and the walking estimated-limitation calculated by history (WELCH) were used to assess walking capacity. Cardiovascular function was assessed by blood pressure, arterial stiffness, heart rate variability and flow-mediated dilation. Mann-Whitney U test were performed, and data are presented in median and interquartile range. RESULTS: Diabetic PAD patients presented lower total walking capacity (308 ± 120 m vs. 370 ± 125m, p=0.025), WIQ distance score (10 ±23 vs. 30 ±46, p=0.002), WIQ speed score (17 ± 21 vs. 28 ± 27, p=0.001), WIQ stairs score (21 ± 42 vs. 42 ± 42, p=0.024), WELCH total score (20 ± 26 vs. 40 ± 42, p=0.006) compared to non-diabetic PAD patients. In addition, diabetic PAD patients had lower SDNN (22 ± 21 vs. 29 ± 36, p=0.030), and a trend to have lower RMSSD (13 ± 19 vs. 19 ± 32, p=0.061), and PNN50 (0.4 ± 3.7 vs. 1.6 ±21.0, p=0.072). The remaining variables were similar between PAD patients with and without diabetes. CONCLUSION: Diabetes impairs walking capacity and cardiac autonomic modulation in patients with PAD. Therefore, interventions to improve these parameters should be emphasized in diabetic PAD patients. Supported by FAPESP (# 2016/16425-9) and CNPq (#310508/2017-7)

Predictors of Health-Related Quality of Life in Patients with Symptomatic Peripheral Arterial Disease

PURPOSE: To identify predictors of baseline measures of health-related quality of life (HRQoL) in symptomatic patients with peripheral artery disease (PAD) from objective markers of severity of PAD, clinical and demographic characteristics, comorbid conditions, cardiovascular risk factors, objectively measured physical activity, and patient-based measures of physical function. METHODS: HRQoL measurements of 216 symptomatic men and women with PAD were assessed with the Medical Outcomes Study Short-Form 36 survey. Patients were further characterized on demographic variables, comorbid conditions, cardiovascular risk factors, ankle/brachial index, peak walking time (PWT) during a maximal treadmill test, 6-minute walk distance (6MWD), gait speed, ambulatory activity monitored during one week, activities of daily living (ADL), mini-mental state examination questionnaire, and walking impairment questionnaire (WIQ). RESULTS: For the physical function HRQoL subscale, the significant predictors included WIQ speed score (p < 0.001), a history of stumbling (p < 0.001), WIQ stair climbing score (p < 0.001), the ADL associated with bathing (p = 0.001), 6MWD (p = 0.004), and daily walking cadence (p = 0.043). For the role emotional function HRQoL subscale, the significant predictors included a history of stumbling (p < 0.001), the ADL associated with transferring from a bed to a chair (p < 0.001), and the WIQ distance score (p = 0.022). CONCLUSIONS: Physical and mental subscales of HRQoL in symptomatic patients with PAD are primarily predicted by patient-based physical function, rather than by more specific markers of PAD severity and comorbid conditions. The clinical significance is that interventions designed to improve HRQoL should focus on improving the quality of executing functional tasks such as walking more steadily without stumbling, completing ADL’s that are not specific to walking, such as bathing and transferring, and improving patient-based ability to walk various distances, speeds, and to climb stairs.

Predictors of health-related quality of life in patients with symptomatic peripheral artery disease

ObjectiveThe aim of this study was to identify predictors of baseline measures of health-related quality of life (HRQoL) in symptomatic patients with peripheral artery disease (PAD) from objective markers of severity of PAD, clinical and demographic characteristics, comorbid conditions, cardiovascular risk factors, objectively measured physical activity, and patient-based measures of physical function. MethodsHRQoL measurements of 216 symptomatic men and women with PAD were assessed with the Medical Outcomes Study 36-Item Short Form Health Survey. Patients were further characterized on demographic variables, comorbid conditions, cardiovascular risk factors, ankle-brachial index, peak walking time during a maximal treadmill test, 6-minute walk distance, gait speed, ambulatory activity monitored during 1 week, activities of daily living (ADLs), Mini-Mental State Examination questionnaire, and Walking Impairment Questionnaire (WIQ). ResultsFor the physical function HRQoL subscale, the significant predictors included WIQ speed score (P < .001), history of stumbling (P < .001), WIQ stair climbing score (P < .001), ADL associated with bathing (P = .001), 6-minute walk distance (P = .004), and daily walking cadence (P = .043). For the role emotional function HRQoL subscale, the significant predictors included a history of stumbling (P < .001), the ADL associated with transferring from a bed to a chair (P < .001), and the WIQ distance score (P = .022). ConclusionsPhysical and mental subscales of HRQoL in symptomatic patients with PAD are primarily predicted by patient-based physical function rather than by more specific markers of PAD severity and comorbid conditions. The clinical significance is that interventions designed to improve HRQoL should focus on improving the quality of executing functional tasks, such as walking more steadily without stumbling; completing ADLs that are not specific to walking, such as bathing and transferring; and improving patient-based ability to walk various distances and speeds and to climb stairs.

Abstract 112: Exploring Sleep Disturbance Among Patients With Symptomatic Peripheral Artery Disease: Results From the Project Voice Pilot Study

Background: Sleep disturbance is an important determinant of both mental and physical health-related quality of life (QOL). Associations between sleep disturbance and subclinical cardiovascular disease have been described but little is known about it among patients with symptomatic PAD. We studied sleep disturbance in symptomatic PAD patients using a wearable device for 30 days. Methods: Patients with claudication confirmed by ABI&lt;0.9 were recruited to participate. Participants received walking exercise instruction, a wearable device to track walking activity and sleep, and an iPad with access to a PAD-specific digital health platform with educational materials and patient surveys. Participants set personal walking goals, received weekly telephone follow up, and completed quality of life instruments [Walking Impairment Questionnaire (WIQ) and VascuQol-6] at baseline and post-completion. Poisson regression was used to examine associations between number of nights with sleep interruption, patient characteristics and survey responses. Results: Twenty participants enrolled and completed the study; 35% were female; 30% were African American. Mean age was 69±9 years; mean ABI was 0.69±0.14. Over a mean study period of 34±6 days, sleep data were recorded an average of 28±6 days and walking activity on 12±10 days. Mean nights of interrupted sleep was 1.3±1.8; 8 participants (40%) had sleep interruption at least one night. No associations were observed between daily walking activity or VascuQol-6 scores and sleep disturbance. Increases in sleep disturbance were associated with higher (i.e., more severe) WIQ distance (P=0.02) and stair (P=0.03) scores at baseline, and WIQ distance (P=0.03), speed (P=0.002) and overall (P=0.009) scores at study completion. Conclusions: These observations suggest that sleep disturbance impacts walking, disability and QOL among people with symptomatic PAD. Further investigation is warranted to characterize sleep disturbance among patients with both claudication and critical limb ischemia, evaluate associations with disease severity, and explore utility as a treatment outcome.

Home-based walking exercise in peripheral artery disease: 12-month follow-up of the GOALS randomized trial.

BackgroundWe studied whether a 6‐month group‐mediated cognitive behavioral (GMCB) intervention for peripheral artery disease (PAD) participants, which promoted home‐based walking exercise, improved 6‐minute walk and other outcomes at 12‐month follow‐up, 6 months after completing the intervention, compared to a control group.Methods and ResultsWe randomized PAD participants to a GMCB intervention or a control group. During phase I (months 1 to 6), the intervention used group support and self‐regulatory skills during weekly on‐site meetings to help participants adhere to home‐based exercise. The control group received weekly on‐site lectures on topics unrelated to exercise. Primary outcomes were measured at the end of phase I. During phase II (months 7 to 12), each group received telephone contact. Compared to controls, participants randomized to the intervention increased their 6‐minute walk distance from baseline to 12‐month follow‐up, (from 355.4 to 381.9 m in the intervention versus 353.1 to 345.6 m in the control group; mean difference=+34.1 m; 95% confidence interval [CI]=+14.6, +53.5; P<0.001) and their Walking Impairment Questionnaire (WIQ) speed score (from 36.1 to 46.5 in the intervention group versus 34.9 to 36.5 in the control group; mean difference =+8.8; 95% CI=+1.6, +16.1; P=0.018). Change in the WIQ distance score was not different between the 2 groups at 12‐month follow‐up (P=0.139).ConclusionsA weekly on‐site GMCB intervention that promoted home‐based walking exercise intervention for people with PAD demonstrated continued benefit at 12‐month follow‐up, 6 months after the GMCB intervention was completed.Clinical Trial RegistrationURL: ClinicalTrials.gov. Unique identifier: NCT00693940.

Clot strength is negatively associated with ambulatory function in patients with peripheral artery disease and intermittent claudication.

Peripheral artery disease (PAD) is associated with exercise impairment and greater thrombotic risk. We investigated whether clot formation and platelet aggregation assessed by thromboelastography and light-transmission aggregometry correlate with the severity of symptomatic PAD assessed by ambulatory function measures. We studied 40 symptomatic patients with PAD in whom severity of disease was assessed using ankle-brachial index, peak walking time (PWT), claudication onset time, peak oxygen uptake, daily ambulatory activity, and walking impairment questionnaire (WIQ) scores. Clot strength correlated negatively with peak oxygen uptake, PWT, WIQ distance, and stair-climbing scores. Time to clot formation did not correlate with exercise parameters. Platelet aggregation was negatively correlated with WIQ distance score and was positively correlated with PWT and peak oxygen uptake. In conclusion, clot strength and platelet aggregation correlated with objective and self-perceived ambulatory measures. Patients with PAD having more severe walking impairment may be likely to form stronger clots.

Declining Walking Impairment Questionnaire Scores Are Associated With Subsequent Increased Mortality in Peripheral Artery Disease

This study determined whether greater 2-year declines in Walking Impairment Questionnaire (WIQ) stair climbing, distance, or speed scores were associated with higher all-cause and cardiovascular disease (CVD) mortality among men and women with lower extremity peripheral artery disease (PAD). Associations of decline in the WIQ with mortality among people with PAD are unknown. Participants were 442 men and women with PAD identified from Chicago area medical centers. The WIQ was completed at baseline and at 2-year follow-up. Cox proportional hazard models were used to assess associations across categories of 2-year changes in WIQ stair climbing, WIQ distance, and WIQ speed scores with subsequent all-cause and CVD mortality, adjusting for age, sex, race, ankle-brachial index, body mass index, smoking, comorbidities, and other covariates. One hundred twenty-three participants (27.8%) died during a median follow-up of 4.7 years after the 2-year change in WIQ score measurements. Forty-five participants died from CVD. Adjusting for covariates, participants with WIQ score declines ≥20.0 points had higher all-cause mortality (hazard ratio [HR]: 1.93, 95% confidence interval [CI]: 1.01 to 3.68 for WIQ stair climbing; HR: 2.34, 95% CI: 1.15 to 4.75 for WIQ distance; and HR: 3.55, 95% CI: 1.57 to 8.04 for WIQ speed, respectively) compared with participants with ≥20.0 point improvement in each of the corresponding WIQ categories. Participants with ≥20.0 point declines in the WIQ distance score had higher CVD mortality (HR: 4.56, 95% CI: 1.30 to 16.01) compared with those with ≥20.0 point improvement in the WIQ distance score. Patients with PAD who experienced ≥20.0 point declines in the WIQ stair climbing, distance, and speed scores had a higher rate of all-cause mortality compared with those with less declines in each WIQ score.

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

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. 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. 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). 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.

The Walking Impairment Questionnaire stair-climbing score predicts mortality in men and women with peripheral arterial disease

The Walking Impairment Questionnaire (WIQ) measures self-reported walking distance, walking speed, and stair-climbing ability in men and women with lower extremity peripheral arterial disease (PAD). We determined whether poorer WIQ scores are associated with higher all-cause and cardiovascular disease (CVD) mortality in individuals with and without PAD. We identified 1048 men and women with and without PAD from Chicago-area medical centers. Participants completed the WIQ at baseline and were monitored for a median of 4.5 years. Cox proportional hazards models were used to relate baseline WIQ scores with death, adjusting for age, sex, race, the ankle-brachial index (ABI), comorbidities, and other covariates. During follow-up, 461 participants (44.0%) died, including 158 deaths from CVD. PAD participants in the lowest baseline quartile of the WIQ stair-climbing scores had higher all-cause mortality (hazard ratio, 1.70; 95% confidence interval, 1.08-2.66, P = .02) and higher CVD mortality (hazard ratio, 3.11; 95% confidence interval, 1.30-7.47, P = .01) compared with those with the highest baseline WIQ stair-climbing score. Among PAD participants, there were no significant associations of lower baseline WIQ distance or speed scores with rates of all-cause mortality (P = .20 and P = .07 for trend, respectively) or CVD mortality (P = .51 and P = .33 for trend, respectively). Among non-PAD participants there were no significant associations of lower baseline WIQ stair-climbing, distance, or speed score with rates of all-cause mortality (P = .94, P = .69, and P = .26, for trend, respectively) or CVD mortality (P = .28, P = .68, and P = .78, for trend, respectively). Among participants with PAD, lower WIQ stair-climbing scores are associated with higher all-cause and CVD mortality, independently of the ABI and other covariates.

The ankle-brachial index is associated with the magnitude of impaired walking endurance among men and women with peripheral arterial disease

Previous reports suggest that the severity of peripheral arterial disease (PAD), measured by the ankle-brachial index (ABI), is not associated with the magnitude of walking impairment, measured by treadmill testing. These prior studies have had small sample sizes and included only PAD participants with symptoms of intermittent claudication. We studied the association of the ABI with diverse measures of walking performance in a cross-sectional study of 156 participants with PAD with and without intermittent claudication symptoms. Outcomes included the Gardner-Skinner treadmill test, 6-minute walk, 4-meter walking velocity at usual and fastest pace, and the walking impairment questionnaire (WIQ). Adjusting for age, sex, race, comorbidities, leg symptoms, and other confounders, lower ABI values were associated with shorter distance achieved in the 6-minute walk (ABI < 0.50: 286 meters; ABI 0.50-0.70: 316 meters; ABI 0.71-0.95: 355 meters, p trend < 0.001), shorter maximal treadmill walking time (ABI < 0.50: 6.0 minutes; ABI 0.50-0.70: 6.9 minutes; ABI 0.71-0.95: 8.3 minutes, p trend = 0.009), and lower WIQ distance scores (p trend = 0.007) among PAD participants. The ABI was not associated significantly with walking velocity over 4 meters, treadmill time to onset of leg symptoms, or the WIQ speed or stair-climbing scores. In conclusion, among 156 participants with PAD with and without intermittent claudication, lower ABI values are associated significantly with poorer walking endurance, assessed by three distinct measures. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00106327.

Measurement of Walking Distance and Speed in Patients With Peripheral Arterial Disease

The maximal walking distance (MWD) performed on a treadmill test remains the "gold standard" in estimating the walking capacity of patients who have peripheral arterial disease with intermittent claudication, although treadmills are not accessible to most physicians. We hypothesized that global positioning system (GPS) recordings could monitor community-based outdoor walking and provide valid information on walking capacity in patients with peripheral arterial disease. We studied 24 patients (6 women) with arterial claudication (median [25th to 75th percentile] values: 57 years old [48 to 67 years], 169 cm tall [164 to 172 cm], weight 81 kg [71 to 86 kg], and ankle-brachial index 0.64 [0.56 to 0.74]). MWD on the treadmill was 184 m (144 to 246 m), which was compared with the results of self-reported MWD, the distance score from the Walking Impairment Questionnaire, MWD observed during a 6-minute walking test, and MWD measured over a GPS-recorded unconstrained outdoor walk in a public park. Self-reported MWD, Walking Impairment Questionnaire distance score, 6-minute walking test score, and GPS-measured MWD were 300 m (163 to 500 m), 28% (15% to 47%), 405 m (338 to 441 m), and 609 m (283 to 1287 m), respectively. The best correlation with MWD on the treadmill test was obtained with the MWD measured by the GPS (Spearman r=0.81, P<0.001). Outdoor walking capacity measured by a low-cost GPS is a potentially innovative way to study the walking capacity of patients with peripheral arterial disease. It opens new perspectives in the study of walking capacity for vascular patients with claudication under free-living conditions or for physicians who do not have a treadmill.

The impact of peripheral arterial disease on health-related quality of life in the Peripheral Arterial Disease Awareness, Risk, and Treatment: New Resources for Survival (PARTNERS) Program

This study tested the hypothesis that patients with PAD have impaired health-related quality of life (HRQoL) to a degree similar to that of patients with other types of cardiovascular disease (other-CVD), and also evaluated the clinical features of PAD associated with impaired HRQoL. This was a cross-sectional study in 350 primary care practice sites nationwide with 6,499 participants. The reference group had no clinical or hemodynamic evidence of PAD or other-CVD; the PAD group had an ankle-brachial index < 0.90 or a prior history of PAD; the other-CVD group had a clinical history of cardiac or cerebral vascular disease (but no PAD), and the combined PAD-other-CVD group included both diagnoses. Individuals were assessed using four HRQoL questionnaires including the Walking Impairment Questionnaire (WIQ), Medical Outcomes Study SF-36 (SF-36), Cantril Ladder of Life and the PAD Quality of Life questionnaire. PAD patients had lower WIQ distance scores than the other-CVD group. Both the PAD and other-CVD groups had significantly lower SF-36 Physical Function scores compared with the reference group. The WIQ revealed that PAD patients were more limited by calf pain, whereas other-CVD patients were more limited by chest pain, shortness of breath and palpitations. In conclusion, in this nationwide study, one of the first to directly compare the HRQoL burden of CVD with that of PAD, the evaluation of PAD in office practice revealed a HRQoL burden as great in magnitude as in patients with other forms of CVD.

Treadmill Exercise Rehabilitation Improves Ambulatory Function and Cardiovascular Fitness in Patients With Chronic Stroke

Physical inactivity propagates disability after stroke through physical deconditioning and learned nonuse. We investigated whether treadmill aerobic training (T-AEX) is more effective than conventional rehabilitation to improve ambulatory function and cardiovascular fitness in patients with chronic stroke. Sixty-one adults with chronic hemiparetic gait after ischemic stroke (>6 months) were randomized to 6 months (3x/week) progressive T-AEX or a reference rehabilitation program of stretching plus low-intensity walking (R-CONTROL). Peak exercise capacity (Vo2 peak), o2 consumption during submaximal effort walking (economy of gait), timed walks, Walking Impairment Questionnaire (WIQ), and Rivermead Mobility Index (RMI) were measured before and after 3 and 6 months of training. Twenty-five patients completed T-AEX and 20 completed R-CONTROL. Only T-AEX increased cardiovascular fitness (17% versus 3%, delta% T-AEX versus R-CONTROL, P<0.005). Group-by-time analyses revealed T-AEX improved ambulatory performance on 6-minute walks (30% versus 11%, P<0.02) and mobility function indexed by WIQ distance scores (56% versus 12%, P<0.05). In the T-AEX group, increasing training velocity predicted improved Vo2 peak (r=0.43, P<0.05), but not walking function. In contrast, increasing training session duration predicted improved 6-minute walk (r=0.41, P<0.05), but not fitness gains. T-AEX improves both functional mobility and cardiovascular fitness in patients with chronic stroke and is more effective than reference rehabilitation common to conventional care. Specific characteristics of training may determine the nature of exercise-mediated adaptations.