Walking Impairment Questionnaire Research Articles

Validation of the Lithuanian Version of the Walking Impairment Questionnaire in Patients with Peripheral Arterial Disease.

Background and Objectives: The Walking Impairment Questionnaire (WIQ) is a short and simple tool to measure walking impairment for patients with peripheral arterial disease requiring no special equipment or trained staff. The aim of this study was to assess the validity and reliability of the culturally adapted Lithuanian WIQ version in patients with intermittent claudication. Materials and Methods: In total, 40 patients with intermittent claudication and ankle-brachial index < 0.90 participated in this study. Reliability and internal consistency of the questionnaire were assessed by the intra-class correlation coefficient (ICC) and Cronbach's alpha (α), respectively. Validity was determined by correlations between the WIQ scores and a subjective test (Quality of Life 5 Dimension Questionnaire 3 Level Version (EQ-5D-3L)) and objective tests (6 min walk test (6MWT), treadmill test, and ankle-brachial index). Results: The test-retest reliability was assessed as excellent with an intraclass correlation coefficient of 0.90. The values of Cronbach's alpha were 0.957 (I time) and 0.948 (II time) and indicated an excellent internal consistency. Statistically significant Spearman correlations were detected between the WIQ and walking distances on the 6MWT (rho 0.514, p < 0.001) and treadmill test (rho 0.515, p < 0.001). Higher WIQ scores were associated with longer walking distances and duration. Moderate negative and low negative correlations were found between the WIQ and EQ-5D-3L scores. Conclusions: The Lithuanian version of culturally adapted WIQ demonstrates reliability and validity for patients with intermittent claudication, supported by two different walking tests showing statistically significant moderate Spearman correlations.

Discordance of patient-reported outcome measures with objectively assessed walking decline in peripheral artery disease

ObjectiveAmong people with peripheral artery disease (PAD), perceived change in walking difficulty over time, compared with people without PAD, is unclear. Among people reporting no change in walking difficulty over time, differences in objectively measured change in walking performance between people with and without PAD are unknown. MethodsA total of 1289 participants were included. Eight hundred seventy-four participants with PAD (aged 71.1 ± 9.1 years) were identified from noninvasive vascular laboratories and 415 without PAD (aged 69.9 ± 7.6 years) were identified from people with normal vascular laboratory testing or general medical practices in Chicago. The Walking Impairment Questionnaire and 6-minute walk were completed at baseline and 1-year follow-up. The Walking Impairment Questionnaire assessed perceived difficulty walking due to symptoms in the calves or buttocks on a Likert scale (range, 0-4). Symptom change was determined by comparing difficulty reported at 1-year follow-up to difficulty reported at baseline. ResultsAt 1-year follow-up, 31.9% of participants with and 20.6% of participants without PAD reported walking difficulty that was improved (P < .01), whereas 41.2% vs 55%, respectively, reported walking difficulty that was unchanged (P < .01). Among all reporting no change in walking difficulty, participants with PAD declined in 6-minute walk, whereas participants without PAD improved (−10 vs +15 meters; mean difference, −25; 95% confidence interval, −38 to −13; P < .01). ConclusionsMost people with PAD reported improvement or no change in walking difficulty from calf or buttock symptoms at one-year follow-up. Among all participants who perceived stable walking ability, those with PAD had significant greater declines in objectively measured walking performance, compared with people without PAD.

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.

Abstract 14128: Walking Exercise for Peripheral Artery Disease: Effects in Women and Black Americans

Introduction: In people with lower extremity peripheral artery disease (PAD), rates of participation in supervised exercise therapy are lower in women and Black Americans, compared to men and White Americans, respectively. This study used data from randomized clinical trials in participants with PAD to assess whether walking exercise improved walking performance in women and Black Americans. Methods: Data were combined from three randomized clinical trials that compared supervised treadmill exercise (3 sessions/week) for six months to a non-exercise control group. Data were also combined from two randomized clinical trials that compared home-based walking exercise for six months to a non-exercise control group. The six-minute walk (6MW), treadmill walking performance, and the Walking Impairment Questionnaire (WIQ) were measured at baseline and six-month follow-up. In meta-analyses, the effects of supervised and home-based exercise were each compared to a non-exercise control group. The effects of supervised and home-based exercise were compared directly. Tests for interaction were used to compare effects of exercise in Black, compared to White participants and in women, compared to men. Results: A total of 370 participants (n=159 [43%] women, n=228 [62%] Black) completed a supervised exercise trial; 349 participants (n=175 [50%] women, n=187 [54%] Black) completed a home-based exercise trial. Supervised and home-based exercise significantly improved 6MW in Black Americans and women (Table). Compared to home-based exercise, supervised exercise was associated with greater improvements in treadmill outcomes, while home-based walking improved 6MW more than supervised exercise. There was no significant interaction of sex or race on exercise outcomes. Conclusions: Supervised and home-based exercise significantly improved 6MW and treadmill walking distance in women and Black Americans with PAD, respectively, compared to a non-exercise control.

Efficacy of a personalised activity plan for BREAKing UP sitting time in patients with intermittent claudication (the BREAK UP study)

IntroductionThe aim of this study was to investigate the concept of an 8-week personalised activity plan, using short periods of physical activity to break up sitting time in people with Intermittent Claudication (IC), to improve walking ability, and reduce time spent sitting. MethodsThe study was designed as a single centre, single arm, before and after study and is registered with clinicaltrials.gov (NCT04572737). The co-primary outcomes are time spent sitting and walking ability measured via the walking impairment questionnaire. Normally distributed data was analysed using paired samples T-tests; non-normally distributed data was analysed using related-samples Wilcoxon signed rank tests. ResultsThere was a significant improvement in both co-primary outcomes: walking ability and time spent sitting, as well as the following secondary outcomes: total bouts and time spent in prolonged sitting, time spent standing and stepping, anxiety, depression, and activity levels reported on the vascular quality of life questionnaire. ConclusionAn 8-week personalised activity plan to break up sitting time shows promise as a treatment for people with IC, improving walking ability and reducing time spent sitting. This study supports the use of large randomised controlled trials to further develop this treatment in people with IC.

Home-Based Walking Exercise and Supervised Treadmill Exercise in Patients With Peripheral Artery Disease

Few people with lower extremity peripheral artery disease (PAD) participate in supervised treadmill exercise covered by the Center for Medicare and Medicaid Services. In people with PAD, the benefits of home-based walking exercise, relative to supervised exercise, remain unclear. To study whether home-based walking exercise improves 6-minute walk (6MW) more than supervised treadmill exercise in people with PAD (defined as Ankle Brachial Index ≤0.90). Data were combined from 5 randomized clinical trials of exercise therapy for PAD using individual participant data meta-analyses, published from 2009 to 2022. Of the 5 clinical trials, 3 clinical trials compared supervised treadmill exercise to nonexercise control (N = 370) and 2 clinical trials compared an effective home-based walking exercise intervention to nonexercise control (N = 349). Individual participant-level data from 5 randomized clinical trials led by 1 investigative team were combined. The 5 randomized clinical trials included 3 clinical trials of supervised treadmill exercise and 2 effective home-based walking exercise interventions. Change in 6MW distance, maximum treadmill walking distance, and Walking Impairment Questionnaire at 6-month follow-up. The supervised treadmill exercise intervention consisted of treadmill exercise in the presence of an exercise physiologist, conducted 3 days weekly for up to 50 minutes per session. Home-based walking exercise consisted of a behavioral intervention in which a coach helped participants walk for exercise in or around home for up to 5 days per week for 50 minutes per session. A total of 719 participants with PAD (mean [SD] age, 68.8 [9.5] years; 46.5% female) were included (349 in a home-based exercise clinical trial and 370 in a supervised exercise trial). Compared with nonexercise control, supervised treadmill exercise was associated with significantly improved 6MW by 32.9 m (95% CI, 20.6-45.6; P < .001) and home-based walking exercise was associated with significantly improved 6MW by 50.7 m (95% CI, 34.8-66.7; P < .001). Compared with supervised treadmill exercise, home-based walking exercise was associated with significantly greater improvement in 6MW distance (between-group difference: 23.8 m [95% CI, 3.6, 44.0; P = .02]) but significantly less improvement in maximum treadmill walking distance (between-group difference:-132.5 m [95% CI, -192.9 to -72.1; P < .001]). In this individual participant data meta-analyses, compared with supervised exercise, home-based walking exercise was associated with greater improvement in 6MW in people with PAD. These findings support home-based walking exercise as a first-line therapy for walking limitations in PAD.

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.

Duplex ultrasound for surveillance of lower limb revascularisation.

Duplex ultrasound for surveillance of lower limb revascularisation.

Long Term Results of a Randomised Trial of Stenting of the Superficial Femoral Artery for Intermittent Claudication

Primary stenting of the superficial femoral artery (SFA) in intermittent claudication (IC) has been shown to increase health related quality of life (HRQoL) after 12 and 24 months. An extended follow up of HRQoL 36 and 60 months after randomisation is presented. A multicentre randomised controlled trial was conducted at seven vascular clinics in Sweden between 2010 and 2020. One hundred patients randomised to either primary stenting and best medical treatment (BMT; n = 48) or BMT alone (n = 52) were followed for 60 months. HRQoL, assessed by the Short Form 36 Health Survey (SF-36) and EuroQoL 5 dimensions (EQ5D) 36 and 60 months after randomisation, was the primary outcome. Walking Impairment Questionnaire (WIQ) score, re-interventions, progression to chronic limb threatening ischaemia (CLTI), amputation, and death were secondary outcomes. At the 36 month follow up, the stent group (n = 32) had statistically significantly better scores in the SF-36 domain “Role Physical” (p = .023) and the Physical Component Summary (p = .032) compared with the control group (n = 30); however, there was no statistically significant difference in EQ5D scores (p = .52). WIQ was statistically significantly better in the stent group compared with the control group (p = .029) at 36 months. At the 60 month follow up, no statistically significant difference in HRQoL was seen between patients in the stent (n = 31) and control groups (n = 32). Crossover from the control group to the stent group was 25% at 60 months. There were no differences in progression to CLTI, amputation (2.1% vs. 1.9%), or mortality (14.6% vs. 15.4%) between groups. In patients with IC caused by isolated SFA lesions, primary stenting conferred benefits to HRQoL until 36 months from treatment vs. BMT alone, but these benefits were no longer detectable at 60 months, where a high crossover rate affected the power of the final analysis.

Is the Walking Impairment Questionnaire a surrogate marker of 6-minute walking test performance in patients with peripheral artery disease with different degrees of claudication symptoms?

To analyze the associations between the Walking Impairment Questionnaire (WIQ) and 6-minute walk test (6MWT) in absolute or relative performance in patients with peripheral artery disease (PAD) and different degrees of claudication symptoms. Two hundred and sixty-seven patients with PAD and claudication symptoms participated in the study. All patients underwent 6MWT and WIQ tests. Patients were divided into tertile groups according to their 6MWT performance (1st tertile = severe, 2nd = moderate, 3rd = mild). Multiple linear regression was performed to investigate the association between WIQ scores and the achievement of expected performance in the 6MWT. Claudication onset distance and time, total walking distance, and the percentage of the predicted values had a significant weak correlation (P < 0.01) with WIQ scores (distance, speed, and stair-climbing capacity). The correlations for almost all variables were slightly higher in the 1st tertile compared with the 2nd and 3rd tertiles (i.e. WIQ-distance and Claudication onset time, r = 0.25 and 0.12, WIQ-distance and Claudication onset distance, r = 0.34 and 0.18; WIQ-distance and total walking distance, r = 0.23 and 0.18, respectively). Multilinear regression confirmed a slightly superior relationship in the 1st tertile compared with the 2nd tertile (i.e. WIQ-distance and Claudication onset time, R2 = 0.24 and R2 = 0.01; WIQ-distance and Claudication onset distance, R2 = 0.25 and R2 = 0.03, respectively). WIQ is weakly associated with absolute and relative 6MWT performance in patients with PAD. Despite slightly better correlations in patients with severe claudication symptoms, WIQ scores must be used with care as a surrogate marker of 6MWT performance in this group.

Use of the Walking Impairment Questionnaire and Walking Estimated-Limitation Calculated by History questionnaire to detect maximal walking distance equal to or lower than 250 m in patients with lower extremity arterial disease.

The objective was to assess the accuracy and optimal threshold of the Walking Impairment Questionnaire (WIQ) and the Walking Estimated-Limitation Calculated by History (WELCH) questionnaire in identifying patients with a maximal walking distance (MWD) below or equal to 250 m. This retrospective study screened 388 consecutive patients with suspected symptomatic lower extremity arterial disease (LEAD). Collected data included the patient's history, resting ankle-brachial index, WIQ, and WELCH. MWD was assessed with a treadmill test at 2 mph (3.2 km/h) with a 10% grade. An optimized threshold for detection of MWD ≤ 250 m was determined for each questionnaire via receiver operating characteristic (ROC) curves. Subsequently, multivariate analysis was performed to build a new simple score to detect MWD ≤ 250 m. The study included 297 patients (63 ± 10 years old). With a threshold of ≤ 64%, the WIQ predicted MWD ≤ 250 m with an accuracy of 71.4% (66.2, 76.5%). With a threshold of ≤ 22, the WELCH predicted a treadmill walking distance of ≤ 250 m with an accuracy of 68.7% (63.4, 74.0%). A new score with only four "yes or no" questions had an accuracy of 71.4% (66.3, 76.6%). Items on this new score consisted of the level of difficulty of walking 1 block, declared maximum walking distance, usual walking speed, and maximum duration of slow walking. A WIQ score ≤ 64% and a WELCH score ≤ 22 help to predict a walking distance of ≤ 250 m in a treadmill test at 2 mph (3.2 km/h) with a 10% grade. A 4-item score could be used for rapid evaluation of walking distance among patients with LEAD, but the validity of this 4-item score requires further confirmation studies.

Treating post-angioplasty dissection in the femoropopliteal arteries using the tack endovascular system: Tack optimized balloon angioplasty II 24-month results.

The TOBA (Tack Optimized Balloon Angioplasty) II trial is a prospective, single-arm, multicenter study that investigated Tack treatment for patients with dissection after angioplasty in the superficial femoral artery and/or proximal popliteal artery. The Tack device is a nitinol-based, short (6mm), stent-like implant with low outward force that can be deployed in a targeted fashion to treat vascular dissection. TOBA II primary results through 12 months have been published previously. This report provides follow-up safety and efficacy results through 24 months (RC). The TOBA II trial enrolled 213 patients with Rutherford classification 2 to 4 and a de novo or non-stented restenotic lesion in the superficial femoral artery and/or proximal popliteal artery who developed a dissection of any grade after treatment with plain balloon or drug-coated balloon (DCB) angioplasty. Participants were followed for 30 days, 6 months, 12 months, 24 months, and 36 months following the procedure. Evaluations included clinically driven target lesion revascularization (CD-TLR), ankle-brachial index, Rutherford classification, peripheral artery questionnaire, quality of life assessed by the EQ-5D-3L, and the Walking Impairment Questionnaire. At enrollment, mean age was 68.2 ± 9.1 years, 70.9% were male, and 95.8% of patients were categorized as RC 2 or 3. The distribution of balloon types in the study were standard balloons: 42.3%; and drug-coated balloons: 57.7%. At 24-month follow-up, 167 patients (78.4%) had available data. The overall survival rate at 24 months was 95.4% and there were no major amputations during this time. After 24 months of follow-up, the Kaplan-Meier freedom from CD-TLR was 77.7%. Rutherford classification, ankle-brachial index, and quality of life were significantly improved compared with baseline through 24 months. The TOBA II 24-month data demonstrate durable intermediate-term outcomes with the use of the Tack Endovascular System. Tack deployment was a safe and effective therapeutic option for dissection repair following angioplasty.

What Do Patients Know About Peripheral Arterial Disease? A Knowledge Questionnaire.

The lack of knowledge about Peripheral Arterial Disease (PAD) is worryingly high as it triggers and main- tains behaviors of denial, indifference, and non-adherence to therapeutics. Therefore, the aim of this study was to build and assess the reliability and validity of a knowledge questionnaire about PAD (Peripheral Arterial Disease Knowledge Questionnaire - PADKQ). A longitudinal study was carried out with two evaluations that included a sample of patients with PAD and Intermittent Claudication, with no history of surgical interventions, in follow-up at the vascular surgery consulta- tion. The PADKQ was applied to 114 patients (85% men, with a mean age of 65 years, SD=7.2). Sociodemographic and clinical data were collected from clinical records, and physical activity level (International Physical Activity Questionnaire - IPAQ) and walking impairment (Walking Impairment Questionnaire - WIQ) were evaluated through questionnaires. A 2nd evaluation session took place two weeks after the 1st evaluation session where an educational intervention was performed. Internal consistency, temporal stability, content validity, and convergent validity were performed Results: The sample related results have reflected the good reliability (kr-20=0.775) and validity properties of the PADKQ. This sample showed a high level of knowledge about PAD (10.96 points, SD=3.28, from 0 to 16 possible points), which increased significantly from moment 1 to moment 2 (t= -7.457, p<.001). Only half of the sample considered the disease to be serious and identified smoking habits as one of the risk factors. Patients with higher education were the most physically active. The PADKQ proved to be a useful, brief, and easy-to-use instrument in health contexts to identify patients' level of knowledge about PAD. Education about PAD increases patients' knowledge about the disease and the greater the knowl- edge about PAD, the greater the practice of physical activity.

Long Term Results of a Randomised Trial of Stenting of the Superficial Femoral Artery for Intermittent Claudication

Primary stenting of the superficial femoral artery (SFA) in intermittent claudication (IC) has been shown to increase health related quality of life (HRQoL) after 12 and 24 months. An extended follow up of HRQoL 36 and 60 months after randomisation is presented. A multicentre randomised controlled trial was conducted at seven vascular clinics in Sweden between 2010 and 2020. One hundred patients randomised to either primary stenting and best medical treatment (BMT; n= 48) or BMT alone (n= 52) were followed for 60 months. HRQoL, assessed by the Short Form 36 Health Survey (SF-36) and EuroQoL 5 dimensions (EQ5D) 36 and 60 months after randomisation, was the primary outcome. Walking Impairment Questionnaire (WIQ) score, re-interventions, progression to chronic limb threatening ischaemia (CLTI), amputation, and death were secondary outcomes. At the 36 month follow up, the stent group (n= 32) had statistically significantly better scores in the SF-36 domain "Role Physical" (p= .023) and the Physical Component Summary (p= .032) compared with the control group (n= 30); however, there was no statistically significant difference in EQ5D scores (p= .52). WIQ was statistically significantly better in the stent group compared with the control group (p= .029) at 36 months. At the 60 month follow up, no statistically significant difference in HRQoL was seen between patients in the stent (n= 31) and control groups (n= 32). Crossover from the control group to the stent group was 25% at 60 months. There were no differences in progression to CLTI, amputation (2.1% vs. 1.9%), or mortality (14.6% vs. 15.4%) between groups. In patients with IC caused by isolated SFA lesions, primary stenting conferred benefits to HRQoL until 36 months from treatment vs. BMT alone, but these benefits were no longer detectable at 60 months, where a high crossover rate affected the power of the final analysis.

High-Frequency versus Low-Frequency Spinal Cord Stimulation in Treatment of Chronic Limb-Threatening Ischemia: Short-Term Results of a Randomized Trial

Introduction: The objective of the study is to determine if high-frequency (1 kHz) spinal cord stimulation (SCS) is better than low-frequency SCS for pain relief in chronic limb-threatening ischemia (CLTI). Methods: HEAL-SCS trial was designed as an open-label, parallel-group, single-center randomized study with a 1:1 allocation ratio. The trial was conducted in Meshalkin National Medical Research Center between August 2018 and February 2020. Total 56 patients underwent screening, 50 were enrolled, 6 were rejected. The participants were randomized into 2 cohorts of 25 patients each by an external coordinator using an online tool. A neurosurgeon and a vascular surgeon both examined all patients and estimated the pain intensity using visual analog scale (VAS), quality of life with short-form-36 health survey (SF-36), and functional status by walking impairment questionnaire (WIQ) at 3 and 12 months. Tissue perfusion was evaluated for 34 patients using transcutaneous oxygen tension measurement (TcPO₂) at baseline and in 12 months. Results: All 50 patients (84% men, median age 66.5 y.o) were available for primary outcome assessment 3 and 12 months after implantation. Intention-to-treat analysis demonstrated comparative advantage of HF-SCS over LF-SCS at 3 months with mean VAS score 2.8 (95% CI, 2.4; 3.2) and 3.3 (95% CI, 3.0; 3.6), respectively (p = 0.031). Clinical superiority of HF-SCS persisted at 12-month follow-up (p < 0.001). HF-SCS produced significantly greater pain relief by WIQ at 3 (p < 0.001) and 12 months (p = 0.009). Despite stair-climbing ability was better in HF-SCS group (p = 0.02), no significant difference between groups was found at 1-year post-op in terms of speed (p = 0.92) and distance scores (p = 0.68). Accordingly, the general and mental health domains of SF-36 were significantly better in HF-SCS at 12 months. Despite a tendency toward better resting oxygen pressure in HF-SCS group, there was no intergroup difference by TcPO₂ (p = 0.076). Only 1 patient (2%) required above-the-knee amputation at 10 months after LF-SCS implantation. Conclusion: High-frequency SCS provides better pain relief, life quality, and functional performance in patients with CLTI during short-term follow-up. The lack of perfusion difference between high-frequency and conventional SCS requires further examination to the possible long-term advantages of the method.

Revascularization of Peripheral Arteries in Patients with Intermittent Claudication Decreases Inflammatory Biomarkers.

Patients with intermittent claudication have significantly higher levels of inflammatory biomarkers, particularly interleukins, which is also a consequence of exercise limitation. Physical activity, which is one of the preventive measures against atherosclerosis, is associated with a decrease in inflammatory biomarkers. Therefore, in our study, we investigated the effects of revascularization of peripheral arteries in patients with intermittent claudication on functional capacity and levels of inflammatory markers. The study included 26 patients with intermittent claudication who underwent percutaneous transluminal angioplasty (PTA). Before the procedure and 2-4 months after successful revascularization, the ankle-brachial index (ABI), functional capacity using the treadmill test, and the walking impairment questionnaire (WIQ) were determined. Inflammatory biomarkers were also measured before and after procedures. Successful revascularization was associated with an increase in intermittent claudication: 120 (20-315) versus 300 (100-1000 m), P < 0.001. Treadmill testing showed a significant increase in initial and maximal walking distance. After revascularization, ABI increased significantly (0.55 vs 0.82, P < 0.003). Improvement in functional performance was also demonstrated by WIQ. Two to three months after revascularization, some inflammatory biomarkers decreased significantly: fibrinogen, interleukin-6 (IL-6), and interleukin-8 (IL-8). The high-sensitivity C-reactive protein (hsCRP) and tumor necrosis factor-alpha (TNFα) also did not decrease significantly. The levels of some inflammatory markers: IL-6, TNFα, and fibrinogen were significantly related to the improvement in patients' functional capacity. The results of our study show that successful revascularization of the lower limb arteries not only improves the functional capacity of patients with intermittent claudication, but also reduces the systemic inflammatory response and may have a preventive effect on local and concomitant other atherosclerotic diseases.

Retrospective Analysis of Walking Distance and Use of Medication After Bariatric Surgery

Aim: The objective of this study was to ascertain the drug use and walking distance of individuals after bariatric surgery.&#x0D; Material and Methods: The sample of the study consisted of 165 individuals. Individuals who underwent bariatric surgery were examined retrospectively after their operations. Data were collected using the Personal Information Form and the Walking Impairment Questionnaire.&#x0D; Results: The mean age of the individuals included in the study was 40.22±9.63. 52.1% of individuals were female. The body mass index of individuals was 39.63±4.69 before bariatric surgery and 23.94±2.57 in the first year follow-up after bariatric surgery. Forty percent of individuals did not have any chronic illnesses. Among individuals who had been on medication before surgery, 72.4% of those taking psychiatric medications, 57.5% of those taking diabetes medications, and 16% of those taking heart medications discontinued medications after their operations. 81.8% of individuals reported improved sleep quality compared to the period before the operation. The walking distance level of the individuals showed a significant increase in the first year after bariatric surgery compared to the period&#x0D; before the surgery.&#x0D; Conclusion: The study showed that bariatric surgery is an effective method for weight loss and reduction of comorbidities, as well as leading to a statistically significant reduction in chronic drug use and an increase in sleep quality and walking distance of individuals

An Ankle Foot Orthosis Implementation To Improve Mobility In Peripheral Artery Disease

<h3>Research Objectives</h3> To explore the perceptions of wearing an ankle foot orthosis (AFO) in patients with peripheral artery disease (PAD). This follows a clinical trial of the effectiveness of an AFO in improving walking distances for patients with PAD-related claudication. <h3>Design</h3> A randomized crossover trial of standard of care and an AFO for three months. Semi-structured interviews were conducted 1.5 months into the AFO intervention to understand acceptability, demand, implementation, and practicality. Questionnaires were administered and claudication time recorded at baseline and after 3-month intervention. Six -month post intervention mixed methods assessments based on i-PARIHS framework were conducted. <h3>Setting</h3> Vascular surgery clinic and biomechanics research laboratory. <h3>Participants</h3> Claudication times and questionnaires were noted at baseline and 3 months for (n=22) participants. 7 subjects met the IRB post intervention criteria and participated in the study. <h3>Interventions</h3> A certified orthotist fit subjects with an AFO that was worn for three months. <h3>Main Outcome Measures</h3> Qualitative analysis of the semi-structured interviews and quantitative analysis of the surveys, Walking impairment questionnaire and Short-form 36 medical outcomes questionnaire, as well as claudication times assessed at baseline and 3 months. <h3>Results</h3> Key differences in responses were found. Patients withdrawing before 3 months had negative perceptions, comorbidities, and physical discomfort. Positive aspects of the AFO such as ease in standing and walking, as well as walking straighter and longer with less pain were reported by all participants Claudication times also showed improvement after 3 months. For surveys highest rating was seen in the complexity (4.6/5) and the cost dimension (4.3/5). The patients found the AFO and instructions easy to follow when starting the intervention. <h3>Conclusions</h3> The subset of preliminary data from the AFO intervention is beneficial towards assessing the implementation success and improvement in quality of life in patients who wore the AFO for three months. <h3>ACKNOWLEDGEMENTS</h3> This research was supported by NIH grants (RO1AG034995 and RO1HD090333), VA Merit grant (I01 RX003266) and UNO GRACA 2020-2021 grant. <h3>Author(s) Disclosures</h3> None to declare.

The Impact of Diabetes in Intermittent Claudication: A Prospective Cohort Study.

The aim of this study was to determine the lower-limb outcome in patients with intermittent claudication (IC) and to identify predictors for deterioration. This study employed a prospective observational cohort single-centre design. One hundred fifty patients with IC attending a vascular surgery unit for the first time were recruited. Lower limb perfusion was assessed utilising ankle brachial index (ABI) measures, toe-brachial index (TBI) measures, Doppler waveform analysis and the walking impairment questionnaire. Follow-up was conducted after 1 year and 2 years following recruitment to assess haemodynamic parameters, symptom severity and outcome. Recruited participants had a mean age of 69.7 (±9.3) years, BMI 27.8(±4.2) and 79.3% were men. Significant haemodynamic decline (decline in ABPI by ≥0.15 and/or decline in TBPI by ≥0.1) occurred in 50.6% of the cohort within 2 years of whom 23.3% developed chronic limb threatening ischaemia (CLTI) with rest pain and/or tissue loss. Baseline ABPI, ABPI ≤ 0.5, TBPI ≤ 0.39, infrapopliteal artery (IPA) disease and high Haemoglobin A1c were identified as significant predictors for deterioration to CLI. (P < .05, binomial logistic regression). Patients with IC are at a high risk of developing CLTI within 2 years. Risk of lower limb adverse events is tripled in patients with IPA disease, low ankle and toe pressures and poorly controlled diabetes. Early identification of those at high risk for early deterioration may justify a paradigm shift in the management of this subgroup.

Tibio-pedal arterial pressure assessment during endovascular intervention to improve quality-of-life in patients with intermittent claudication.

The aim of this study is to compare the quality-of-life (QOL) outcomes and the tibio-pedal arterial pressure post-endovascular intervention. Physiological assessment of peripheral arterial lesions is infrequently performed during endovascular interventions. We retrospectively reviewed all 343 patients with intermittent claudication who underwent an endovascular intervention via tibio-pedal artery access from October 2018 to May 2021. The baseline and post-intervention tibio-pedal arterial pressures from the pedal sheaths were measured. QOL was assessed using a pre-validated Walking Impairment Questionnaire (WIQ) score before and at 30-day after intervention. We compared the baseline tibio-pedal arterial pressure, post-intervention tibio-pedal arterial pressure, delta pressure (post-intervention minus baseline), baseline WIQ scores, 30-day WIQ scores, and delta score (30-day minus baseline). All 343 patients had successful tibio-pedal accesses. The average tibio-pedal arterial pressure at baseline was 87.0 ± 1.8 mmHg vs. 135.5 ± 1.7 mmHg post-intervention (p < 0.001). Average baseline and 30-day WIQ scores were summation (99.8 ± 3.3 vs. 115.0 ± 3.1, p < 0.001), walking distance (35.7 ± 1.3 vs. 42.5 ± 1.3, p < 0.001), walking speed (21.1 ± 0.9 vs. 23.6 ± 0.8, p = 0.036), stair climbing (4.7 ± 1.4 vs. 24.2 ± 1.4, p = 0.019), and symptoms (18.8 ± 0.2 vs. 20.1 ± 0.2, p < 0.001), respectively. When comparing the increased post-intervention tibio-pedal arterial pressure <60 mmHg vs. ≥60 mmHg, the average delta WIQ scores were all significantly improved with summation (10.0 ± 3.9 to 25.8 ± 5.5, p = 0.01), walking distance (4.1 ± 1.7 to 9.8 ± 2.5, p = 0.02), walking speed (1.5 ± 1.1 to 4.3 ± 1.5, p = 0.02), stair climbing (2.3 ± 1.8 to 9.4 ± 2.5, p = 0.02), and symptoms (1.0 ± 0.3 to 1.8 ± 0.4, p = 0.04), respectively. Increasing the post-intervention tibio-pedal arterial pressure by 60 mmHg can enhance QOL as suggested by improvement of WIQ scores.