Quality of Life in Patients with Intermittent Claudication: Relationship with Laboratory Exercise Performance

Abstract

In patients with peripheral arterial disease, limitation of exercise capacity will reduce the level of everyday physical activity and affect the quality of life. This study was designed (1) to examine the health-related quality of life of patients with intermittent claudication, and (2) to verify whether treadmill performance is related to the patient's perceived ability to function in the community. In 251 patients with intermittent claudication and 89 matched normal subjects, quality of life was assessed by a general health index questionnaire, the McMaster Health Index Questionnaire (MHIQ), which covers three dimensions of life (physical, social and emotional function). The maximal walking capacity of intermittent claudication patients was measured by the treadmill test. When controls were compared to intermittent claudication patients using the MHIQ, it was found that intermittent claudication patients showed a significant (p < 0.01) impairment of 'general health' and lower scores for physical (0.90 +/- 0.17 vs 0.65 +/- 0.17; p < 0.01), social (0.71 +/- 0.11 vs 0.63 +/- 0.12; p < 0.01) and emotional (0.75 +/- 0.17 vs 0.65 +/- 0.15; p < 0.01) function. Age, gender and work status had a significant impact upon health scores in several areas. Treadmill performance did not correlate with social or emotional function, whereas there was a small but significant relationship between maximal walking capacity and physical function scores (r = 0.197; p < 0.01). This study suggests that impairment in quality of life experience by patients with intermittent claudication poorly correlates with the reduced exercised capacity assessed by the treadmill test. Therefore, the evaluation of medical and surgical treatment of intermittent claudication should include the administration of a questionnaire for quality of life assessment.

Lessons Learned from Recent Randomized Clinical Trials for Intermittent Claudication

“…13,14 Evidence for this recommendation includes poor correlation between physician and patient assessment of the impact of IC on the patient's QOL, 15 poor correlation between ABI and self-reported level of disability, 16 and poor correlation between objective measures, such as treadmill walking distance and QOL. 17 Similar to prior studies, discordance was observed between treadmill performance, free step activity, and QOL measures in the treatment arms of CLEVER. 10 The greater improvement in QOL in the stent arm may reflect the gratification of symptom relief, as 43% of the stent group were free of IC at 6 months, compared with 21% of the supervised exercise group.…”

Association of anger proneness, depression and low social support with peripheral arterial disease: the Atherosclerosis Risk in Communities Study

“…Specifically, patients with PAD often describe a sense of shame and powerlessness; limitation in exercise tolerance; being a burden to family and friends; and depression and a diminished overall quality of life. [12][13][14][15][16] This study further explored this area and reveals results that are unique in several aspects. In contrast to other studies, which concentrated on individuals with symptomatic PAD, this study objectively measured the ABI and methodically ascertained PAD-related hospital discharge diagnoses and intermittent claudication in a large communitybased population to define PAD cases and noncases for comparison.…”

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

“…Furthermore, treadmill MWD may not be correlated with the "true" free-living MWD at usual pace and on a flat surface 5 and does not correlate with the patient's perception of disability. 6 Various methods that do not require a treadmill have been proposed to estimate walking capacity, including "unguided" self-estimated MWD, estimation of walking impairment by standardized questionnaires, and the 6-minute walking test.…”