Elsevier

Cardiovascular Surgery

Volume 5, Issue 4, July 1997, Pages 361-366
Cardiovascular Surgery

Correlating clinical indicators of lower-limb ischaemia with quality of life1

https://doi.org/10.1016/S0967-2109(97)00011-2Get rights and content

Abstract

The objectives of the study were to analyse the impact of increasing lower-limb ischaemia upon quality of life and to assess the correlation between clinical indicators of lower-limb ischaemia and such quality. A prospective observational study of a consecutive series of 235 patients (144 men and 91 women; median age 68 (range 41–87) years presenting with varying degrees of lower-limb ischaemia graded according to ISCVS criteria was performed. Data was collected at interview before any intervention. Clinical indicators of lower-limb perfusion included: intermittent claudication and maximum walking distance on standardized treadmill testing; ankle:brachial pressure indices and isotope limb blood flow. Quality of life analysis was performed using the EuroQol (EQ) questionnaire. This is a standardized generic instrument for describing health-related quality of life and consists of a descriptive system of five dimensions, each measured on three levels. Thus, a profile and two single indices of quality of life were derived using different methods. Increasing lower-limb ischaemia results in a statistically significant deterioration in both global quality of life and in all EQ-measured quality of life dimensions (P<0.01 Kruskal–Wallis ANOVA). The correlation between clinical indicators and quality of life is statistically significant but not sufficiently close (correlation coefficients <0.6) to assume that variations in clinical indicators result in reciprocal variations in quality of life. In conclusion, as might be expected, a significant correlation exists between clinical indicators of lower-limb ischaemia and health-related quality of life. However, the low correlation coefficients emphasize how tenuous the association is. Thus, a significant improvement in the clinical indicators of lower-limb ischaemia cannot be assumed to impart a similar benefit on quality of life. The latter concept must therefore be analysed independently.

Section snippets

Patients

This study received approval from the ethics committee of St. James's and Seacroft University Hospitals. A consecutive series of 235 patients presenting with various grades of lower-limb ischaemia were invited to participate in the study. Those patients who were enrolled in the study gave informed written consent. The severity of patients lower-limb ischaemia was graded according to ISCVS criteria [6]. Patients underwent measurement of: ankle:brachial pressure indices; intermittent claudication

Results

With progressively increasing lower-limb ischaemia, there was a significant increase in the patients' age and a significant deterioration in all measured clinical parameters (intermittent claudication distance, maximum walking distance, ankle:brachial pressure index isotope limb blood flow) of lower-limb ischaemia (Table 1).

Discussion

Increasing lower-limb ischaemia results in a significant deterioration in all EQ measured domains of quality of life. As may be expected, high percentages of patients in all groups reported problems with mobility, and all patients in all groups reported some pain. However, other effects of lower-limb ischaemia on quality of life may not have been so easily predicted. For example, patients with claudication report a 15–20% incidence of problems washing and dressing, a 70% incidence of limitation

Acknowledgements

Financial support for this study was received from the Northern and Yorkshire Regional Health Authority Research Fellowship Scheme and from the Yorkshire Vascular and Surgical Research Fund.

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1

Presented at the 45th International Congress of the European Society for Cardiovascular Surgery (Dos Santos Prize Session), Venice, Italy, September 1996.

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