Measurement of ankle-brachial index and walking distance in patients with peripheral arterial occlusive disease – should it be limited only to surgical nurses?

Background: Claudication, the common regional manifestation of peripheral arterial occlusive disease (PAOD), is usually described as an ischaemic pain of lower limb muscles during walking. Functional ability in patients with claudication is decreased because of limited pain free and maximal walking distance. Walking distance of 100 m or less is usually the indication for surgical treatment. The assessment of walking distance as well as ankle-brachial index (ABI) may be successfully performed by the trained nurse.

Aim of the study : The aim of this study was to popularize the measurement of ABI and walking distance, performed by the nurses, in PAOD patients.

Material and methods : Forty five patients with PAOD were assessed. The measurement of maximal walking distance was performed in each patients to verified patient’s self reported walking data. Additionally 44 nurses of various specialities and 12 physicians were asked if they there familiar with ABI measurement.

Results :Thirty eight patients (85%) with PAOD reported lower maximal claudication distance then measured by walking test. The group of 42 nurses and 11 physicians (n = 53, 94%) were not familiar with ABI measurement.

Conclusions :

1. The value of patient’s self-reported walking distance should be verified objectively eg. during corridor walking test.

2. TASC II recommends that ABI measurement should be performed in every patient with claudication, every patient 50-69 years old with diabetes and smoking history, and every patient in the age of 70 or older. Therefore this recommendation ought to be considered in every nurse, physiotherapist and physician’s practice. It also should be emphasized, especially in primary health care professionals’ group, that the presence of atherosclerosis in lower limbs may indicate the risk of cerebral and cardiac events.