Elsevier

American Heart Journal

Volume 147, Issue 2, February 2004, Pages 301-308
American Heart Journal

Clinical investigation: outcomes, health policy, and managed care
The peripheral artery questionnaire: a new disease-specific health status measure for patients with peripheral arterial disease

https://doi.org/10.1016/j.ahj.2003.08.001Get rights and content

Abstract

Background

The most common indication for treating patients with peripheral arterial disease is to improve their health status: their symptoms, function, and quality of life. Quantifying health status requires a valid, reproducible, and sensitive disease-specific measure. The Peripheral Artery Questionnaire (PAQ) is a 20-item questionnaire developed to meet this need by quantifying patients' physical limitations, symptoms, social function, treatment satisfaction, and quality of life.

Methods

Psychometric and clinical properties of the PAQ were evaluated in a prospective cohort study of 44 patients undergoing elective percutaneous peripheral revascularization. To establish reproducibility, 2 assessments were performed 2 weeks apart and before revascularization. The change in scores before and 6 weeks after revascularization were used to determine the instruments' responsiveness and were compared with the Short Form-36 and the Walking Impairment Questionnaire. A series of cross-sectional analyses were performed to establish the construct validity of the PAQ.

Results

The 7 domains of the PAQ were internally reliable, with Cronbach α = 0.80 to 0.94. The test-retest reliability analyses revealed insignificant mean changes of 0.6 to 2.3 points (P = not significant for all). Conversely, the change after revascularization ranged from 13.7 to 41.9 points (P ≤ .001 for all), reflecting substantial sensitivity of the PAQ to clinical improvement. The PAQ Summary Scale was the most sensitive of all scales tested. Construct validity was established by demonstrating correlations with other measures of patient health status.

Conclusions

The PAQ is a valid, reliable, and responsive disease-specific measure for patients with peripheral arterial disease. It may prove to be a useful end point in clinical trials and a potential aid in disease management.

Section snippets

Development of the PAQ

The PAQ (Appendix) was modeled after previous disease-specific cardiovascular instruments.13, 14 It was developed after review of the medical literature, examination of available health status measures, focus groups with experienced clinicians, and unstructured interviews with patients. To make the instrument specific to PAD, patients are asked to rate each question in terms of the limitations that they had as the result of symptoms of inadequate lower extremity perfusion. By referencing a

Results

Forty-four patients agreed to participate in this study. Mean age of participants was 68 ± 11, and 55% were men. The following comorbid conditions were present: 39% had diabetes, 86% had hypertension, 27% had had a prior peripheral revascularization procedure (23% in the same leg and 2% in the opposite leg), 2% had a history of congestive heart failure, and 9% had chronic obstructive lung disease; 66% of the patients had a history of smoking, and 25% continued to smoke at the time of the study.

Discussion

Quantifying the impact of PAD from the patient's perspective is an essential component of evaluating new pharmacologic and revascularization treatments. The measurement of health status is particularly important, given that other outcomes such as limb amputation and death are relatively rare in the current era.6 This study describes a new disease-specific health status measure for patients with PAD. The individual domains of the PAQ appear to be valid in that expected correlations with other

References (25)

  • W.R Hiatt

    Medical treatment of peripheral arterial disease and claudication

    N Engl J Med

    (2001)
  • J.I Weitz et al.

    Diagnosis and treatment of chronic arterial insufficiency of the lower extremitiesa critical review

    Circulation

    (1996)
  • Cited by (0)

    Research grants for this project were provided by the Max Baer Foundation from the Prairie Heart Institute, Springfield, Mo, and the Saint Luke's Foundation, Kansas City, Mo.

    View full text