The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: LauMitchell D. Content is updated monthly with systematic literature reviews and conferences. A diagram was added for exact site of pain, thus making self-application easier. Patients should address specific medical concerns with their physicians. Showing of extracted citations.
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Abstract Background We determined the diagnostic accuracy of the Edinburgh Claudication Questionnaire ECQ in 1st generation Black African-Caribbean UK migrants as previous diagnostic questionnaires have been found to be less accurate in this population. We also determined the diagnostic accuracy of translated versions of the ECQ in 1st generation South Asian UK migrants, as this has not been investigated before.
Translated versions of the ECQ were prepared following a recognised protocol. Subjects answering positively to experiencing leg pain or discomfort on walking were asked to return to have Ankle Brachial Pressure Index ABPI measured.
Non-responders were younger than participants 59 vs. Punjabi, English and Bengali questionnaires identified participants with Intermittent Claudication, so these questionnaires were assessed. There were significant differences in diagnostic accuracy between the 3 versions Punjabi: No significant differences were found in sensitivity and specificity between illiterate and literate participants in any of the questionnaires and there was no significant different difference between those under and over 60 years of age.
Conclusions Our findings suggest that the ECQ is not as sensitive or specific a diagnostic tool in 1st generation Black African-Caribbean and South Asian UK migrants than in the Edinburgh Artery Study, reflecting the findings of other diagnostic questionnaires in these minority ethnic groups.
However this study is limited by sample size so conclusions should be interpreted with caution. Peer Review reports Background Peripheral artery disease PAD is an important healthcare problem in developed nations and is associated with considerable morbidity and mortality.
Intermittent claudication IC is the most common symptomatic manifestation of PAD, and typically occurs in up to one third of patients with this disease [ 1 ]. Intermittent claudication is characterised by pain, aching or cramping in the calf, buttock, hip or thigh on ambulation that resolves upon rest. Symptoms arise from an inadequate blood supply to the peripheral arteries of the legs that result in anaerobic metabolism and build up of lactic acid within the muscles.
Only about a quarter of patients with IC will ever significantly deteriorate [ 1 ]. Intermittent claudication can be diagnosed with the use of a questionnaire along with evidence of PAD.
It was also found to have excellent reliability after repeating the questionnaire at 6 months. The ECQ has been validated in French and Brazilian Portugese [ 7 — 9 ] and in English in a community based study in the Netherlands [ 10 ] though not amongst languages of the Indian Sub-continent or amongst Black African-Caribbean groups.
Ethnic minority groups make up 7. Studies have shown that questionnaires designed to diagnose cardiovascular diseases in European populations may not always be applicable in an ethnically diverse population [ 12 , 13 ]. In order to meet the healthcare needs of the diverse populations which exists in the UK [ 11 ], it is important to know if any differences exist in the reporting of symptoms of disease and also whether current diagnostic tools designed in European populations are applicable in the diagnosis of disease in other ethnic groups.
Methods Translation of Edinburgh Claudication of Questionnaire A diagrammatic representation of the translation process for each South Asian language is shown in Figure 1. For each translation a consortium comprising 3 bilingual healthcare professionals and a lay person was used to assess grammatical and semantic equivalence. A general consensus was made between these 4 people as to whether amendments needed to be made to the original translation.
If so, the suggested amendments were sent back to the initial independent translator and a new version was produced. Once a translation was deemed to be acceptable, it was then independently back-translated into English.
The back-translated version was then compared to the original English version of the ECQ. All translations were found to be grammatically and semantically equivalent. Translated versions of the ECQ are shown in appendix 1.
Using the practice age-sex register, all subjects of South Asian or Black ethnicity age 45 and over were invited to participate. Subjects attended for an assessment at their local general practice.
All participants screened between October and February were asked to complete the ECQ in their chosen language. The study was approved by the local research and ethics committee and written informed consent was obtained from all patients. All literate patients completed the questionnaire independently and illiterate patients were provided with a bilingual interpreter if required and the questions were read out to them as written.
Participants responding negatively to question one of the ECQ "Do you get a pain or discomfort in your leg s when you walk? Systolic blood pressure SBP in the brachial artery was measured in both arms using an appropriately sized blood pressure cuff and Doppler detection in the antecubital fossa.
SBP was recorded 3 times in each arm, and in the left and right dorsalis pedis and posterior tibial arteries just proximal to the malleoli. For each pressure measurement, the pulse was located using the Doppler probe and the cuff then inflated until the pulse was obliterated. The cuff was then deflated slowly and the pressure noted when the pulse detected by the Doppler probe re-appeared. To standardise the blood pressure measurements all recordings were performed by 1 operator PB , trained in the measurement of ABPI.
The absence of PAD was defined as levels from 0. Results of the Edinburgh Claudication Questionnaire The diagnosis of a positive questionnaire was made on the basis of the original guidelines - see additional file 1. The respondent must have answered yes to question 1, no to question 2, yes to question 3, usually disappears in less than 10 minutes to question 5 and in question 6, mark the calf, thigh or buttock regions. A negative questionnaire was one that did not have this exact combination.
Question 4 was only used to define the severity of claudication if present. The sensitivity, specificity, positive predictive value, negative predictive values were calculated. Diagnostic accuracy was then calculated by dividing the number of individuals under correct classification on the ECQ by the total number of subjects assessed. Data with a continuous variation were subjected to the Anderson-Darling test to determine mode of distribution.
If normally distributed, such data is summarised using mean and standard deviation, and if non-normally distributed by median inter-quartile range. One way ANOVA was used to assess whether there were any differences in continuous variables between the 3 groups speakers of English, Punjabi or Bangladeshi. Demographic data for attenders and non-attenders is shown in Table 1.
Non-attendees were significantly younger 59 standard deviation [SD][ 9 ] vs. There were no differences in cardiovascular risk factors and illiteracy rate between those participating in validation exercise and those not. All participants completing the translated versions were 1st generation South Asian migrants.
PAD was evident in Intermittent claudication was present in 8. There was no significant age difference between those with PAD and those without. The participant demographics of those completing each version of the ECQ are shown in Table 2.
Table 2 Participant Demographics by language of Edinburgh Claudication Questionnaire Full size table Punjabi Questionnaire Thirty-seven participants completed this translated version Table 2. Their mean age was 66 [s. For subjects attending school, the median age of leaving education was 15 [inter-quartile range IQR ] years, with only 2. The diagnostic accuracy of this version was We attempted to look for differences in sensitivity and specificity between illiterate sensitivity There were no differences in diagnostic accuracy between these 2 groups We also attempted to investigate whether age would affect the sensitivity and specificity of the ECQ and found participants under the age of 60 years had higher sensitivity vs.
However due to very small numbers of true claudicants significance was not reached. Table 3 Sensitivity, Specificity, Positive and Negative predictive values of the Edinburgh Claudication Questionnaire Full size table Bengali Questionnaire Twenty participants completed the Bengali translation Table 2 , in whom the mean age was 64 [s.
The sensitivity and specificity of this translation were None of the illiterate Bengali speakers had intermittent claudication and so we could not compare the sensitivity of this questionnaire between those attending school and those whom never attended. The specificity between the former and latter were Likewise no Bengali participants below the age of 60 had intermittent claudication and no significant difference in sensitivity was found with age.
Their mean age was 67 [s. All participants attended school and the median age of leaving school was 16 [IQR ] years. The sensitivity of the ECQ in those under 60 and over 60 years of age were 50 vs. The diagnostic accuracy was Overall Cohort There was no difference in age, sex distribution and prevalence of cardiovascular risk factors between the English, Punjabi and Bengali ECQ groups Table 1.
There were also no differences in body mass index and waist circumference in these 3 groups. There were significant differences in illiteracy between South Asian participants and African Caribbean participants Table 2.
Of those attending school however, no significant differences were found in median age of leaving and proportion of people attending higher education. We investigated the sensitivity and specificity of each of the questions 2 to 6 in the ECQ Table 4. In all languages question 3, "Do you get it [Pain] when you walk uphill or hurry? The least sensitive question was question 5, pertaining to duration of pain.
This question was overall the most specific in the diagnosis of intermittent claudication. Table 4 Sensitivity, Specificity, Positive and Negative predictive values of each question of the Edinburgh Claudication Questionnaire Full size table Discussion We have shown that translated versions of the ECQ into South Asian languages and the original English version in 1st generation Black Caribbean migrants have lower sensitivity and specificity than the original version [ 6 ] but similar levels reported in other populations [ 7 , 10 ].
We also report significant differences in diagnostic accuracy between the Punjabi, Bengali and English versions. Our study differs from the study by Leng et al. The researchers questioned participants over the age of 55 with leg pain and reported The original ECQ was used in large observational study investigating people presenting to their general practitioner with symptoms suggestive of IC, in the Netherlands, which reported a much lower sensitivity of Makdisse et al.
Previously Aboyans et al. Studies have previously shown that questionnaires designed to diagnose cardiovascular disease in White European populations may not always be applicable in an ethnically diverse population [ 12 , 13 , 16 ].
This reflects the findings of other researchers using the Rose Angina questionnaire [ 12 , 13 ]. It is possible that South Asians and Blacks are less good at describing pain than white European populations, which may account for the apparent differences in sensitivity and specificity when compared to Leng et al.
Indeed it has previously been reported that the Rose Angina questionnaire has a lower sensitivity and specificity in South Asians than in white Europeans [ 12 ]; site of pain and duration of pain being least likely to score a positive response to Rose Angina questionnaire in both South Asian men and women. We found question 5 of the ECQ, pertaining to duration of pain to have the least specificity of all of the questions in the ECQ in all versions, which may partly explain the low sensitivity and specificity we found overall.
People of African descent have also been reported to be less likely to score positively to angina using the Rose questionnaire and less likely to seek treatment than white group [ 16 ].
We used an objective measure ABPI to diagnose PAD rather than clinical assessment only, and our findings of lower sensitivity and specificity, positive and negative predictive values of the ECQ when compared to Leng et al. Limitations The main limitations to this study were recruitment of participants answering positively to question one of the ECQ and re-attendance for ABPI measurement. Previous studies used more symptomatic participants in their validation exercises [ 9 , 10 ].
EDINBURGH CLAUDICATION QUESTIONNAIRE PDF
Abstract Background We determined the diagnostic accuracy of the Edinburgh Claudication Questionnaire ECQ in 1st generation Black African-Caribbean UK migrants as previous diagnostic questionnaires have been found to be less accurate in this population. We also determined the diagnostic accuracy of translated versions of the ECQ in 1st generation South Asian UK migrants, as this has not been investigated before. Translated versions of the ECQ were prepared following a recognised protocol. Subjects answering positively to experiencing leg pain or discomfort on walking were asked to return to have Ankle Brachial Pressure Index ABPI measured. Non-responders were younger than participants 59 vs.
Edinburgh Claudication Questionnaire