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Associated Clinical Characteristics and Functional Impairment

Mary McGrae McDermott, MD; Philip Greenland, MD; Kiang Liu, PhD; Jack M. Guralnik, MD, PhD; Michael H. Criqui, MD, MPH; Nancy C. Dolan, MD; Cheeling Chan, MS; Lillian Celic, BS; William H. Pearce, MD; Joseph R. Schneider, MD; Leena Sharma, MD; Elizabeth Clark, MD; Daniel Gibson, BA; Gary J. Martin, MD

JAMA. 2001;286:1599-1606.

Context  Persons with lower-extremity peripheral arterial disease (PAD) are often asymptomatic or have leg symptoms other than intermittent claudication (IC).

Objective  To identify clinical characteristics and functional limitations associated with a broad range of leg symptoms identified among patients with PAD.

Design, Setting, and Participants  Cross-sectional study of 460 men and women with PAD and 130 without PAD, who were identified consecutively, conducted between October 1998 and January 2000 at 3 Chicago-area medical centers.

Main Outcome Measures  Ankle-brachial index score of less than 0.90; scores from 6-minute walk, accelerometer-measured physical activity over 7 days, repeated chair raises, standing balance (full tandem stand), 4-m walking velocity, San Diego claudication questionnaire, Geriatric Depression Score Short-Form, and the Walking Impairment Questionnaire.

Results  All groups with PAD had poorer functioning than participants without PAD. The following values are for patients without IC vs those with IC. Participants in the group with leg pain on exertion and rest (n = 88) had a higher (poorer) score for neuropathy (5.6 vs 3.5; P<.001), prevalence of diabetes mellitus (48.9% vs 26.7%; P<.001), and spinal stenosis (20.8% vs 7.2%; P = .002). The atypical exertional leg pain/carry on group (exertional leg pain other than IC associated with walking through leg pain [n = 41]) and the atypical exertional leg pain/stop group (exertional leg pain other than IC that causes one to stop walking [n = 90]) had better functioning than the IC group. The group without exertional leg pain/inactive (no exertional leg pain in individual who walks 6 blocks per week [n = 28]) and the leg pain on exertion and rest group had poorer functioning than those with IC. Adjusting for age, sex, race, and comorbidities and compared with IC, participants with atypical exertional leg pain/carry on achieved a greater distance on the 6-minute walk (404.3 vs 328.5 m; P<.001) and were less likely to stop during the 6-minute walk (6.8% vs 36%; P = .002). The group with pain on exertion and rest had a slower time for completing 5 chair raises (13.5 vs 11.9 seconds; P = .009), completed the tandem stand less frequently (37.5% vs 60.0%; P = .004), and had a slower 4-m walking velocity (0.80 vs 0.90 m/s; P<.001).

Conclusions  There is a wide range of leg symptoms in persons with PAD beyond that of classic IC. Comorbid disease may contribute to these symptoms in PAD. Functional impairments are found in every PAD symptom group, and the degree of functional limitation varies depending on the type of leg symptom.

Author Affiliations: Departments of Medicine (Drs McDermott, Greenland, Dolan, Sharma, and Martin, and Ms Celic and Mr Gibson), Preventive Medicine (Drs McDermott, Greenland, and Liu, and Ms Chan), and Surgery (Drs Pearce and Schneider), Northwestern University Medical School, Chicago, Ill; Division of Vascular Surgery, Department of Surgery, Evanston/Northwestern Hospital, Evanston, Ill (Dr Schneider); Epidemiology, Demography, and Biometry Program, National Institute on Aging, Bethesda, Md (Dr Guralnik); Department of Family and Preventive Medicine, University of California, San Diego (Dr Criqui); and Division of Vascular Surgery, Department of Surgery, Catholic Health Partners, Chicago, Ill (Dr Clark).

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