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Reproducibility and reliability of the ankle-brachial index as assessed by vascular experts, family physicians and nurses

Reproducibility and reliability of the ankle-brachial index as assessed by vascular experts, family physicians and nurses
Reproducibility and reliability of the ankle-brachial index as assessed by vascular experts, family physicians and nurses
The reliability of ankle—brachial index (ABI) measurements performed by different observer groups in primary care has not yet been determined. The aims of the study were to provide precise estimates for all effects influencing the variability of the ABI (patients' individual variability, intra- and inter-observer variability), with particular focus on the performance of different observer groups. Using a partially balanced incomplete block design, 144 unselected individuals aged 65 years underwent double ABI measurements by one vascular surgeon or vascular physician, one family physician and one nurse with training in Doppler sonography. Three groups comprising a total of 108 individuals were analyzed (only two with ABI < 0.90). Errors for two repeated measurements for all three observer groups did not differ (experts 8.5%, family physicians 7.7%, and nurses 7.5%, p = 0.39). There was no relevant bias among observer groups. Intra-observer variability expressed as standard deviation divided by the mean was 8%, and inter-observer variability was 9%. In conclusion, reproducibility of the ABI measurement was good in this cohort of elderly patients who almost all had values in the normal range. The mean error of 8—9% within or between observers is smaller than with established screening measures. Since there were no differences among observers with different training backgrounds, our study confirms the appropriateness of ABI assessment for screening peripheral arterial disease (PAD) and generalized atherosclerosis in the primary case setting. Given the importance of the early detection and management of PAD, this diagnostic tool should be used routinely as a standard for PAD screening. Additional studies will be required to confirm our observations in patients with PAD of various severities.
ankle—brachial index, peripheral arterial disease, precision, reproducibility, screening
1358-863X
105-112
Holland-Letz, Tim
94061f92-9cc2-4102-b383-6743dc8295bb
Endres, Heinz G.
20cd50d4-5193-4869-aa08-63d9c04cf312
Biedermann, Stefanie
fe3027d2-13c3-4d9a-bfef-bcc7c6415039
Mahn, Matthias
16bb1899-4416-4c21-9401-685b318d2172
Kunert, Joachim
2a94bcad-855b-4043-8b7f-97f565a4b30a
Groh, Sabine
7e5da959-45ff-4c7f-a9a3-a58d32d8d680
Pittrow, David
a01e64e3-30fc-482c-8f53-66c629114d84
von Bilderling, Peter
f7663216-a1a6-401c-a5aa-9fdcf57b8539
Sternitzky, Reinhardt
0750b2bc-1a31-45c0-b6e7-44041510844c
Diehm, Curt
ad01ee4c-a646-4f23-8f96-066f6f284112
Holland-Letz, Tim
94061f92-9cc2-4102-b383-6743dc8295bb
Endres, Heinz G.
20cd50d4-5193-4869-aa08-63d9c04cf312
Biedermann, Stefanie
fe3027d2-13c3-4d9a-bfef-bcc7c6415039
Mahn, Matthias
16bb1899-4416-4c21-9401-685b318d2172
Kunert, Joachim
2a94bcad-855b-4043-8b7f-97f565a4b30a
Groh, Sabine
7e5da959-45ff-4c7f-a9a3-a58d32d8d680
Pittrow, David
a01e64e3-30fc-482c-8f53-66c629114d84
von Bilderling, Peter
f7663216-a1a6-401c-a5aa-9fdcf57b8539
Sternitzky, Reinhardt
0750b2bc-1a31-45c0-b6e7-44041510844c
Diehm, Curt
ad01ee4c-a646-4f23-8f96-066f6f284112

Holland-Letz, Tim, Endres, Heinz G., Biedermann, Stefanie, Mahn, Matthias, Kunert, Joachim, Groh, Sabine, Pittrow, David, von Bilderling, Peter, Sternitzky, Reinhardt and Diehm, Curt (2007) Reproducibility and reliability of the ankle-brachial index as assessed by vascular experts, family physicians and nurses. Vascular Medicine, 12 (2), 105-112. (doi:10.1177/1358863X07077281).

Record type: Article

Abstract

The reliability of ankle—brachial index (ABI) measurements performed by different observer groups in primary care has not yet been determined. The aims of the study were to provide precise estimates for all effects influencing the variability of the ABI (patients' individual variability, intra- and inter-observer variability), with particular focus on the performance of different observer groups. Using a partially balanced incomplete block design, 144 unselected individuals aged 65 years underwent double ABI measurements by one vascular surgeon or vascular physician, one family physician and one nurse with training in Doppler sonography. Three groups comprising a total of 108 individuals were analyzed (only two with ABI < 0.90). Errors for two repeated measurements for all three observer groups did not differ (experts 8.5%, family physicians 7.7%, and nurses 7.5%, p = 0.39). There was no relevant bias among observer groups. Intra-observer variability expressed as standard deviation divided by the mean was 8%, and inter-observer variability was 9%. In conclusion, reproducibility of the ABI measurement was good in this cohort of elderly patients who almost all had values in the normal range. The mean error of 8—9% within or between observers is smaller than with established screening measures. Since there were no differences among observers with different training backgrounds, our study confirms the appropriateness of ABI assessment for screening peripheral arterial disease (PAD) and generalized atherosclerosis in the primary case setting. Given the importance of the early detection and management of PAD, this diagnostic tool should be used routinely as a standard for PAD screening. Additional studies will be required to confirm our observations in patients with PAD of various severities.

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More information

Published date: May 2007
Keywords: ankle—brachial index, peripheral arterial disease, precision, reproducibility, screening
Organisations: Statistics

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Local EPrints ID: 46733
URI: http://eprints.soton.ac.uk/id/eprint/46733
ISSN: 1358-863X
PURE UUID: a3ed87e5-5730-4911-af47-1a9a32b0eead
ORCID for Stefanie Biedermann: ORCID iD orcid.org/0000-0001-8900-8268

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Date deposited: 17 Jul 2007
Last modified: 08 Jan 2022 03:04

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Contributors

Author: Tim Holland-Letz
Author: Heinz G. Endres
Author: Matthias Mahn
Author: Joachim Kunert
Author: Sabine Groh
Author: David Pittrow
Author: Peter von Bilderling
Author: Reinhardt Sternitzky
Author: Curt Diehm

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