J P Pell1. 1. Wolfson Unit for the Prevention of Peripheral Vascular Diseases, Department of Public Health Sciences, University of Edinburgh, U.K.
Abstract
OBJECTIVES: Surgical treatment of intermittent claudication is aimed primarily at improving quality of life, rather than survival. The aim of this study was to examine the impact of claudication on quality of life and the ability of surgeons to judge this. DESIGN AND MATERIALS: 201 claudicants rated their quality of life and completed an SF36 health status questionnaire prior to their first consultation. Following the consultation, the surgeons rated their perceptions of the patients' quality of life. CHIEF OUTCOME MEASURES: SF36 scores were compared with population norms. Multiple linear regression analysis determined the factors influencing quality of life. Agreement between surgeon and patient ratings of quality of life was expressed as a kappa coefficient. MAIN RESULTS: Compared to population norms, claudicants had significantly reduced quality of life in all respects. The severity of disease, as measured by stopping distance, was a significant predictor of general health, pain, vitality and physical and social parameters. Mental and emotional wellbeing were also reduced, but were not related to disease severity. The agreement between patient and surgeon assessments of quality of life was not high (k = 0.4). Patients had a higher perception of their quality of life than their surgeons. CONCLUSIONS: Intermittent claudication impairs quality of life in all respects. The type of treatment offered to patients should reflect their quality of life at presentation, but subjective assessments by surgeons may not be sufficiently accurate. Health status questionnaires have been used almost exclusively in research, but they may also be of use in clinical settings as an objective measure of quality of life.
OBJECTIVES: Surgical treatment of intermittent claudication is aimed primarily at improving quality of life, rather than survival. The aim of this study was to examine the impact of claudication on quality of life and the ability of surgeons to judge this. DESIGN AND MATERIALS: 201 claudicants rated their quality of life and completed an SF36 health status questionnaire prior to their first consultation. Following the consultation, the surgeons rated their perceptions of the patients' quality of life. CHIEF OUTCOME MEASURES: SF36 scores were compared with population norms. Multiple linear regression analysis determined the factors influencing quality of life. Agreement between surgeon and patient ratings of quality of life was expressed as a kappa coefficient. MAIN RESULTS: Compared to population norms, claudicants had significantly reduced quality of life in all respects. The severity of disease, as measured by stopping distance, was a significant predictor of general health, pain, vitality and physical and social parameters. Mental and emotional wellbeing were also reduced, but were not related to disease severity. The agreement between patient and surgeon assessments of quality of life was not high (k = 0.4). Patients had a higher perception of their quality of life than their surgeons. CONCLUSIONS:Intermittent claudication impairs quality of life in all respects. The type of treatment offered to patients should reflect their quality of life at presentation, but subjective assessments by surgeons may not be sufficiently accurate. Health status questionnaires have been used almost exclusively in research, but they may also be of use in clinical settings as an objective measure of quality of life.
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