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-
1
Norman PE, Eikelboom JW, Hankey GJ: Peripheral arterial disease: prognostic significance and prevention of atherothrombotic complications. Med J Aust 181: 150, 2004.
-
2
Ouriel K: Peripheral arterial disease. Lancet 358: 1257, 2001.
-
3
Burns P, Gough S, Bradbury AW: Management of peripheral arterial disease in primary care. BMJ 326: 584, 2003.
-
4
Williams DT, Pugh ND, Coleman DP, et al: Review: the laboratory evaluation of lower limb perfusion in diabetes mellitus: a clinical review. Br J Diabetes Vasc Dis 6: 64, 2005.
-
5
Brooks B, Dean R, Patel S, et al: TBI or not TBI: that is the question: is it better to measure toe pressure than ankle pressure in diabetic patients? Diabet Med 18: 528, 2001.
-
6
Caruana MF, Bradbury AW, Adam DJ: The validity, reliability, reproducibility and extended utility of ankle to brachial pressure index in current vascular surgical practice. Eur J Vasc Endovasc Surg 29: 443, 2005.
-
7
Chao CYL, Cheing GLY: Microvascular dysfunction in diabetic foot disease and ulceration. Diabetes Metab Res Rev 25: 604, 2009.
-
8
Hile C, Veves A: Diabetic neuropathy and microcirculation. Curr Diabetes Rep 3: 446, 2003.
-
9
Williams DT, Harding KG, Price P: An evaluation of the efficacy of methods used in screening for lower-limb arterial disease in diabetes. Diabetes Care 28: 2206, 2005.
-
10
Allison MA, Criqui MH, Wright CM: Patterns and risk factors for systemic calcified atherosclerosis. Arterioscler ThrombVasc Biol 24: 331, 2004.
-
11
Moe SM, Chen NX: Mechanisms of vascular calcification in chronic kidney disease. J Am Soc Nephrol 19: 213, 2008.
-
12
Vinik AI, Erbas T, Park TS, et al: Dermal neurovascular dysfunction in type 2 diabetes. Diabetes Care 24: 1468, 2001.
-
13
Carter SA, Tate RB: Value of toe pulse waves in addition to systolic pressures in the assessment of the severity of peripheral arterial disease and critical limb ischaemia. J Vasc Surg 24: 258, 1996.
-
14
Fleck CA: Measuring toe brachial index. Adv Skin Wound Care 21: 20, 2008.
-
15
Scanlon C, Park K, Mapletoft D, et al: Interrater and intrarater reliability of photoplethysmography for measuring toe blood pressure and toe-brachial index in people with diabetes mellitus. J Foot Ankle Res 5: 13, 2012.
-
16
Romanos MT, Raspovic A, Perrin BM: The reliability of toe systolic pressure and the toe brachial index in patients with diabetes. J Foot Ankle Res 3: 31, 2010.
-
17
Cloete N, Kiely C, Colgan MP, et al: Reproducibility of toe pressure measurements. J Vasc Ultrasound 33: 129, 2009.
-
18
de Graaff JC, Ubbink DT, Legemate DA, et al: Interobserver and intraobserver reproducibility of peripheral blood and oxygen pressure measurements in the assessment of lower extremity arterial disease. J Vasc Surg 33: 1033, 2001.
-
19
Walters SD, Eliasziw M, Donner A: Sample size and optimal designs for reliability studies. Stat Med 17: 101, 1998.
-
20
Hirsch AT, Haskal ZJ, Hertzer NR, et al: ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society for Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol 47: e1, 2006.
-
21
Vowden K, Vowden P: Doppler and the ABPI: how good is our understanding? J Wound Care 10: 197, 2001.
-
22
Sacks D, Bakal C, Beatty PT, et al: Position statement on the use of the ankle brachial index in the evaluation of patients with peripheral vascular disease: a consensus statement developed by the standards division of the Society of Cardiovascular and Interventional Radiology. J Cardiovasc Interv Radiol 14: S389, 2003.
-
23
Menz HB: Two feet, or one person? problems associated with statistical analysis of paired data in foot and ankle medicine. Foot 14: 2, 2004.
-
24
Fleiss J: “Reliability of Measurement,” in The Design and Analysis of Clinical Experiments, edited by J Fleiss, John Wiley & Sons, New York, 1986.
-
25
Portney LG, Watkins MP: Foundations of Clinical Research: Applications to Practice, 2nd Ed, Prentice Hall Health, Upper Saddle River, NJ, 2000.
-
26
Pickering TG, Hall JE, Appel LJ, et al: Recommendations for blood pressure measurement in humans and experimental animals. Hypertension 45: 142, 2005.
-
27
Vinik AI, Maser RE, Mitchel BD, et al: Diabetic autonomic neuropathy. Diabetes Care 26: 1553, 2003.
-
28
Chuter VH, Casey SL: Effect of premeasurement rest time on systolic ankle pressure. J Am Heart Assoc 2: e000203, 2013.
-
29
TransAtlantic Inter-Society Consensus (TASC): Management of peripheral arterial disease (PAD). Eur J Vasc Endovasc Surg 19 (suppl A): S1, 2000.
Intratester and Intertester Reliability of Toe Pressure Measurements in People with and Without Diabetes Performed by Podiatric Physicians
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Background
Toe pressures and the toe brachial index (TBI) represent possible screening tools for peripheral arterial disease; however, limited evidence is available regarding their reliability. The aim of this study was to determine intratester and intertester reliability of toe systolic pressure and the TBI in participants with and without diabetes performed by podiatric physicians.
Methods
Two podiatric physicians performed toe and brachial pressure measurements on 80 participants, 40 with and 40 without diabetes, during two testing sessions using photoplethysmography and Doppler probe. Intraclass correlation coefficients (ICCs) and 95% limits of agreement were determined.
Results
In people with diabetes, intratester reliability of toe pressure measurement was excellent for both testers (ICCs, 0.84 and 0.82). Reliability of the TBI was good (ICCs, 0.72 and 0.75) and brachial pressure fair (ICCs, 0.43 and 0.55). The intertester reliability of toe pressure (ICC, 0.82) and the TBI (ICC, 0.80) was excellent. Intertester reliability of brachial pressure was reduced in people with diabetes (ICC, 0.49). In age-matched participants, intratester reliability of toe pressure measurement was excellent for both testers (ICCs, 0.83 and 0.87), and reliability of the TBI (ICCs, 0.74 and 0.80) and brachial pressure (ICCs, 0.73 and 0.78) was good to excellent. Intertester reliability of toe pressure (ICC, 0.84), the TBI (ICC, 0.81), and brachial pressure (ICC, 0.77) was excellent.
Conclusions
Toe pressures and the TBI demonstrated excellent reliability in people with and without diabetes and can be an effective component of lower-extremity vascular screening. However, wide limits of agreement relative to blood pressure values for both cohorts indicate that results should be interpreted with caution.
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