Clinical indicators and psychosocial aspects in peripheral arterial disease.

HYPOTHESIS

Patients with peripheral arterial disease (PAD) often experience substantial impairment in health status and quality of life (QOL), but factors associated with these outcomes are unknown. We hypothesized that subjective pain symptoms in the legs and social support and stress (the degree to which situations are appraised as stressful) are associated with impaired health status and QOL.

DESIGN

Cross-sectional observational study.

SETTING

Vascular outpatient clinic of a teaching hospital.

PATIENTS

The study included consecutive patients seeking treatment for the first time because of walking pain. Diagnosis and severity of PAD were based on history, physical examination, treadmill-walking distance, and ankle-brachial pressure indexes (ABPIs). Patients with PAD (n = 188) and patients with atypical leg symptoms (n = 57) completed the 10-item version of the Perceived Stress Scale (perceived stress), the 12-item version of the Perceived Social Support Scale-Revised (social support), the RAND 36-Item Health Survey (health status), and the World Health Organization Quality of Life Assessment Instrument-100.

MAIN OUTCOME MEASURES

Health status and QOL.

RESULTS

Both groups had equally poor health status and QOL, with patients with atypical leg symptoms reporting more bodily pain (P = .004). In patients with PAD, the ABPI (P = .008) and perceived stress (P = .001) were associated with maximum walking distance. Furthermore, the health status domain of physical functioning was affected by the ABPI (P = .002), cardiac disease (P = .005), body mass index (P = .007), and perceived stress (P<.001). Overall QOL in patients with PAD was independently influenced by sex (P = .04), carotid disease (P = .03), and perceived stress (P<.001).

CONCLUSIONS

Subjective pain in the legs is associated with impaired health status and QOL. Stress adversely influences the health status and QOL of patients with PAD above and beyond the influence of clinical indicators. These findings indicate the importance of accounting for perceived stress in patients with PAD.