Trevethan Robert
Independent academic researcher and author, Albury, NSW, Australia.
Curr Diabetes Rev. 2019;15(2):85-92. doi: 10.2174/1573399814666180123113619.
BACKGROUND & AIMS: Toe Systolic Blood Pressures (TSPs) and Toe-Brachial Indices (TBIs) have been identified as useful adjuncts in the identification of pedal ischemia, peripheral artery occlusive diseases, and risk for either nonhealing of lower extremity wounds or for amputation. Valid measurement of TSPs and TBIs is therefore essential. However, it could be jeopardized by rater, instrument, and intratestee inconsistency. These three sources of inconsistency were examined in this research.
Five publications addressing TSP and TBI consistency were identified and their results were analyzed using intraclass correlation coefficients.
Moderate variability in TSPs was found across all studies; greater variability was evidenced in brachial systolic pressure, particularly for people who had diabetes; and TBI values also exhibited considerable variability, but little difference between people who did and did not have diabetes.
These findings provide qualified evidence of consistency regarding measurement of TSPs but challenge TBI as a valid and useful indicator in screening, prognostic, and monitoring contexts, particularly for people who have diabetes. However, there is a prospect that TBI assessment could be improved by adherence to standardized protocols and by obtaining multiple measurements from toes and arms on a single occasion as well as on different occasions.
趾收缩压（TSPs）和趾臂指数（TBIs）已被确定为识别足部缺血、外周动脉闭塞性疾病以及下肢伤口不愈合或截肢风险的有用辅助指标。因此，TSPs和TBIs的有效测量至关重要。然而，这可能会受到评估者、仪器和被测试者内部不一致性的影响。本研究对这三种不一致性来源进行了考察。
确定了五篇关于TSP和TBI一致性的出版物，并使用组内相关系数分析其结果。
在所有研究中均发现TSPs存在中度变异性；肱动脉收缩压变异性更大，尤其是糖尿病患者；TBI值也表现出相当大的变异性，但糖尿病患者与非糖尿病患者之间差异不大。
这些发现为TSPs测量的一致性提供了有限的证据，但对TBI作为筛查、预后和监测背景下的有效和有用指标提出了挑战，特别是对于糖尿病患者。然而，如果坚持标准化方案，并在单次及不同时间从趾部和臂部获取多次测量值，TBI评估有望得到改善。
