Watson C J, Phillips D, Hands L, Collin J
University of Oxford, Nuffield Department of Surgery, John Radcliffe Hospital, UK.
Br J Surg. 1997 Aug;84(8):1107-9.
Claudication distance is the commonest measure of the disability caused by lower-limb occlusive arterial disease. The accuracy of claudication distance as a surrogate for handicap has been assessed.
Seventy patients who attended a specialist vascular clinic with intermittent claudication were studied prospectively. Patients were asked to estimate their claudication distance and maximum walking distance before undergoing both a patient-controlled corridor walk and a fixed-speed treadmill walk.
The claudication distance reported by patients bore little relation to the distance recorded in the medical correspondence. There was no correlation between the estimated distance and the actual distance walked on either a patient-controlled corridor walk or a fixed-speed treadmill walk. Most patients were able to walk substantially further at their own speed on the corridor than on the treadmill at a slower speed.
Claudication distance is spuriously estimated, inaccurately reported, falsely recorded, inappropriately measured and usually misinterpreted. It is of little value in judging the need for treatment. Objective measures of the handicap caused by the disability of reduced walking distance are required if rational management decisions are to be made.
跛行距离是下肢闭塞性动脉疾病所致残疾最常用的衡量指标。已对跛行距离作为残疾替代指标的准确性进行了评估。
对70名因间歇性跛行前往专科血管门诊就诊的患者进行了前瞻性研究。在患者进行自主控制的走廊行走和固定速度的跑步机行走之前,要求他们估计自己的跛行距离和最大行走距离。
患者报告的跛行距离与病历记录中的距离几乎没有关系。在自主控制的走廊行走或固定速度的跑步机行走中,估计距离与实际行走距离之间均无相关性。大多数患者能够以自己的速度在走廊上行走的距离比在跑步机上以较慢速度行走的距离远得多。
跛行距离被虚假估计、报告不准确、记录错误、测量不当且通常被误解。它在判断治疗需求方面价值不大。如果要做出合理的管理决策,就需要对因行走距离缩短导致的残疾所造成的障碍进行客观测量。