VMJ0010.1177/1358863X14520870Vascular MedicineTew et al.
Validation of the English version of the Walking Estimated-Limitation Calculated by History (WELCH) questionnaire in patients with intermittent claudication
Vascular Medicine 2014, Vol. 19(1) 27–32 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1358863X14520870 vmj.sagepub.com
Garry A Tew1, Shah Nawaz2, Liam Humphreys3, Nafi Ouedraogo4 and Pierre Abraham4 Abstract The Walking Estimated-Limitation Calculated by History (WELCH) questionnaire has recently been proposed as a valid and simple instrument for assessing walking limitation in patients with intermittent claudication. The aim of this study was to validate an English version of the WELCH questionnaire in an English native population. Thirty-nine patients (ankle– brachial index 0.59 ± 0.16, age 65 ± 11 years, 82% male) completed an English version of the WELCH questionnaire. Maximum walking distance was measured objectively using the Gardner–Skinner treadmill test and the 6-minute walk test. The median WELCH score was 24 (9–39). Maximum walking distances were 412 m (149–675 m) for the treadmill test and 381 ± 88 m for the 6-minute walking test. The Spearman’s correlation coefficient was ρ = 0.59 between the WELCH score and treadmill distance (p < 0.001) and ρ = 0.82 between the WELCH score and 6-minute walk distance (p < 0.001). These findings suggest that the English version of the WELCH questionnaire is a valid instrument for assessing walking impairment in patients with intermittent claudication. Keywords exercise, exercise testing, peripheral artery disease, questionnaires, walking impairment
Introduction Approximately one third of patients with lower-limb peripheral artery disease (PAD) have ‘typical’ intermittent claudication,1 which is defined as lower-limb pain or discomfort that is evoked by walking and relieved by rest of less than 10 minutes.2 Intermittent claudication impairs patients’ walking capacity,3 and the degree of limitation can be quantified by treadmill testing.4 However, treadmills are not readily available to most physicians and testing procedures can be time-consuming and expensive. The use of questionnaires facilitates the estimation of walking impairment and they are particularly useful for those who cannot perform treadmill tests or in large epidemiological studies.5 Various questionnaires have been proposed, among which the recently developed Walking Estimated-Limitation Calculated by History (WELCH) questionnaire6 seems to compare favourably to the Walking Impairment Questionnaire (WIQ), a largely studied tool.7–10 Compared to the WIQ, the WELCH is shorter, suffers fewer errors when self-completed, provides comparable correlation with treadmill results, and can be scored easily without a calculator or computer spreadsheet.6 These characteristics make it attractive for routine clinical use. However, the WELCH has only been validated in France (i.e. French language) and against a single specific treadmill procedure.
The aim of the present study was to validate an English version of the WELCH in a group of English patients with intermittent claudication.
Methods Study design and population With local research ethics committee approval, 39 patients with intermittent claudication due to PAD were recruited 1York
Trials Unit, Department of Health Sciences, University of York, York, UK 2Sheffield Vascular Institute, Northern General Hospital, Sheffield, UK 3Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK 4Laboratory for Vascular Investigations, University Hospital of Angers, Angers, France Corresponding author: Pierre Abraham University Hospital of Angers UMR CNRS771-INSERM1083 Angers France Email: [email protected]
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Vascular Medicine 19(1)
from the Sheffield Vascular Institute at the Northern General Hospital, Sheffield, United Kingdom. The diagnosis of PAD was based on an ankle–brachial index