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RELATION BETWEEN TISSUE OXYGENATION AND WALKING IMPAIRMENT QUESTIONNAIRE SCORES IN PAD PATIENTS

Abstract

Alexandra Conley1, Matthew Martenson1, Judy Muller-Delp1, Jacob Caldwell2, Lawrence Kaelin3, Albert Hakaim4, Lynn Panton, FACSM1. 1Florida State University, Tallahassee, FL. 2University of Wisconsin-La Crosse, La Crosse, WI. 3Vascular Surgery Associates of Florida, Tallahassee, FL. 4Mayo Clinic, Jacksonville, FL.

BACKGROUND: Peripheral artery disease (PAD) is a condition affecting blood flow to the extremities that starts as early as 40 years of age. Symptoms include poor oxygenation in the tissues, endothelial dysfunction, and pain while walking. This pain greatly reduces physical activity in most individuals with PAD, which further contributes to their risk of adverse cardiovascular events. Walking performance is subjectively assessed via the Walking Impairment Questionnaire (WIQ) in PAD patients; however, the relation between changes in tissue oxygenation (StO2) and changes in WIQ scores is unknown. PURPOSE: The goal of this study was to examine the relation between measures of StO2 and subjective measures of walking performance via the WIQ. METHODS: Six patients (71±9 yrs) completed a vascular occlusion test, 6-minute walk test (6MWT), and the WIQ before and after a 4-week stretching intervention. StO2 was measured using near-infrared spectroscopy (NIRS). Reperfusion following the occlusion protocol was measured as a slope of StO2 over time. Patients were fitted for an ankle dorsiflexion splint which stretches the calf muscles. Degree of stretching was measured by a subjective scale of discomfort. Patients wore the dorsiflexion splint for 30 minutes per day for 4 weeks. Data were analyzed by paired t-tests and changes in values were analyzed with Pearson Product Correlations. Significance was accepted at p<0.05. RESULTS: Due to the small sample size there were no significant differences in pre to post values of StO2 reperfusion (Pre:0.82±0.58; Post: 0.98±0.49), 6MWT distance (Pre: 433±62m; 454±75m), and WIQ distance (Pre: 50.8±28.7; Post: 61.3±32.5), speed (Pre: 57.8±15.8; Post: 62.5±15.8), and stair climbing scores (Pre:67.4±15.0; Post:66.7±17.7). However, when doing correlations with the percent changes in measurements, there was a significant correlation between the change in reperfusion following the occlusion test and change in WIQ distance scores (r=0.853). CONCLUSIONS: Changes in microvascular reactivity, induced by muscle stretching, may play a role in decreasing pain associated with PAD, allowing for individuals to increase walking distance before the onset of pain. This may improve compliance of PAD patients to walking or exercise prescriptions.

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