Rutherford Claudication Severity Compared to Patient Reported Quality of Life and Function

This study compared patient-reported claudication-related quality of life and function with physician classification of disease severity, with the goal of developing a more patient-centered assessment tool. Consecutive patients with leg pain and diagnosis of isolated infrainguinal disease were evaluated from 2011 to 2013 with the Vascular Quality of Life Questionnaire (VascuQoL) and Walking Impairment Questionnaire (WIQ). Patient scores were divided in tertiles, and concordance was performed to clinician-reported Rutherford assessment (mild, moderate, or severe). Of 323 patients enrolled, 225 participants (males, 70.7%) completed all three measures (VascuQoL, WIQ, and Rutherford) and were included in the analysis (mean ± standard deviation age, 70.7 ± 9.7 years.) Mean VascuQoL score was 4.72 ± 1.2 of 7 (1, lowest; 7, highest). Mean WIQ distance score was 34.7 ± 29.9 of 100 (lower score indicates lower function). The tertile ranges for the VascuQoL were low (1.4-4.1), moderate (4.2-5.4), and high (5.4-6.9). The tertiles for the WIQ were low (0-13.7), moderate (13.9-44.5), and high (44.6-100). The correlation between the WIQ or VascuQoL score and the Rutherford index were low (ρ = −0.34; P < .001 and ρ = −0.38; P < .001, respectively; Table). In patients reporting low QoL, physicians classified claudication as severe in 54%, moderate in 33%, and as mild in 13%. In patients reporting high QoL, 59% were classified as mild, 23% as moderate, and 18% as severe. Similarly, in patients reporting low walking function, 55% were classified as severe, 29% as moderate, and 16% as mild. In patients reporting high function, 21% were classified as severe, 26% as moderate, and 53% as mild. Lastly, the mean ankle-brachial indices for the Rutherford categories were 0.68, 0.68, and 0.62 for mild, moderate, and severe claudication, respectively (P = .12). The ankle-brachial index to Rutherford association was low (ρ = 0.2217; P = .002). There is significant discordance between quality of life and functional impairment due to claudication as reported by patients and as assessed by clinicians. Physicians overestimate effect of mild claudication and underestimate effect of severe claudication in 50% to 60% of patients. In this era of patient-centered health care, a tool that accounts for patient perception of disease severity is warranted.TableNumber and percentage of patients from each survey category by physician assigned claudication severityVascuQoL categoryRutherford classificationLow QoL (n = 84), No. (%)Moderate QoL (n = 76), No. (%)High QoL (n = 61), No. (%)Mild11 (13)27 (36)36 (59)Moderate28 (33)18 (24)14 (23)Severe45 (54)31 (41)11 (18)WIQ distance categoryRutherford classificationLow function (n = 82), No. (%)Moderate function (n = 71), No. (%)High function (n = 66), No. (%)Mild13 (16)26 (37)35 (53)Moderate24 (29)19 (27)17 (26)Severe45 (55)26 (37)14 (21) Open table in a new tab