The Peripheral Artery Questionnaire: A New Disease-Specific
Background: The most common indication for treating patients with peripheral arterial disease is to improve their health status: their symptoms, function, and quality of life. Quantifying health status requires a valid, reproducible, and sensitive disease-specific measure. The Peripheral Artery Questionnaire (PAQ) is a 20-item questionnaire developed to meet this need by quantifying patients' physical limitations, symptoms, social function, treatment satisfaction, and quality of life.
Methods: Psychometric and clinical properties of the PAQ were evaluated in a prospective cohort study of 44 patients undergoing elective percutaneous peripheral revascularization. To establish reproducibility, 2 assessments were performed 2 weeks apart and before revascularization. The change in scores before and 6 weeks after revascularization were used to determine the instruments' responsiveness and were compared with the Short Form-36 and the Walking Impairment Questionnaire. A series of cross-sectional analyses were performed to establish the construct validity of the PAQ.
Results: The 7 domains of the PAQ were internally reliable, with Cronbach α = 0.80 to 0.94. The test-retest reliability analyses revealed insignificant mean changes of 0.6 to 2.3 points (P = not significant for all). Conversely, the change after revascularization ranged from 13.7 to 41.9 points (P ≤ .001 for all), reflecting substantial sensitivity of the PAQ to clinical improvement. The PAQ Summary Scale was the most sensitive of all scales tested. Construct validity was established by demonstrating correlations with other measures of patient health status.
Conclusions: The PAQ is a valid, reliable, and responsive disease-specific measure for patients with peripheral arterial disease. It may prove to be a useful end point in clinical trials and a potential aid in disease management.
Medical practice is becoming increasingly dependent on clinical evidence to justify and guide practice. When the needed evidence concerns the symptomatic, functional, and quality-of-life benefits of treatment, then a means of quantifying these health status outcomes is needed. Health status measures are the most direct approach to quantifying such patient-centered outcomes. Health status measures quantify patient perspectives about symptoms, functioning (either physical, emotional, or social), and quality of life. Such measures may be either generic or disease-specific, with the latter having increased clinical relevance and greater sensitivity to clinical change.
Perhaps no cardiovascular disease has a greater need for a disease-specific health status measure than peripheral arterial disease (PAD), a disease whose treatment is almost entirely directed toward improving health status rather than survival or limb preservation. Approximately 1 in 20 individuals older than 50 years of age have PAD, and current efforts to increase public awareness of the disease and its potential treatment are likely to increase the numbers of patients seeking care. With an increasing armamentarium for the treatment of PAD becoming available, including medications, peripheral revascularization, and surgery, the need to evaluate and compare these treatment options is of growing importance, and quantifying patient perspectives of the treatment benefit received will be essential. The Peripheral Arterial Questionnaire (PAQ) was created to address the need for a well-developed, disease-specific measure for PAD.
The PAQ is a new, self-administered, 20-item health status measure for patients with PAD. It quantifies, in a disease-specific fashion, physical limitation, symptoms (frequency, severity, and recent change over time), quality of life, social function, and treatment satisfaction. It sought to improve upon existing PAD health status measures in either the breadth of domains quantified and/or the brevity of its assessment. Before being used, however, health status measures must be rigorously evaluated and demonstrated to be valid (measure what they intend to), reliable (be reproducible over time in stable patients), and responsive (sensitive) to clinical change. This report documents the development of the PAQ, its validity, its reliability, and its responsiveness to clinical change.
Background: The most common indication for treating patients with peripheral arterial disease is to improve their health status: their symptoms, function, and quality of life. Quantifying health status requires a valid, reproducible, and sensitive disease-specific measure. The Peripheral Artery Questionnaire (PAQ) is a 20-item questionnaire developed to meet this need by quantifying patients' physical limitations, symptoms, social function, treatment satisfaction, and quality of life.
Methods: Psychometric and clinical properties of the PAQ were evaluated in a prospective cohort study of 44 patients undergoing elective percutaneous peripheral revascularization. To establish reproducibility, 2 assessments were performed 2 weeks apart and before revascularization. The change in scores before and 6 weeks after revascularization were used to determine the instruments' responsiveness and were compared with the Short Form-36 and the Walking Impairment Questionnaire. A series of cross-sectional analyses were performed to establish the construct validity of the PAQ.
Results: The 7 domains of the PAQ were internally reliable, with Cronbach α = 0.80 to 0.94. The test-retest reliability analyses revealed insignificant mean changes of 0.6 to 2.3 points (P = not significant for all). Conversely, the change after revascularization ranged from 13.7 to 41.9 points (P ≤ .001 for all), reflecting substantial sensitivity of the PAQ to clinical improvement. The PAQ Summary Scale was the most sensitive of all scales tested. Construct validity was established by demonstrating correlations with other measures of patient health status.
Conclusions: The PAQ is a valid, reliable, and responsive disease-specific measure for patients with peripheral arterial disease. It may prove to be a useful end point in clinical trials and a potential aid in disease management.
Medical practice is becoming increasingly dependent on clinical evidence to justify and guide practice. When the needed evidence concerns the symptomatic, functional, and quality-of-life benefits of treatment, then a means of quantifying these health status outcomes is needed. Health status measures are the most direct approach to quantifying such patient-centered outcomes. Health status measures quantify patient perspectives about symptoms, functioning (either physical, emotional, or social), and quality of life. Such measures may be either generic or disease-specific, with the latter having increased clinical relevance and greater sensitivity to clinical change.
Perhaps no cardiovascular disease has a greater need for a disease-specific health status measure than peripheral arterial disease (PAD), a disease whose treatment is almost entirely directed toward improving health status rather than survival or limb preservation. Approximately 1 in 20 individuals older than 50 years of age have PAD, and current efforts to increase public awareness of the disease and its potential treatment are likely to increase the numbers of patients seeking care. With an increasing armamentarium for the treatment of PAD becoming available, including medications, peripheral revascularization, and surgery, the need to evaluate and compare these treatment options is of growing importance, and quantifying patient perspectives of the treatment benefit received will be essential. The Peripheral Arterial Questionnaire (PAQ) was created to address the need for a well-developed, disease-specific measure for PAD.
The PAQ is a new, self-administered, 20-item health status measure for patients with PAD. It quantifies, in a disease-specific fashion, physical limitation, symptoms (frequency, severity, and recent change over time), quality of life, social function, and treatment satisfaction. It sought to improve upon existing PAD health status measures in either the breadth of domains quantified and/or the brevity of its assessment. Before being used, however, health status measures must be rigorously evaluated and demonstrated to be valid (measure what they intend to), reliable (be reproducible over time in stable patients), and responsive (sensitive) to clinical change. This report documents the development of the PAQ, its validity, its reliability, and its responsiveness to clinical change.
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