Leg symptoms in peripheral arterial disease - Associated clinical characteristics and functional impairment

Context Persons with lower-extremity peripheral arterial disease (PAD) are often asymptomatic or have leg symptoms other than intermittent claudicatio n (IC). Objective To identify clinical characteristics and functional limitations a ssociated with a broad range of leg symptoms identified among patients with PAD. Design, Setting, and Participants Cross-sectional study of 460 men and wome n with PAD and 130 without PAD, who were identified consecutively, conducte d between October 1998 and January 2000 at 3 Chicago-area medical centers. Main Outcome Measures Ankle-brachial index score of less than 0.90; scores from 6-minute walk, accelerometer-measured physical activity over 7 days, r epeated chair raises, standing balance (full tandem stand), 4-m walking vel ocity, San Diego claudication questionnaire, Geriatric Depression Score Sho rt-Form, and the Walking Impairment Questionnaire. Results All groups with PAD had poorer functioning than participants withou t PAD. The following values are for patients without IC vs those with IC. P articipants in the group with leg pain on exertion and rest (n=88) had a hi gher (poorer) score for neuropathy (5.6 vs 3.5; P<.001), prevalence of diab etes mellitus (48.9% vs 26.7%; P<.001), and spinal stenosis (20.8% vs 7.2%; P=.002). The atypical exertional leg pain/carry on group (exertional leg p ain other than IC associated with walking through leg pain [n=41]) and the atypical exertional leg pain/stop group (exertional leg pain other than IC that causes one to stop walking [n=90]) had better functioning than the IC group. The group without exertional leg pain/inactive (no exertional leg pa in in individual who walks less than or equal to6 blocks per week [n=28]) a nd the leg pain on exertion and rest group had poorer functioning than thos e with IC. Adjusting for age, sex, race, and comorbidities and compared wit h IC, participants with atypical exertional leg pain/carry on achieved a gr eater distance on the 6-minute walk (404.3 vs 328.5 m; P<.001) and were les s likely to stop during the 6-minute walk (6.8% vs 36%; P=.002). The group with pain on exertion and rest had a slower time for completing 5 chair rai ses (13.5 vs 11.9 seconds; P=.009), completed the tandem stand less frequen tly (37.5% vs 60.0%; P=.004), and had a slower 4-m walking velocity (0.80 v s 0.90 m/s; P<.001). Conclusions There is a wide range of leg symptoms in persons with PAD beyon d that of classic IC. Comorbid disease may contribute to these symptoms in PAD. Functional impairments are found in every PAD symptom group, and the d egree of functional limitation varies depending on the type of leg symptom.