title: Interobserver and intraobserver reproducibility of peripheral blood and oxygen pressure measurements in the assessment of lower extremity arterial disease.
abstract: BACKGROUND
  Peripheral blood pressure measurements play a prominent role in the diagnosis and follow-up of patients with peripheral vascular diseases. Toe pressure of the hallux (TP1) and second toe (TP2) and transcutaneous oxygen pressure (TCPO2) measurements are becoming more important. The ankle/brachial pressure index (ABPI) is known to be a reliable parameter, but the toe pressure and TCPO2 are evaluated less thoroughly. Therefore, we evaluated the reproducibility of TP1, TP2, TCPO2, ABPI, ankle pressure (AP), and brachial pressure (BP).
  
  
  METHODS
  In 54 patients with various stages of peripheral vascular disease, the intraobserver and interobserver reproducibility of BP, AP, ABPI, TP1, TP2, and TCPO2 was investigated by calculating the repeatability coefficient (RC) and the intraclass correlation coefficient (ICC) and by using Bland-Altman plots.
  
  
  RESULTS
  The intraobserver and interobserver reproducibility at 1 day and after 1 week of BP, AP, ABPI, and TP1 was substantial and comparable (ICC range, 0.80-0.99), except for the BP after 1 week. The TP2 and TCPO2 were less reproducible (ICC range, 0.62-0.98). The interobserver RC of BP was 31 mm Hg; of AP, 44 mm Hg; of ABPI, 27%; of TP1, 41 mm Hg; of TP2, 67 mm Hg; and of TCPO2; 30 mm Hg. The difference plot showed that the observer variability was equally distributed across the range of pressure in all measurements.
  
  
  CONCLUSIONS
  The BP, AP, ABPI, and TP1 have a substantial intraobserver and interobserver reproducibility, whereas TP2 and TCPO2 show worse reproducibility. Especially when low values (or values around a cutoff value) are measured, the RC should be taken into account, and repetition of the measurement is advocated.
authors.affiliation: Department of Vascular Surgery and Clinical Epidemiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: de Graaff
authors.forename: D T
authors.initials: DT
authors.lastname: Ubbink
authors.forename: D A
authors.initials: DA
authors.lastname: Legemate
authors.forename: R J
authors.initials: RJ
authors.lastname: de Haan
authors.forename: M J
authors.initials: MJ
authors.lastname: Jacobs
mesh_terms: D000368:Aged; D000842:Ankle / Q000098:blood supply; D001785:Blood Gas Monitoring, Transcutaneous; D001795:Blood Pressure Determination / Q000379:methods*; D005260:Female; D006214:Hallux / Q000098:blood supply; D006801:Humans; D007383:Intermittent Claudication / Q000097:blood / Q000503:physiopathology*; D007511:Ischemia / Q000097:blood / Q000503:physiopathology*; D007866:Leg / Q000098:blood supply*; D008297:Male; D015588:Observer Variation; D017156:Photoplethysmography; D015203:Reproducibility of Results; D014034:Toes / Q000098:blood supply