title: The impact of walking impairment, cardiovascular risk factors, and comorbidity on quality of life in patients with intermittent claudication.
abstract: OBJECTIVE
  The objective of this study was to assess the impact of walking impairment, cardiovascular risk factors, and comorbidity on quality of life (QOL) in patients with intermittent claudication (IC).
  
  
  METHODS
  The prospective observational study was conducted in the setting of a vascular outpatient department of a teaching hospital. QOL was assessed in 200 consecutive patients with IC, with a reduced version of the World Health Organization Quality of Life Assessment Instrument-100. The reduced instrument assesses 17 facets of QOL within five domains (Physical and Psychological Health, Level of Independence, Social Relationships, and Environment). Age, gender, degree of IC, risk factors, comorbidity, as recommended by the Society for Vascular Surgery/North American Chapter of the International Society for Cardiovascular Surgery (SVS/ISCVS), and the presence of back, hip, or knee symptoms were analyzed as possible predictors of QOL. Multiple regression analyses were run with each of the QOL facets and domains as dependent variable. A probability value of less than.05 was considered to be statistically significant.
  
  
  RESULTS
  Male gender was found to be a predictor of better scores for Energy and Fatigue and for Sleep and Rest. Women had more Negative Feelings. The presence of back, hip, or knee symptoms was a significant predictive value for many aspects of QOL. With more concomitant diseases, patients had lower scores on the facets of Overall QOL and General Health and of Energy and Fatigue and showed more dependence on medication and treatments. The degree of IC, as expressed in the SVS/ISCVS classification, was a statistically significant predictor of QOL on the domain Level of Independence and its facets Mobility, Activities of Daily Living, and Working Capacity and the facets Pain and Discomfort, Sexual Activity, and Transport. Hypertension was the second most important single predictor of QOL in patients with IC.
  
  
  CONCLUSIONS
  QOL in patients with IC is only partially determined by the severity of walking limitation as expressed in the SVS/ISCVS classification. The significant impact of cardiovascular risk factors and comorbidity and the presence of back, hip, or knee symptoms on QOL should be recognized and taken into account in the treatment policy.
authors.affiliation: Department of Surgery, Martini Hospital, Groningen, The Netherlands. J.C.Breek@MZH.NL
authors.forename: J C
authors.initials: JC
authors.lastname: Breek
authors.forename: J F
authors.initials: JF
authors.lastname: Hamming
authors.forename: J
authors.initials: J
authors.lastname: De Vries
authors.forename: D P
authors.initials: DP
authors.lastname: van Berge Henegouwen
authors.forename: G L
authors.initials: GL
authors.lastname: van Heck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D018434:Sickness Impact Profile; D016138:Walking / Q000502:physiology*