title: Reliability and feasibility of methods to quantitatively assess peripheral edema.
abstract: OBJECTIVE
  To evaluate methods to assess peripheral edema for reliability, feasibility and correlation with the classic clinical assessment of pitting edema.
  
  
  METHODS
  Cross-sectional observational study.
  
  
  METHODS
  Large primary care clinic in Marshfield, Wisconsin, USA.
  
  
  METHODS
  Convenience sample of 20 patients with type 2 diabetes and a range of edema severity, including patients without edema.
  
  
  METHODS
  Eight methods of edema assessment were evaluated: (1) clinical assessment of pit depth and recovery at three locations, (2) patient questionnaire, (3) ankle circumference, (4) figure-of-eight (ankle circumference using eight ankle/foot landmarks), (5) edema tester (plastic card with holes of varying size pressed to the ankle with a blood pressure cuff), (6) modified edema tester (edema tester with bumps), (7) indirect leg volume (by series of ankle/leg circumferences), and (8) foot/ankle volumetry by water displacement. Patients were evaluated independently by three nurse examiners.
  
  
  RESULTS
  Water displacement and ankle circumference had high inter-examiner agreement (intraclass correlation coefficient 0.93, 0.96 right; 0.97, 0.97 left). Agreement was inconsistent for figure-of-eight (0.64, 0.86), moderate for indirect leg volume (0.53, 0.66), and low for clinical assessments at all locations. Agreement was low for the edema testers but varied by the pressure administered. Correlation with the classic, subjective clinical assessment was good for the nurse-performed assessments and patient questionnaire. Ankle circumference and patient questionnaires each took 1 minute to complete. Other tools took >5 minutes to complete.
  
  
  CONCLUSIONS
  Water displacement and ankle circumference showed excellent reliability; however, water displacement is a time-consuming measure and may pose implementation challenges in the clinical and clinical trial environments. Patient-reported level and frequency of edema, based on an unvalidated questionnaire, was generally well correlated with the physician assessment of edema severity and may prove to be another reliable and accurate method of assessing edema. Additional study is needed to evaluate the validity and responsiveness of these methods.
authors.affiliation: Department of Epidemiology, Merck Research Laboratories, North Wales, Pennsylvania 19454, USA. kimberly_brodovicz@merck.com
authors.forename: Kimberly G
authors.initials: KG
authors.lastname: Brodovicz
authors.forename: Kristin
authors.initials: K
authors.lastname: McNaughton
authors.forename: Naoto
authors.initials: N
authors.lastname: Uemura
authors.forename: Gary
authors.initials: G
authors.lastname: Meininger
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Girman
authors.forename: Steven H
authors.initials: SH
authors.lastname: Yale
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000502:physiology; D000886:Anthropometry / Q000379:methods; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000175:diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology; D004487:Edema / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D005528:Foot; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires