Changes in functional status after treatment of critical limb ischemia.
OBJECTIVE
This study evaluated changes in functional status with the Academic Medical Center Linear Disability Score (ALDS) and in quality of life with the Vascular Quality of Life Questionnaire (VascuQol) in patients treated for critical limb ischemia (CLI).


METHODS
We conducted a prospective observational cohort study in a single academic center that included consecutive patients with CLI who presented between May 2007 and May 2010. The ALDS and VascuQol questionnaires were administered before treatment (baseline) and after treatment at 6 and 12 months of follow-up. Changes in functional status (ALDS) and quality of life (VascuQol) scores after 6 and 12 months, compared with baseline, were tested with the appropriate statistical tests, with significance set at P < .05.


RESULTS
The study included 150 patients, 96 (64%) were men, and mean (± standard deviation) age was 68.1 (± 12.4) years. The primary treatment was endovascular in 98 (65.3%), surgical in 36 (24%), conservative in 11 (7.3%), or a major amputation in five (3.3%). The ALDS was completed by 112 patients after 12 months. At that time, the median ALDS score had increased by 10 points (median, 83; range, 12-89; P = .001) in patients who achieved limb salvage, which corresponds with more difficult outdoor and indoor activities. In patients with a major amputation, the median ALDS score decreased by 14 points (median, 55; range, 16-89; P = .117) after 12 months, which corresponds with domestic activities only. VascuQol scores improved significantly in all separate domains for the limb salvage group (P < .001). All VascuQol scores, except for the activity and social domains, increased significantly after amputation.


CONCLUSIONS
Our study confirms the clinical validity of the ALDS in patients treated for CLI and shows that it is a valuable and sophisticated instrument to measure changes in functional status in these patients.
Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: f.a.frans@amc.uva.nl.
Franceline Alkine
FA
Frans
Rosemarie
R
Met
Mark J W
MJ
Koelemay
Shandra
S
Bipat
Marcel G W
MG
Dijkgraaf
Dink A
DA
Legemate
Jim A
JA
Reekers
D000046:Academic Medical Centers; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D004185:Disability Evaluation; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D023821:Limb Salvage; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures