title: Impact of psychological factors on objective ambulatory measures in patients with intermittent claudication.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the difference in objective measures of ambulation and psychosocial factors in patients with intermittent claudication (IC) stratified by type D personality, which incorporates elements of social inhibition and negative affectivity.
  
  
  METHODS
  During a 1-year period, routine history and physical examination, ankle-brachial index, and pulse volume recording were performed on IC patients. Questionnaires assessing type D personality and psychosocial factors were also collected. The 6-minute walk test (6MWT) was performed, assessing symptoms and distance walked. Univariate and multivariate methods were used to assess the association between ambulation and type D personality.
  
  
  RESULTS
  Seventy-one patients were enrolled (mean age, 62.5 ± 1.1 years; mean ankle-brachial index, 0.55 ± 0.03). Mean distance to symptoms and total distance walked were 83.7 ± 80.1 m and 206.5 ± 126.3 m, respectively. Type D personality was present in 29.6% of the population (n = 21). On 6MWT, 83.1% of all patients developed symptoms, and 57.4% quit because of symptoms. Univariate analysis of objective measures of ambulation demonstrated lower distance to symptoms in the type D group and trends toward lower total distance walked and quitting the 6MWT. Multivariate models showed increased odds of quitting the 6MWT (odds ratio, 7.71; P = .01) and less total distance walked by an average of 33.2 ± 13.3 m (P = .02) for the type D group.
  
  
  CONCLUSIONS
  Despite equivalent demographic, medical, and psychosocial factors, the type D group was limited in ambulation, suggesting that type D personality is a strong predictor of disease impact in patients with IC.
authors.affiliation: Department of Cardiovascular Sciences, East Carolina University, Greenville, NC.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Torrent
authors.affiliation: Department of Cardiovascular Sciences, East Carolina University, Greenville, NC.
authors.forename: Mandy R
authors.initials: MR
authors.lastname: Maness
authors.affiliation: Department of Cardiovascular Sciences, East Carolina University, Greenville, NC.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Capps
authors.affiliation: Department of Cardiovascular Sciences, East Carolina University, Greenville, NC.
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Sears
authors.affiliation: Department of Cardiovascular Sciences, East Carolina University, Greenville, NC.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Whited
authors.affiliation: Department of Cardiovascular Sciences, East Carolina University, Greenville, NC.
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Yamaguchi
authors.affiliation: Department of Cardiovascular Sciences, East Carolina University, Greenville, NC.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Parker
authors.affiliation: Division of Vascular Surgery, University of Rochester, Rochester, NY. Electronic address: michael_stoner@urmc.rochester.edu.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Stoner
mesh_terms: D000339:Affect; D000368:Aged; D055109:Ankle Brachial Index; D003430:Cross-Sectional Studies; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007266:Inhibition, Psychological; D007383:Intermittent Claudication / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010552:Personality Assessment; D011446:Prospective Studies; D012919:Social Behavior; D011795:Surveys and Questionnaires; D064415:Type D Personality; D014655:Vascular Resistance; D016138:Walking