title: Intra-tester and inter-tester reliability of post-occlusive reactive hyperaemia measurement at the hallux.
abstract: BACKGROUND
  Post-occlusive reactive hyperaemia (PORH) is a measurement of the vasodilatory capacity of the microvasculature that is associated with cardiovascular disease, peripheral arterial disease and foot ulceration. The reliability of its measurement in the hallux (great toe) for clinical and research purposes has not been adequately assessed. This study assesses both the intra-tester reliability and inter-tester reliability of four methods of assessing PORH in the hallux.
  
  
  RESULTS
  A within-subject repeated measures design was used. Forty-two participants underwent PORH testing using four methods: pressure measurement with photoplethysmography; an automated laser Doppler technique with local heating; an automated laser Doppler technique without local heating; and a manual laser Doppler technique. Participants underwent testing on two occasions with a three to 14 day interval. Laser Doppler measurement with a heating probe was found to be the most reliable method of PORH measurement. The index of the area under the curve pre- and post-occlusion and peak perfusion as a percentage of baseline were the most reliable variables.
  
  
  CONCLUSIONS
  PORH can be reliably measured using laser Doppler when combined with a heating probe. Further research is required to determine the clinical utility of photoplethysmography in the measurement of PORH.
authors.affiliation: University of Newcastle, Australia. Electronic address: alex.barwick@newcastle.edu.au.
authors.forename: Alex
authors.initials: A
authors.lastname: Barwick
authors.affiliation: University of Newcastle, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Lanting
authors.affiliation: University of Newcastle, Australia.
authors.forename: Vivienne
authors.initials: V
authors.lastname: Chuter
mesh_terms: D000368:Aged; D001331:Automation; D002318:Cardiovascular Diseases / Q000503:physiopathology; D017719:Diabetic Foot / Q000503:physiopathology; D005260:Female; D016523:Foot Ulcer / Q000503:physiopathology; D006214:Hallux / Q000098:blood supply*; D006801:Humans; D006940:Hyperemia / Q000175:diagnosis* / Q000503:physiopathology; D017078:Laser-Doppler Flowmetry; D007834:Lasers; D008297:Male; D008833:Microcirculation; D055806:Microvessels; D008875:Middle Aged; D015588:Observer Variation; D058729:Peripheral Arterial Disease / Q000503:physiopathology; D017156:Photoplethysmography; D015203:Reproducibility of Results; D012867:Skin / Q000473:pathology; D012881:Skin Temperature
keywords: Endothelial function; Laser Doppler; Microvascular; Peripheral arterial disease; Post-occlusive reactive hyperemia; Reliability