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Reproducibility and reliability of the anklebrachial index as assessed by vascular experts, family physicians and nurses
Tim Holland-Letz
Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Germany
Heinz G. Endres
Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Germany
Stefanie Biedermann
Department of Mathematics , Stochastic and Statistics, Ruhr-University Bochum, Germany
Matthias Mahn
Medical Department, Sanofi-Aventis, Berlin, Germany
Joachim Kunert
Department of Statistics, University of Dortmund, Dortmund, Germany
Sabine Groh
Department of Internal Medicine/Vascular Medicine, Affiliated Teaching Hospital, University of Heidelberg, Heidelberg, Germany
David Pittrow
Institute for Clinical Pharmacology, Technical University Dresden, Dresden, Germany
Peter von Bilderling
Internist/ Angiology, Munich, Germany
Reinhardt Sternitzky
Praxisklinik Herz und Gefässe, Dresden, Germany
Curt Diehm
Department of Internal Medicine/Vascular Medicine, Affiliated Teaching Hospital, University of Heidelberg, Heidelberg, Germany, curt.diehm{at}kkl.srh.de
The reliability of anklebrachial index (ABI) measurements performed by different observer groups in primary care has not yet been determined. The aims of the study were to provide precise estimates for all effects influencing the variability of the ABI (patients' individual variability, intra- and inter-observer variability), with particular focus on the performance of different observer groups. Using a partially balanced incomplete block design, 144 unselected individuals aged 65 years underwent double ABI measurements by one vascular surgeon or vascular physician, one family physician and one nurse with training in Doppler sonography. Three groups comprising a total of 108 individuals were analyzed (only two with ABI < 0.90). Errors for two repeated measurements for all three observer groups did not differ (experts 8.5%, family physicians 7.7%, and nurses 7.5%, p = 0.39). There was no relevant bias among observer groups. Intra-observer variability expressed as standard deviation divided by the mean was 8%, and inter-observer variability was 9%. In conclusion, reproducibility of the ABI measurement was good in this cohort of elderly patients who almost all had values in the normal range. The mean error of 89% within or between observers is smaller than with established screening measures. Since there were no differences among observers with different training backgrounds, our study confirms the appropriateness of ABI assessment for screening peripheral arterial disease (PAD) and generalized atherosclerosis in the primary case setting. Given the importance of the early detection and management of PAD, this diagnostic tool should be used routinely as a standard for PAD screening. Additional studies will be required to confirm our observations in patients with PAD of various severities.
Key Words: anklebrachial index peripheral arterial disease precision reproducibility screening
Vascular Medicine, Vol. 12, No. 2,
105-112 (2007)
DOI: 10.1177/1358863X07077281

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