Can the scoring of the walking estimated limitation calculated by history (WELCH) questionnaire be simultaneously simplified and improved?

BACKGROUND: The WELCH questionnaire includes 4 items (A, B, C and D) and estimates the maximal walking time (MWT) on treadmill in patients with claudication. Its scoring was empirically defined. We aimed to test various methods for scoring to estimate whether the scoring of the WELCH could be improved or simplified. PATIENTS AND METHODS: In 423 patients, we tested 8 methods (from H1 to H8) of weighing D or calculating alpha, beta and gamma in the equation MWT = (alphaA + betaB + gammaC) D. RESULTS: While the WELCH Pearson r was 0.639 and area under ROC curve for the ability to walk 5 minutes on treadmill was 0.795 for the reference empirical method, tested hypotheses resulted in values ranging 0.566 to 0.661 for the Pearson r values and 0.750 to 0.809 for the areas under ROC curve respectively. CONCLUSIONS: None of the tested methods simultaneously improved the correlation to MWT, remained simple enough to be scored by mental calculation and ranged between intuitive minimal and maximal values. The original empirical scoring seems a good compromise between accuracy and simplicity

External Validation of the “Walking Estimated Limitation Calculated by History” (WELCH) Questionnaire in Patients with Claudication

ObjectiveTo externally validate the recently proposed “Walking Estimated Limitation Calculated by History” (WELCH) questionnaire.MethodsA prospective study was performed on 450 new patients referred to our laboratory for treadmill testing (constant load 3.2 km/h and 10% slope for 15 minutes and then incremental increases). Results are presented as mean ± SD or median [25th–75th percentiles] or number (percentage). An ankle brachial index <0.90 defined the presence of peripheral artery disease (PAD). Typical “vascular-type claudication” is a lower-limb pain or discomfort that is absent at rest, appears at exercise, forces stopping, and disappears within 10 minutes of exercise stopping. The Spearman r coefficient of correlation between maximal walking time (MWT) on treadmill and WELCH scores was calculated for patients with (PAD+) or without (PAD−) PAD, and reporting typical vascular-type claudication (VTC+) or not (VTC−).ResultsThe WELCH score was obtained in all included patients. The number (%) of patients with a WELCH score <25 was 37 (54%), 198 (65%), 14 (44%), and 18 (38%), and the Spearman correlation coefficient between WELCH score and treadmill MWT was 0.588, 0.609, 0.581, and 0.591 in the VTC−/PAD+, VTC+/PAD+, VTC−/PAD−, and VTC+/PAD− groups respectively (all p < .001). In PAD+/VTC+ patients, the WELCH positive predictive value for the inability to walk for 5 minutes on the treadmill was 79%.ConclusionThe WELCH score correlates moderately with treadmill-walking capacity in patients with or without PAD, and with or without typical VTC. It appears to be a simple to complete and easily scored instrument to help clinicians standardise the subjective estimation of walking capacity in their patients

Proficiency of medical students at obtaining pressure measurement readings using Automated ankle and toe measuring devices for diagnosis of lower extremity peripheral artery disease

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