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

Development and evaluation of the Walking Estimated-Limitation Calculated by History questionnaire in patients with claudication

BACKGROUND: The Walking Impairment Questionnaire (WIQ) is used to estimate walking impairment in patients with peripheral artery disease; however, it faces frequent errors when self-completed and is complex to score. We aimed to validate an alternative, easily scored four-item tool, the Walking Estimated-Limitation Calculated by History (WELCH) questionnaire. METHODS: The WIQ and WELCH were prospectively tested in five centers. We studied 434 patients, among which 298 had a treadmill test (3.2 km/h; 10% slope) to determine their maximum walking time (MWT), and 30 were seen twice during the study period. RESULTS: After self-completion, we found at least one error in 177 WIQ (40.8%; 95% confidence interval [CI], 36.3%-45.5%) vs 56 WELCH (12.9%; 95% CI, 10.1%-16.4%) questionnaires (P &lt; .0001). When scoring only questionnaires without missing or duplicate answers, 267 WIQ (61.5%; 95% CI, 56.9%-66.0%) vs 393 WELCH (90.6%; 95% CI, 87.4%-93.0%) questionnaires could be scored (P &lt; .001). The median MWT was 233 seconds (interquartile range, 133-654 seconds) for the 298 patients who had a treadmill test. When the 296 patients who had both questionnaire scores available were studied, no difference was found between the Pearson r coefficient of correlation of the WIQ (r = 0.615) and the WELCH (r = 0.653) with MWT (P = .211). In the 30 patients who completed the WELCH twice, correlation was r = 0.839 (P &lt; .001) between the two scores in 22 nonrevascularized patients, and the area under the receiver-operating characteristic curve was 0.830 +/- 0.105 (P &lt; .01) to discriminate the eight revascularized from the 22 nonrevascularized patients. CONCLUSIONS: The WELCH questionnaire is a simple tool to estimate walking limitation in patients with suspected peripheral artery disease. It is easily scored by mental calculation. It may help to standardize the estimation of walking limitation in routine clinical practice

Comparison of reported symptoms to those produced by treadmill testing in patients with claudication suspected of arterial origin

AIM: We aimed at comparing lower limb symptoms reported by history to those observed during a standard treadmill test. METHODS: We retrospectively studied symptomatic patients referred over a three years period for suspected arterial claudication and used the Edinburgh claudication questionnaire before exercise and symptoms observed on a treadmill. We confronted, right and left, proximal (lower-back thigh or buttocks) and distal (leg or foot) lower-limb symptoms before and during treadmill exercise. Results are reported as mean +/- standard deviation for percentage and 95% confidence interval and Kappa statistics are performed. RESULTS: Of 795 patients with claudication, aged 63 +/- 12 years, treadmill test resulted in 715 reporting lower-limb symptoms on treadmill. Cohen\u27s Kappa for the site-specific analysis of symptoms by history vs. symptoms on treadmill was 0.509 +/- 0.21 (P &lt; 0.01), showing a moderate agreement. Nevertheless, symptoms on treadmill reproduced, at least partly, symptoms by history in 675 (84.9% 95CI: 82.3-87.2) of patients, although symptoms on treadmill were strictly of the same localizations as symptoms by history in only 378 (47.6% 95CI: 44.1-51.0) of all studied patients. Last, 279 patients (35.1% of all patients) reported non limb symptoms on treadmill. CONCLUSION: Although on a site by site basis the concordance of symptoms by history to symptoms by treadmill is moderate, most patients reproduced their usual symptoms on treadmill. Age does not seem to impair the concordance. Last, beyond the sole measurement of maximal walking capacity, treadmill frequently unmasks non-limb limiting symptoms that may require clinical attention

Somatic Practices: How Motion Analysis and Mind Images Work Hand in Hand in Dance

Somatic Practices are body-based movement practices that foreground self-awareness and a first person experience of moving. Increasingly, somatic practices are informing how dance is taught, created, and performed with many dancers turning towards somatics to ensure a healthy and holistic approach to dance. Several somatic practices draw on imagery as a source for moving, for stimulating a more sensorial engagement with movement and to encourage a sense of moving “naturally” and with respect for the “natural environment.” When somatic practices and the imagery that is important for many of these practices are coupled with motion analysis tools, the necessary processing of movement often requires an intervention that can disrupt the “natural” sense of moving somatically. This processing can thus appear to be at odds with a somatic approach to dance. However, there are many examples where motion analysis and mind images do work hand in hand in dance and can generate exciting new insights to the production, teaching, and making of dance. It is this intersection between somatic principles, imagery, and motion analysis tools that is the focus for this essay, which discusses projects that have explored and exploited the intersection between motion analysis, imagery, and somatic practices.The uploaded document is the pre-print final manuscript of the published article