Interobserver reliability of the ankle-brachial index, toe-brachial index and distal pulse palpation in patients with diabetes

Abstract

Objective: We conducted a prospective pilot study in patients with diabetes to analyse the interobserver reliability of the ankle-brachial index, toe-brachial index and distal pulse palpation depending on the training of the professional involved.

Materials and methods: The ankle-brachial index, toe-brachial index and distal pulses were assessed by three clinicians with different levels of experience on the same day. Measurements were supervised and recorded by a fourth clinician.

Results: Twenty-one patients (42 ft) were included in this study. We observed moderate agreement between clinicians in the palpation of posterior tibial arteries (K = 0.45, p < 0.001) and low agreement in dorsalis pedis arteries (K = 0.33, p < 0.001). The measurement of ankle-brachial index had moderate agreement between clinicians in patients with medial arterial calcification (K = 0.43, p < 0.001) and low agreement in patients with normal ankle-brachial index (K = 0.4, p < 0.001). The measurement of toe-brachial index had moderate agreement between clinicians in patients with a normal toe-brachial index (K = 0.4, p < 0.001) and in patients with medial arterial calcification (K = 0.60, p < 0.001).

Conclusion: Palpation of distal pulses, ankle-brachial index and toe-brachial index determination in patients with diabetes are not highly reproducible and reliable between clinicians with different levels of experience under routine conditions.

Keywords: Ankle–brachial index; distal pulses palpation; interobserver reliability; patients with diabetes; toe–brachial index.