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CLINICAL RESEARCH: PERIPHERAL ARTERIAL DISEASE

Baseline Functional Performance Predicts the Rate of Mobility Loss in Persons With Peripheral Arterial Disease

Mary M. McDermott, MD^_*,,_*, Jack M. Guralnik, MD, PhD, Lu Tian, ScD, Luigi Ferrucci, MD, PhD, Kiang Liu, PhD, Yihua Liao, MS and Michael H. Criqui, MD, MPH^¶

^_* Department of Medicine
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Laboratory of Epidemiology, Demography, and Biometry
Laboratory of Clinical Epidemiology, National Institute on Aging, Bethesda, Maryland
^¶ Department of Family and Preventive Medicine, University of California at San Diego, San Diego, California

Manuscript received February 2, 2007; revised manuscript received May 29, 2007, accepted May 30, 2007.

^_* Reprint requests and correspondence to: Dr. Mary McDermott, 676 North St. Clair, Suite 200, Chicago, Illinois 60611. (Email: mdm608{at}northwestern.edu).

Objectives: We compared rates of mobility loss among persons with versus without peripheral arterial disease (PAD). Associations between baseline functional performance and mobility loss in persons with and without PAD were studied.

Background: Persons with PAD have poorer functional performance than persons without PAD. The prognostic value of poorer performance in persons with PAD is unknown.

Methods: Participants were 398 persons with and 240 without PAD who were free of mobility impairment at baseline. Participants were followed for a median of 50 months. Baseline measures included the 6-min walk and the Short Physical Performance Battery score. Mobility status, assessed annually, was defined as the self-reported loss of the ability to walk one-quarter mile or walk up and down one flight of stairs without assistance.

Results: Adjusting for age and gender, we found that PAD participants had a greater rate of mobility loss than persons without PAD (hazard ratio [HR] 1.63; 95% confidence interval [CI] 1.03 to 2.56). This difference was not statistically significant after additional adjustment for baseline performance. Among PAD participants, risk of mobility loss in the lowest versus the 2 highest quartiles of baseline performance were as follows: HR 9.65 (95% CI 3.35 to 27.77, p < 0.001) for the 6-min walk and HR 12.84 (95% CI 4.64 to 35.55, p < 0.001) for the Short Physical Performance Battery when adjusting for confounders.

Conclusions: Persons with PAD experience greater mobility loss than persons without PAD. This association was explained by poorer baseline functional performance among participants with PAD. Poorer lower extremity performance predicts increased mobility loss in persons with and without PAD.

Abbreviations and Acronyms   ABI = ankle-brachial index   BMI = body mass index   PAD = peripheral arterial disease   SPPB = Short Physical Performance Battery   WALCS = Walking and Leg Circulation Study

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