Objective measurement of lower extremity function and quality of life following surgical revascularization for critical lower extremity ischemia

Background—Outcomes of revascularization for critical limb ischemia (CLI) have historically been patency, limb salvage and survival. Functional status and quality of life (QOL) have not been well described. This study utilized functional and QOL assessments to measure patient-centered outcomes following revascularization for CLI. Methods—18 patients (age 65±11 yrs) were followed prospectively before and after lower extremity bypass for CLI. Patients completed the Short Physical Performance Battery (SPPB) which measures walking speed, leg strength and balance, as well as performing a 6 minute walk, and measuring caloric expenditure with an accelerometer. Isometric muscle strength was assessed using the Muscle Function Evaluation chair (MFEC). QOL instruments included the Short Form 36 (SF-36) and Vascular Quality of Life (VascuQol). Patients’ preoperative status was compared with four month postoperative status. Results—MFEC measurements of ipsilateral leg strength demonstrated a significant increase in knee flexion from 64±63 Newtons (N) to 135±133N (p=0.038), and near significant increase in knee extension 120±110N to 186±85N (p=0.062) and ankle plantar flexion 178±126N to 267±252N (p=0.078). In the contralateral leg, knee flexion increased 71±96N to 149±162N (p=0.028), knee extension 162±112N to 239±158N (p=0.036). Absolute improvements were noted in 6 minute walk distance, daily caloric expenditure and in individual domains and overall SPPB scores, and upper extremity strength decreased, though none were significant. The VascuQol captured significant improvement in all individual domains, and overall score (p<0.015). Significant improvement was noted only for Body Pain (p=0.011) using the SF-36. Conclusions—Despite lack of statistical improvement in most functional tests, revascularization for critical limb ischemia results in improved patient perceived leg function. Significant improvements in isometric muscle strength may explain the measured improvement in quality of life following revascularization for CLI. Correspondence: Gregory J. Landry, MD, Associate Professor of Surgery, Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP11, Portland, Oregon 97239-3098, Tel: 503 494 7593, Fax: 503 494 4324, landryg@ohsu.edu. Presented at the Society for Clinical Vascular Surgery, 39th Annual Symposium, Orlando, Florida, March 18, 2011 Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HHS Public Access Author manuscript J Vasc Surg. Author manuscript; available in PMC 2021 April 06. Published in final edited form as: J Vasc Surg. 2014 July ; 60(1): 136–142. doi:10.1016/j.jvs. 2014.01. 067. A uhor M anscript