The reliability of toe systolic pressure and the toe brachial index in patients with diabetesReportar como inadecuado

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Journal of Foot and Ankle Research

, 3:31

First Online: 22 December 2010Received: 19 June 2010Accepted: 22 December 2010


BackgroundThe Ankle Brachial Index is a useful clinical test for establishing blood supply to the foot. However, there are limitations to this method when conducted on people with diabetes. As an alternative to the Ankle Brachial Index, measuring Toe Systolic Pressures and the Toe Brachial Index have been recommended to assess the arterial blood supply to the foot. This study aimed to determine the intra and inter-rater reliability of the measurement of Toe Systolic Pressure and the Toe Brachial Index in patients with diabetes using a manual measurement system.

MethodsThis was a repeated measures, reliability study. Three raters measured Toe Systolic Pressure and the Toe Brachial Index in thirty participants with diabetes. Measurement sessions occurred on two occasions, one week apart, using a manual photoplethysmography unit Hadeco Smartdop 45 and a standardised measurement protocol.

ResultsThe mean intra-class correlation for intra-rater reliability for toe systolic pressures was 0.87 95% LOA: -25.97 to 26.06 mmHg and the mean intra-class correlation for Toe Brachial Indices was 0.75 95% LOA: -0.22 to 0.28. The intra-class correlation for inter-rater reliability was 0.88 for toe systolic pressures 95% LOA: -22.91 to 29.17.mmHg and 0.77 for Toe Brachial Indices 95% LOA: -0.21 to 0.22.

ConclusionDespite the reasonable intra-class correlation results, the range of error 95% LOA was broad. This raises questions regarding the reliability of using a manual sphygmomanometer and PPG for the Toe Systolic Pressure and Toe Brachial Indice.

AbbreviationsABIankle brachial index

ANOVAanalysis of variance

ICCintra-class correlation coefficient

LOAlimits of agreement

PAODperipheral arterial occlusive disease


TBItoe brachial index.

Electronic supplementary materialThe online version of this article doi:10.1186-1757-1146-3-31 contains supplementary material, which is available to authorized users.

Mary T Romanos, Anita Raspovic and Byron M Perrin contributed equally to this work.

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Autor: Mary T Romanos - Anita Raspovic - Byron M Perrin


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