Abstract Background We determined the diagnostic accuracy of the Edinburgh Claudication Questionnaire ECQ in 1st generation Black African-Caribbean UK migrants as previous diagnostic questionnaires have been found to be less accurate in this population. We also determined the diagnostic accuracy of translated versions of the ECQ in 1st generation South Asian UK migrants, as this has not been investigated before. Translated versions of the ECQ were prepared following a recognised protocol. Subjects answering positively to experiencing leg pain or discomfort on walking were asked to return to have Ankle Brachial Pressure Index ABPI measured. Non-responders were younger than participants 59[9] vs. Punjabi, English and Bengali questionnaires identified participants with Intermittent Claudication, so these questionnaires were assessed.

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Go to: Discussion We have shown that translated versions of the ECQ into South Asian languages and the original English version in 1st generation Black Caribbean migrants have lower sensitivity and specificity than the original version [ 6 ] but similar levels reported in other populations [ 7 , 10 ].

We also report significant differences in diagnostic accuracy between the Punjabi, Bengali and English versions. Our study differs from the study by Leng et al. The researchers questioned participants over the age of 55 with leg pain and reported The original ECQ was used in large observational study investigating people presenting to their general practitioner with symptoms suggestive of IC, in the Netherlands, which reported a much lower sensitivity of Makdisse et al.

Previously Aboyans et al. Studies have previously shown that questionnaires designed to diagnose cardiovascular disease in White European populations may not always be applicable in an ethnically diverse population [ 12 , 13 , 16 ]. This reflects the findings of other researchers using the Rose Angina questionnaire [ 12 , 13 ]. It is possible that South Asians and Blacks are less good at describing pain than white European populations, which may account for the apparent differences in sensitivity and specificity when compared to Leng et al.

Indeed it has previously been reported that the Rose Angina questionnaire has a lower sensitivity and specificity in South Asians than in white Europeans [ 12 ]; site of pain and duration of pain being least likely to score a positive response to Rose Angina questionnaire in both South Asian men and women. We found question 5 of the ECQ, pertaining to duration of pain to have the least specificity of all of the questions in the ECQ in all versions, which may partly explain the low sensitivity and specificity we found overall.

People of African descent have also been reported to be less likely to score positively to angina using the Rose questionnaire and less likely to seek treatment than white group [ 16 ].

We used an objective measure ABPI to diagnose PAD rather than clinical assessment only, and our findings of lower sensitivity and specificity, positive and negative predictive values of the ECQ when compared to Leng et al.

Limitations The main limitations to this study were recruitment of participants answering positively to question one of the ECQ and re-attendance for ABPI measurement. Previous studies used more symptomatic participants in their validation exercises [ 9 , 10 ]. However, as the E-ECHOES study [ 14 ] was based within primary care and screened all eligible subjects whether or not they were symptomatic with cardiovascular disease; only 5.

The attempt to validate the ECQ in several languages meant the number of expected cases of IC in each language questionnaire was going to be low. Of the eligible participants, only This may have resulted in responder bias and may have affected the validity of the ECQ. We analysed potential differences in participant characteristics between non-attendees and those participating in the validation exercise and suggest that the significantly younger age of the former group may have resulted in work-related commitments preventing a return visit for ABPI measurement.

However, the younger age group might also have had a lower risk of PAD and therefore may not have yielded more cases of IC. It is possible the inclusion of illiterate participants may have contributed to the low sensitivity, specificity and diagnostic accuracy of the ECQ versions.

However, we found no significant differences in these groups. It is also possible that the age of participants may have contributed to the diagnostic accuracy of the questionnaires. However we found no significant differences. Our findings must be interpreted with caution however due to aforementioned sample size limitations.

As such, subjects with arterial calcification may have had falsely elevated ABPI, contributing to some of the false negative results, which may have masked an underlying diagnosis of claudication.

Other diseases potentially affecting our population, such as Takayasu disease, would not have been detected by ABPI alone and as such may have also contributed to the false negatives we found. Go to: Conclusions This validation study findings suggest the original English ECQ is not a sensitive or specific tool in the diagnosis of intermittent claudication in UK Black African Caribbean migrants. Punjabi and Bengali versions also did not show high sensitivity and specificity.

Larger studies, involving minority ethnic groups, need to be performed before firm conclusions can be made about the utility of the ECQ in non-White groups. The high concordance between cardiovascular risk factors and leg pain reported in this sub-study should prompt clinicians to perform an objective assessment of PAD, such as ABPI, in suspicious patients presenting to primary and secondary care.



The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: LauMitchell D. Content is updated monthly with systematic literature reviews and conferences. A diagram was added for exact site of pain, thus making self-application easier. Patients should address specific medical concerns with their physicians.


Edinburgh Claudication Questionnaire






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