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.