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Annelies E. Aquarius, PhD; Jolanda De Vries, PhD, Msc; Dennis P. Van Berge Henegouwen, MD, PhD; Jaap F. Hamming, MD, PhD

Arch Surg. 2006;141:161-166.

Hypothesis  Patients with peripheral arterial disease (PAD) often experience substantial impairment in health status and quality of life (QOL), but factors associated with these outcomes are unknown. We hypothesized that subjective pain symptoms in the legs and social support and stress (the degree to which situations are appraised as stressful) are associated with impaired health status and QOL.

Design  Cross-sectional observational study.

Setting  Vascular outpatient clinic of a teaching hospital.

Patients  The study included consecutive patients seeking treatment for the first time because of walking pain. Diagnosis and severity of PAD were based on history, physical examination, treadmill-walking distance, and ankle-brachial pressure indexes (ABPIs). Patients with PAD (n = 188) and patients with atypical leg symptoms (n = 57) completed the 10-item version of the Perceived Stress Scale (perceived stress), the 12-item version of the Perceived Social Support Scale–Revised (social support), the RAND 36-Item Health Survey (health status), and the World Health Organization Quality of Life Assessment Instrument-100.

Main Outcome Measures  Health status and QOL.

Results  Both groups had equally poor health status and QOL, with patients with atypical leg symptoms reporting more bodily pain (P = .004). In patients with PAD, the ABPI (P = .008) and perceived stress (P = .001) were associated with maximum walking distance. Furthermore, the health status domain of physical functioning was affected by the ABPI (P = .002), cardiac disease (P = .005), body mass index (P = .007), and perceived stress (P<.001). Overall QOL in patients with PAD was independently influenced by sex (P = .04), carotid disease (P = .03), and perceived stress (P<.001).

Conclusions  Subjective pain in the legs is associated with impaired health status and QOL. Stress adversely influences the health status and QOL of patients with PAD above and beyond the influence of clinical indicators. These findings indicate the importance of accounting for perceived stress in patients with PAD.

Author Affiliations: Department of Psychology and Health, Medical Psychology, Tilburg University (Drs Aquarius and De Vries), Research Institute for Psychology and Health (Drs Aquarius and De Vries), and Department of Surgery (Dr Van Berge Henegouwen), St Elisabeth Hospital, Tilburg, the Netherlands; and Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands (Dr Hamming).

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Clinical Indicators and Psychosocial Aspects in Peripheral Arterial Disease—Invited Critique
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