External Validation of the "Walking Estimated Limitation Calculated by History" (WELCH) Questionnaire in Patients with Claudication

Objective: To externally validate the recently proposed "Walking Estimated Limitation Calculated by History" (WELCH) questionnaire. Methods: A prospective study was performed on 450 new patients referred to our laboratory for treadmill testing (constant load 3.2 km/h and 10% slope for 15 minutes and then incremental increases). Results are presented as mean +/- SD or median [25th-75th percentiles] or number (percentage). An ankle brachial index <0.90 defined the presence of peripheral artery disease (PAD). Typical "vascular-type claudication" is a lower-limb pain or discomfort that is absent at rest, appears at exercise, forces stopping, and disappears within 10 minutes of exercise stopping. The Spearman r coefficient of correlation between maximal walking time (MWT) on treadmill and WELCH scores was calculated for patients with (PAD+) or without (PAD-) PAD, and reporting typical vascular-type claudication (VTC+) or not (VTC-). Results: The WELCH score was obtained in all included patients. The number (%) of patients with a WELCH score <25 was 37 (54%), 198 (65%), 14 (44%), and 18 (38%), and the Spearman correlation coefficient between WELCH score and treadmill MWT was 0.588, 0.609, 0.581, and 0.591 in the VTC- /PAD+,VTC+/PAD+, VTC-/PAD-, and VTC+/PAD- groups respectively (all p<.001). In PAD+/VTC+ patients, the WELCH positive predictive value for the inability to walk for 5 minutes on the treadmill was 79%. Conclusion: The WELCH score correlates moderately with treadmill-walking capacity in patients with or without PAD, and with or without typical VTC. It appears to be a simple to complete and easily scored instrument to help clinicians standardise the subjective estimation of walking capacity in their patients. (C) 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.