Automated ABPI in Peripheral Arterial Disease a Pilot Study (AUTO-PAD)
Assessing the Diagnostic Accuracy of AUTOmated Ankle-Brachial Pressure Index Devices Across the Spectrum of Peripheral Arterial Disease (AUTO-PAD)- A Pilot Study
The aim of this pilot study is to investigate the diagnostic accuracy of two automated ABPI devices across the spectrum of PAD (asymptomatic PAD, suspected symptomatic PAD [IC; including mild moderate and severe IC based on the Rutherford classification (21) and CLTI] and post-bypass surveillance). A second aim is to assess their useability and tolerability through semi-structured interviews with patients and clinicians. This means the research will be split into two workstreams.
Tutkimuksen yleiskatsaus
Tila
Ehdot
Interventio / Hoito
Opintotyyppi
Ilmoittautuminen (Arvioitu)
Yhteystiedot ja paikat
Opiskeluyhteys
- Nimi: Jon Prosser
- Puhelinnumero: 01482 674703
- Sähköposti: jonathon.prosser@nhs.net
Tutki yhteystietojen varmuuskopiointi
- Nimi: Judith Long
- Sähköposti: judith.long3@nhs.net
Opiskelupaikat
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Hull, Yhdistynyt kuningaskunta, HU3 2JZ
- Rekrytointi
- Hull University Teaching Hospitals NHS Trust
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Ottaa yhteyttä:
- James Illingworth
- Puhelinnumero: 01482 461903
- Sähköposti: james.illingworth3@nhs.net
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Osallistumiskriteerit
Kelpoisuusvaatimukset
Opintokelpoiset iät
Hyväksyy terveitä vapaaehtoisia
Sukupuolet, jotka voivat opiskella
Näytteenottomenetelmä
Tutkimusväestö
Group 1: Asymptomatic PAD:
Patients identified by the GP (PIC sites). Records screened to identify 'at risk' of PAD with >1 cardiovascular disease risk factor
Group 2: Suspected symptomatic PAD:
2a. Patients with suspected IC referred to dedicated nurse-led claudication clinic.
Group 2b. Patients with suspected CLTI referred to dedicated urgent vascular (HOT) clinic.
Group 3: Patients undergoing surveillance seen in dedicated clinics by vascular scientists
Kuvaus
Inclusion Criteria:
Group 1: Asymptomatic
- Adults aged 18 and over
- At risk of PAD with ≥1 cardiovascular risk factor
- No previous diagnosis of PAD
- English speaking and able to understand test protocols
Group 2a: Suspected PAD (intermittent claudication)
- Adults aged 18 and over
- Referred and booked into the nurse-led claudication clinic due to signs/symptoms in keeping with suspected intermittent claudication
- English speaking and able to understand test protocols
Group 2b: Suspected PAD (CLTI)
- Adults aged 18 and over
- Referred and booked into the vascular HOT clinic due to signs/symptoms in keeping with suspected CLTI
- English speaking and able to understand test protocols
Group 3: Post-bypass surveillance
- Adults aged 18 and over
- History of lower limb bypass surgery, enrolled in and attending the local surveillance programme
- English speaking and able to understand test protocols
Exclusion Criteria:
- Patients who are unable to provide informed consent
- Recent (≤4 weeks) lower-limb surgery
- Ulcers, casts or bandages that cannot or should not be compressed
- Patients who have had a therapeutic intervention (stent or graft) which extends to the ankle
- Patients with known or suspected acute deep vein thrombosis (DVT) or superficial thrombophlebitis
- Marked oedema in one or both feet
- Inability to tolerate a supine position
- Patients with spasms or tremors of any kind
- Arm arteriovenous fistula
- Inability to cooperate due to impaired cognition
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Havaintomallit: COHORT
- Aikanäkymät: CROSS_SECTIONAL
Kohortit ja interventiot
Ryhmä/Kohortti |
Interventio / Hoito |
|---|---|
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Group 1 Asymptomatic
Participants with one or more CVD risk factors |
The MESI mTablet uses 3CUFFTM technology to detect pulse waveforms to assess ABPI. This involves placing a blood pressure cuff on all 4 limbs at the same time. The two arm cuffs then inflate and simultaneously measure the blood pressure in both brachial arteries. The cuff with the highest systolic pressure than reinflates with both the ankle cuffs simultaneously. The ABPI is then calculated and displayed on the tablet. A ratio of <0.9 will indicate the presence of PAD. The BlueDop device is a cuffless device which comprises an egg-shaped handheld probe component and an output monitor device. The device measures mean arterial blood pressure through an algorithm. Simply, it calculates the average blood pressure based on the normal rise and fall of pressure during each heartbeat. The device then automatically generates an ankle-brachial pressure index and a corresponding traffic-light classification for each lower-limb artery, based on waveform. This output is interpreted using table 2 below. Essentially an ABPI of 0.8-1.0 with a biphasic or triphasic waveform indicates no disease whereas an ABPI <0.8 and / or a monophasic/non-specific waveform indicates the presence of PAD. |
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Group 2a Suspected PAD (intermittent claudication)
Partcipants presenting with Suspected PAD (intermittent claudication) |
The MESI mTablet uses 3CUFFTM technology to detect pulse waveforms to assess ABPI. This involves placing a blood pressure cuff on all 4 limbs at the same time. The two arm cuffs then inflate and simultaneously measure the blood pressure in both brachial arteries. The cuff with the highest systolic pressure than reinflates with both the ankle cuffs simultaneously. The ABPI is then calculated and displayed on the tablet. A ratio of <0.9 will indicate the presence of PAD. The BlueDop device is a cuffless device which comprises an egg-shaped handheld probe component and an output monitor device. The device measures mean arterial blood pressure through an algorithm. Simply, it calculates the average blood pressure based on the normal rise and fall of pressure during each heartbeat. The device then automatically generates an ankle-brachial pressure index and a corresponding traffic-light classification for each lower-limb artery, based on waveform. This output is interpreted using table 2 below. Essentially an ABPI of 0.8-1.0 with a biphasic or triphasic waveform indicates no disease whereas an ABPI <0.8 and / or a monophasic/non-specific waveform indicates the presence of PAD. |
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Group 2b Suspected PAD (CLTI)
Participants presenting with tissue loss or rest pain |
The MESI mTablet uses 3CUFFTM technology to detect pulse waveforms to assess ABPI. This involves placing a blood pressure cuff on all 4 limbs at the same time. The two arm cuffs then inflate and simultaneously measure the blood pressure in both brachial arteries. The cuff with the highest systolic pressure than reinflates with both the ankle cuffs simultaneously. The ABPI is then calculated and displayed on the tablet. A ratio of <0.9 will indicate the presence of PAD. The BlueDop device is a cuffless device which comprises an egg-shaped handheld probe component and an output monitor device. The device measures mean arterial blood pressure through an algorithm. Simply, it calculates the average blood pressure based on the normal rise and fall of pressure during each heartbeat. The device then automatically generates an ankle-brachial pressure index and a corresponding traffic-light classification for each lower-limb artery, based on waveform. This output is interpreted using table 2 below. Essentially an ABPI of 0.8-1.0 with a biphasic or triphasic waveform indicates no disease whereas an ABPI <0.8 and / or a monophasic/non-specific waveform indicates the presence of PAD. |
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Group 3 Post-bypass surveillance
Participants presenting for post-bypass surveillance |
The MESI mTablet uses 3CUFFTM technology to detect pulse waveforms to assess ABPI. This involves placing a blood pressure cuff on all 4 limbs at the same time. The two arm cuffs then inflate and simultaneously measure the blood pressure in both brachial arteries. The cuff with the highest systolic pressure than reinflates with both the ankle cuffs simultaneously. The ABPI is then calculated and displayed on the tablet. A ratio of <0.9 will indicate the presence of PAD. The BlueDop device is a cuffless device which comprises an egg-shaped handheld probe component and an output monitor device. The device measures mean arterial blood pressure through an algorithm. Simply, it calculates the average blood pressure based on the normal rise and fall of pressure during each heartbeat. The device then automatically generates an ankle-brachial pressure index and a corresponding traffic-light classification for each lower-limb artery, based on waveform. This output is interpreted using table 2 below. Essentially an ABPI of 0.8-1.0 with a biphasic or triphasic waveform indicates no disease whereas an ABPI <0.8 and / or a monophasic/non-specific waveform indicates the presence of PAD. |
Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Diagnostic Accuracy
Aikaikkuna: From enrolment to the end of treatment (1 day)
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Diagnostic accuracy assessed via sensitivity, specificity, positive predictor value (PPV) and negative predictor value (NPV). |
From enrolment to the end of treatment (1 day)
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Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
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Validity assessed via correlation
Aikaikkuna: Data collected at enrolment (1 day)
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Diagnostic performance assessed via area under the receiver operating characteristic (AUROC) curve and the assessment time difference, assessed via measurement of the time taken to perform each automated ABPI assessment and the manual ABPI assessment. |
Data collected at enrolment (1 day)
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Diagnostic performance
Aikaikkuna: Data collected at enrolment (1 day)
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Assessed via area under the receiver operating characteristic (AUROC) curve. |
Data collected at enrolment (1 day)
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Time taken to perform each automated ABPI assessment and the manual ABPI assessment.
Aikaikkuna: Data collected at enrolment (1 day)
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Time taken to perform each assessment in seconds |
Data collected at enrolment (1 day)
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Qualitative Workstream - Assessment of usability and tolerability of automated devices.
Aikaikkuna: Within the 2 year recruitment period
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Semi structured interviews analysed using thematic analysis |
Within the 2 year recruitment period
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Visual Analogue Scale (VAS) score of 0-10
Aikaikkuna: Data collected at point of enrolment (1 day)
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VAS used to assess tolerability |
Data collected at point of enrolment (1 day)
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Yhteistyökumppanit ja tutkijat
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Todellinen)
Ensisijainen valmistuminen (Arvioitu)
Opintojen valmistuminen (Arvioitu)
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
Lisää tietoa
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Muita asiaankuuluvia MeSH-ehtoja
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