| Peripheral arterial disease(PAD)is the stenosis and occlusion of upper- or lower-extremity arteries. PAD is a common large vessel complication of diabetes and also the leading cause of lower-extremity amputation in diabetes. PAD can exist in a clinically asymptomatic form or may manifest symptoms of atypical leg pain, intermittent claudication, rest pain, ulcers, and gangrene. It often results in the impairment of patients'daily activities, particularly the poor walking ability which is the major cause of impaired quality of life(QOL). Treadmill testing and 6-minute walking test are often used to assess the walking ability of PAD patients. However, both of them often need to throw in the massive manpower, the physical resource and the financial resource, these factors lead to their limit in use. For this reason, the disease-specific Walking Impairment Questionnaire (WIQ), a short, easy to fill out, practical questionnaire, was developed by Regensteiner and his colleagues in 1990 to evaluate the walking impairment in patients with PAD. WIQ has been widely used in foreign countries, including the assessment of walking ability and QOL, and the evaluation of the therapeutic effect in PAD patients. It is also used in primary care health agency and large scale studies. However, this questionnaire has not been translated into Chinese. Thus, the goal of present study was to translate and verify the reliability, validity and responsibility of the Chinese version WIQ, investigate the walking ability and QOL and explore the impact of walking ability on QOL in Type 2 diabetic PAD patients and Type 2 diabetic patients.Objectives1. Translate and validate the Chinese version WIQ in Type 2 diabetic PAD patients and Type 2 diabetic patients.2. Investigate the walking ability and QOL of Type 2 diabetic PAD patients and Type 2 diabetic patients.3. Explore the impact of walking ability on QOL in Type 2 diabetic PAD patients and Type 2 diabetic patients.MethodsA cross-sectional survey was conducted. A convenience sample of 196 patients from Diabetic care and research center of Jiangsu province official hospital from 2009.Feb to 2010.Feb were included. After establishing the Chinese version WIQ,all patients were asked to complete the Chinese version WIQ , the Chinese version SF-36 and Six-Minute Walk Test (6MWT). Statistical analysis were conducted by Spearman correlation, t test, One-way ANOVA and so on.Results1. Application of Chinese version WIQ in Type 2 diabetic PAD patients. The internal consistency determined by Cronbach's alpha was 0.94 for the overall scale and each dimension of WIQ was 0.84～0.91. The half-split reliability was 0.92 for the overall scale and each dimension of WIQ was 0.74～0.91. Test-retest reliability expressed by intraclass correlation coefficient(ICC) was 0.93 for the overall scale and each dimension of WIQ was 0.73～0.94. The correlation coefficients between each dimension and total WIQ were 0.82～0.96(P<0.01). Significant correlations were observed between each dimension and their subordinate item, the Spearman correlation coefficients were 0.233～0.995(P<0.05). The correlation coefficients between each dimension and other dimension were 0.71～0.81(P<0.01). Significant correlations were found between WIQ scores and Six-minute walking distance (6MWD)(r=0.67～0.88,P<0.01), and the Physical Function, Role-Physical and General Health dimension of SF-36(r=0.27～0.86, P<0.05). No significant correlations were observed between WIQ scores and the Role-emotional and Social Function dimension of of SF-36. Significant differerences of WIQ scores were found between Type 2 diabetic PAD patients and Type 2 diabetic PAD patients by analysis of Covariance.2. Application of Chinese version WIQ in Type 2 diabetic patients. The internal consistency determined by Cronbach's alpha was 0.72 for the overall scale and each dimension of WIQ was 0.62～0.66. The half-split reliability was 0.71 for the overall scale and each dimension of WIQ was 0.61～0.92. The correlation coefficients between each dimension and total WIQ were 0.54～0.93(P<0.01). Significant correlations were observed between the distance dimension and its subordinate item 5～7 (r=0.328～0.826, P<0.01), between the speed dimension and its subordinate item 9～11 (r=0.323～0.998, P<0.01), between the stair dimension and its subordinate item 12～14 (r=0.232～0.999, P<0.01). The correlation coefficients between each dimension and other dimension were 0.35～0.46(P<0.01). Significant correlations were found between WIQ scores and 6MWD(r=0.40～0.73, P<0.01), and the Physical Function and Role-Physical dimension of SF-36(r=0.21～0.60,P<0.05). No significant correlations were observed between WIQ scores and the Social Function and Mental Health dimension of of SF-36. Significant differerences were found between different distance groups and age groups. A shorter walking distance corresponds with lower scores of the WIQ. Younger patients correspond with higher scores of the WIQ and older patients with lower scores.3. The walking ability and QOL of Type 2 diabetic PAD patients and Type 2 diabetic patients is lower than health people. Significant correlations were observed between walking ability and QOL.Conclusions1. The Chinese version WIQ has satisfactory reliability, validity and responsibility. It has the potential to be used as a clinical and research instrument for assessing the walking ability both in diabetic PAD patients and Type 2 diabetic patients.2. The walking ability and quality of life of Type 2 diabetic PAD patients and Type 2 diabetic patients is lower than health people. Significant correlations were found between walking ability and quality of life. Clinical physician should focus on the walking ability of Type 2 diabetic PAD patients without intermittent claudication and Type 2 diabetic patients.
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