- Title
- The clinical utility of the toe brachial index in older adults and people with diabetes
- Creator
- Sonter, Jennifer
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2016
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- This thesis presents an investigation of the utility of the toe brachial index (TBI) in older people and those with diabetes. While recommended as a screening tool for peripheral arterial disease (PAD), there is very limited information available regarding the reliability, diagnostic accuracy and clinical utility of the TBI. This study comprised of a systematic review and a further five studies investigating the reliability of the TBI, the diagnostic accuracy of the TBI for determining the presence of PAD, and investigations of the relationship between the TBI and the risk of foot complications, diabetes-related microvascular disease and health-related quality of life. Review and meta-analysis revealed toe blood pressures of less than 30 mmHg to be predictive of non-healing chronic foot wounds and amputation, and exposed a deficit of quality research regarding the interpretation of TBI values. As monitoring of PAD is ongoing, an investigation of the reliability of the TBI was necessary. The TBI demonstrated excellent reliability when performed by podiatrists using automated devices in an older population. However the ability of the TBI to detect PAD was still unknown. The TBI was then compared to colour duplex ultrasound for the diagnosis of stenosis affecting the lower limbs in people with and without diabetes. A value of 0.72 was determined to have the greatest accuracy for detecting stenosis and contributed to the limited evidence in support of current international guidelines for interpreting the TBI. To further explore the utility of the TBI a cross-sectional investigation of the relationship with ulceration, amputation and the painful symptoms of PAD was undertaken. People with TBI values lower than 0.70 were 19-times more likely to have foot ulcers or amputations than those with higher values. As both PAD and microvascular dysfunction are known to contribute to the development of foot wounds and impaired healing, the relationship between the TBI and microvascular disease was investigated. TBI values less than 0.70 were associated with a three-fold increase in the likelihood of diabetes-related microvascular disease. With correlates including foot complications and microvascular disease, the health-related quality of life associated with low TBI values warranted investigation. Modest associations between low TBI values and physical aspects of quality of life were found. The studies presented here indicate the TBI has a potential role beyond PAD diagnosis that may extend to include identifying those at risk of other vascular diseases and impaired quality of life.
- Subject
- toe brachial index; diabetes; toe blood pressure; peripheral arterial disease; wound healing; ischaemic ulcers; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1313657
- Identifier
- uon:22624
- Rights
- Copyright 2016 Jennifer Sonter
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Abstract | 108 KB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Thesis | 1 MB | Adobe Acrobat PDF | View Details Download |