Combined training of GPs and practice-assistants on peripheral arterial disease: positive effects after six months

OBJECTIVES: To improve the use of the ankle-brachial index (ABI) measurement, and management of patients with peripheral arterial disease (PAD) a combined training, targeting GPs and practice assistants (PAs) was developed. To measure the effect of the combined training on the management of patients with PAD, a cross-sectional study was performed. METHODS: Fifty consecutive patients referred by GPs to a vascular surgery out-patient clinic were analysed. Six months after the training an additional fifty patients were included. In all patients the ABI measurement, risk factor management, and treatment as performed by the GP, prior to referral, were analysed. RESULTS: The measurement of the ABI significantly increased from 10% before the training to 53% after the training (GPs with training: 83%, GPs without training: 35%; P: 0.001). The referral of patients with actual PAD significantly increased from 32% before the training to 70% after the training (GPs with training: 83%, GPs without training: 59%; P: 0.05). The presence and treatment of risk factors did not differ between the groups. CONCLUSIONS: Within the limitations of a before and after study the combined training of GPs and PAs appears to be an effective method to increase ABI measurements and significantly improve adequate diagnostics.     

冠心病患者尿酸与外周动脉阻塞性疾病的相关性研究

目的评价冠心病患者尿酸与外周动脉阻塞性疾病（PAD）的关系.方法连续入选上海第十人民医院等32家医院的冠心病住院患者（年龄≥50岁）3251例为研究对象;使用SPSS 11.5软件建立数据库并进行统计分析;测量踝臂指数（ABI）并检测尿酸水平;ABI〈0.9诊断为PAD;在多因素logistic分析中调整混杂变量（P〈0.10）;通过受试者工作特征曲线（ROC曲线）确定尿酸作为冠心病患者PAD诊断的参考指标的最佳界值.结果在单变量分析中,PAD组尿酸水平及高尿酸血症患病率明显高于非PAD组（P〈0.001）;把尿酸水平五等份后各等级的PAD患病率依次为23.2%、27.4%、36.1%、43.2%、72.7%（趋势x2检验,P〈0.05）;尿酸作为连续性变量在多因素logistic分析中OR值为1.002（95%CI：1.001～1.002）;通过ROC曲线得到尿酸作为冠心病患者PAD诊断的参考指标的最佳界值为227.2 μmol/L,灵敏度为0.846,特异度为0.203,曲线下面积为0.521（95%CI：0.504～0.547）;以此界值划分尿酸水平为二分类变量,在多因素logistic分析中OR值为1.292（95%CI：1.047～1.596）,剔除使用利尿剂的研究对象后得到类似的结果.结论冠心病患者（年龄≥50岁）的尿酸是PAD一个显著的、独立的危险因素.     

The inter-arm blood pressure difference and peripheral vascular disease: cross-sectional study

BACKGROUND: A blood pressure (BP) difference between the upper limbs is often encountered in primary care. Knowledge of its prevalence and importance in the accurate measurement of BP is poor, representing a source of error. Current hypertension guidelines do not emphasize this. OBJECTIVES: To establish the prevalence of an inter-arm blood pressure difference (IAD) and explore its association with other indicators of peripheral vascular disease (PVD) in a hypertensive primary care population. METHODS: This was a cross-sectional study. Primary care, one rural general practice, was the setting of the study. The methods were controlled simultaneous measurement of brachial BPs, ankle-brachial pressure index (ABPI) and tiptoe stress testing in 94 subjects. RESULTS: In all, 18 of 94 [19%, 95% confidence interval (CI) 11-27%] subjects had mean systolic inter-arm difference (sIAD) > or =10 mmHg and seven of 94 (7%, 95% CI 2-12%) had mean diastolic inter-arm difference (dIAD) > or =10 mmHg. Nineteen of 91 (20%, 95% CI 12-28%) had a reduced ABPI <0.9. There was negative correlation between systolic (Pearson's correlation coefficient - 0.378; P = 0.01) and diastolic (Pearson's correlation coefficient - 0.225; P = 0.05) magnitudes of IAD with ABPI. On tiptoe testing, 9/90 subjects (10%, 95% CI 4-16%) had a pressure drop > or =20%. CONCLUSIONS: An IAD and asymptomatic PVD are common in a primary care hypertensive population. Magnitude of the IAD is inversely correlated with ABPI, supporting the hypotheses that IADs are causally linked to PVD, and that IAD is a useful marker for the presence of PVD. Consequently, detection of an IAD should prompt the clinician to screen subjects for other signs of vascular disease and target them for aggressive cardiovascular risk factor modification.     

2型糖尿病患者并发外周动脉疾病的危险因素

目的分析外周动脉疾病(PAD)在伴有危险因素的2型糖尿病(T2DM)患者中的发病率及PAD的危险因素。方法401例T2DM患者中,男201例,女200例,平均年龄(63.4±8.8)岁,双下肢任一侧踝肱指数(ABI)≤0.9诊断为PAD。结果T2DM患者PAD发病率为19.4%,性别差异无统计学意义。单变量分析提示年龄、高血压、收缩压、低密度脂蛋白-胆固醇和(T2DM)病程为其危险因素,多因素Logistic回归分析提示年龄、收缩压、低密度脂蛋白-胆固醇和T2DM病程为其独立危险因素,各自OR值及95%可信限(CI)分别为:年龄1.94(1.20~2.60),收缩压1.12(0.88~1.43),低密度脂蛋白-胆固醇1.32(0.97~1.63),T2DM病程1.27(0.96~1.73)。结论T2DM患者PAD发病率约为19.4%,其主要危险因素是年龄、收缩压、低密度脂蛋白-胆固醇和T2DM病程。这提示尽早良好控制血压、血脂和血糖对延缓或阻止PAD发生非常重要。     

Quality of life and objective disease criteria in patients with intermittent claudication in general practice

BACKGROUND: The quality of life (QoL) of patients with chronic diseases is an important decision criterion for medical treatment, especially in primary care settings. It is known that subjective sickness feelings often cannot be correlated with objective disease criteria. OBJECTIVE: The aim of the study was to determine the QoL of patients with intermittent claudication with the arterial morphology, haemodynamic parameters and functional disability of peripheral arterial occlusive disease (PAOD). METHODS: In 150 patients with stable intermittent claudication, the health-related QoL was compared with the angiogram score, the resting Doppler pressure values, and the initial claudication distance (ICD) and absolute claudication distance (ACD) with treadmill exercise. RESULTS: The QoL did not correlate significantly with either the angiogram score or the ankle systolic blood pressure and ankle brachial index. ICD and ACD correlated significantly with the QoL activity subscales of pain, complaints and functional status (P < 0.001). In a multiple regression analysis, ACD and body mass index were the most predictive variables for the QoL. CONCLUSION: The QoL of PAOD patients is independent of the peripheral Doppler pressure and the angiographic severity of the disease. The most important criterion for the QoL is the patient's functional disability.     

Epidemiology, classification, and modifiable risk factors of peripheral arterial disease

Peripheral arterial disease (PAD) is part of a global vascular problem of diffuse atherosclerosis. PAD patients die mostly of cardiac and cerebrovascular-related events and much less frequently due to obstructive disease of the lower extremities. Aggressive risk factors modification is needed to reduce cardiac mortality in PAD patients. These include smoking cessation, reduction of blood pressure to current guidelines, aggressive low density lipoprotein lowering, losing weight, controlling diabetes and the use of oral antiplatelet drugs such as aspirin or clopidogrel. In addition to quitting smoking and exercise, cilostazol and statins have been shown to reduce claudication in patients with PAD. Patients with critical rest limb ischemia or severe progressive claudication need to be treated with revascularization to minimize the chance of limb loss, reduce symptoms, and improve quality of life.     

Knowledge and attitude of physicians in a major teaching hospital towards atherosclerotic risk reduction therapy in patients with peripheral arterial disease

Background

Peripheral arterial disease (PAD) is a marker of advanced atherosclerosis with an elevated risk of cardiovascular mortality and morbidity. Although intensive risk reduction therapy is critical in reducing the adverse cardiovascular outcomes in patients with PAD, the awareness of this information among all physicians is felt to be low. Given the role of family physicians (FP), general internists (GI), cardiologists (C), and vascular surgeons (VS) in treating patients with PAD, we sought to determine their perceptions and knowledge of risk reduction therapy in these patients.

Methods and results

We conducted a cross-sectional self-administered survey of 84 physicians who work at a major teaching hospital. FP, GI, C, and VS represent 39%, 33%, 16%, and 12% of the surveyed physicians, respectively. The recommended targets of LDL-cholesterol, blood glucose and blood pressure in PAD patients were known to 37.3%, 94.1% and 35.3% of physicians, respectively. The majority of physicians reported to screen for risk factors in PAD. Although 86.3% of physicians would recommend antiplatelets therapy in PAD, only 17.6% would recommend angiotensin converting enzyme (ACE) inhibitors; 25.5% would recommend nicotine replacement therapy for smokers and 62.7% would recommend statins. Compared to other specialties, cardiologists had the lowest threshold, whereas GI had the highest threshold for initiating antiplatelets and statins for patients with PAD.

Conclusion

The perceptions towards risk reduction in PAD identify glaring knowledge and action gaps. Effective strategies to encourage health professionals to use risk reduction therapy are needed.     

多普勒血流探测仪检测糖尿病下肢动脉病变的临床意义

目的 探讨踝肱指数(ABI)用于诊断2型糖尿病下肢动脉病变的临床意义及影响因素.方法 应用ES-1000 SPM多普勒血流探测仪检测110例2型糖尿病患者肱动脉、足背动脉或胫后动脉血流波形图及收缩压,根据ABI分为下肢动脉病变组(A组)和非下肢动脉病变组(B组),比较两组患者的临床资料并分析其危险因素.结果 110例患者中,ABI小于0.9者20例,占18.2%.A组平均患者年龄、TC、LDL-C、24 h尿微量白蛋白(24hUMA)、冠心病病史率均显著高于B组(P＜0.05),LDL-C、有冠心病病史为下肢动脉病变独立危险因素.结论 测定糖尿病患者ABI可客观评价其下肢动脉功能状况,为临床治疗提供可靠依据,冠心病病史、高龄及高TC、LDL-C及24hUMA是下肢动脉病变的主要因素,且LDL-C和冠心病病史是独立危险因素.     

Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative

OBJECTIVE: Our aim was to improve the accuracy and completeness of reporting of studies of diagnostic accuracy in order to allow readers to assess the potential for bias in a study and to evaluate the generalizability of its results. METHODS: The Standards for Reporting of Diagnostic Accuracy (STARD) steering committee searched the literature to identify publications on the appropriate conduct and reporting of diagnostic studies and extracted potential items into an extensive list. Researchers, editors and members of professional organizations shortened this list during a 2-day consensus meeting with the goal of developing a checklist and a generic flow diagram for studies of diagnostic accuracy. RESULTS: The search for published guidelines about diagnostic research yielded 33 previously published checklists, from which we extracted a list of 75 potential items. At the consensus meeting, participants shortened the list to a 25-item checklist, by using evidence whenever available. A prototype of a flow diagram provides information about the method of recruitment of patients, the order of test execution and the numbers of patients undergoing the test under evaluation and/or the reference standard. CONCLUSIONS: Evaluation of research depends on complete and accurate reporting. If medical journals adopt the checklist and the flow diagram, the quality of reporting of studies of diagnostic accuracy should improve, to the advantage of clinicians, researchers, reviewers, journals and the public.     

Performance of a single screening question for depression in a representative sample of 13 670 people aged 75 and over in the UK: results from the MRC trial of assessment and management of older people in the community

BACKGROUND: A concise, accurate screening question for depression would be an important contribution to the Single Assessment Process for Older People. OBJECTIVE: To examine the performance of a previously validated screening question for depression, in a large community sample. METHODS: Both the single screening question, and the Geriatric Depression Scale (GDS-15) were completed by 13 670 people aged 75 and over in the community. Responses to the question were compared with a "standard" of scoring above different thresholds on the Geriatric Depression Scale (GDS-15). RESULTS: For more severe GDS-15 depression, the best performance of the question was a sensitivity of only 52% and a specificity of 93%. CONCLUSION: Even at its best, the question therefore misses almost half the cases. This highlights the problems of such simple approaches to routine screening.     

Evaluating the accuracy of a simple heuristic to identify serious causes of low back pain

BACKGROUND: Among patients presenting with low back pain (LBP), GPs have to identify those with serious, treatable conditions. However, excluding these conditions in every patient with LPB is time consuming and of low yield. We have suggested that identifying those patients where these serious conditions need to be considered can be made more efficient through asking patient if they feel their LBP is new or unfamiliar in some way. OBJECTIVE: To evaluate the diagnostic validity of a simple heuristic based on the patient's view of the familiarity of LBP. METHODS: Cross-sectional diagnostic study with delayed-type reference standard, nested within a three-arm randomized trial of quality improvement for LBP. A total of 1378 patients presenting, with LBP, to one of 126 participating GPs were included. They were asked whether their LBP was familiar or not (index test). At 1 year, patients were interviewed with regard to relevant conditions that in hindsight might explain their LBP. Reviewers deciding on disease status (reference standard) were blinded to the results of the index test. RESULTS: Totally 1190 patients answered the index test question and were available for interview at 1 year. Only four of these had a serious cause of their LBP. Two of these were identified by the familiarity heuristic, resulting in low sensitivity. CONCLUSION: The number of diseased patients was too small to obtain a reliable estimate of sensitivity. Low prevalence of serious disease in primary care poses difficulties for diagnostic research. In hindsight we would question whether an RCT-setting emphasizing non-specific LBP is suitable for this kind of research. At present, the familiarity heuristic cannot be recommended for patients presenting with LBP.     

心血管病高危人群下肢动脉疾病和肾功能不全的相关性研究

目的 评价心血管事件高危人群通过测量踝臂指数(ABI)诊断的下肢动脉疾病(PAD)和肾功能的相关性.方法 人选5270例年龄≥50岁的心脑血管疾病或存在多重动脉粥样硬化危险因素患者,测定ABI值,采用Cockcrofl-Gault公式计算肌酐清除率(CRCL),观察该人群中ABI异常(ABI≤0.9)和肾功能不全(CRCL＜60ml·min-1·1.73m-1)的发生情况及其二者关联.结果 5270例患者中有2648例(50.2%)存在肾功能不全,746例(14.2%)经ABI证实为PAD.ABI与CRCL呈正相关(r=0.217,P<0.001).肾功能不全患者中PAD的患病率显著高于肾功能正常者(19.9%vs.8 3%,P<0.001).经对危险因素和伴随疾病校正后,CRCL与PAD独立相关(OR=0.98,95%CI:0.98～0.99.P<0.001).结论 心血管病高危人群中,存在肾功能不全的患者PAD发生率高.

Abstract：

Objective This study was to examine the relation of peripheral arterial disease (PAD) and renal insufficiency in cardiovascular patients with high risk. Methods PAD, defined as an ankle brachial index (ABI)≤0.9 in either leg and renal insufficiency, defined as an estimated creatinine clearance (CRCL) <60 ml ? min-1 ? 1.73 m-1 were evaluated in 5270 Chinese patients at high risk of CV. Results 2648(50.2%) patients had an estimated ABI≤0.9. ABI and CRCL were positively correlated (r=0.217,P<0.001). The prevalence of PAD in patients with renal dysfunction was significantly higher than those with normal renal function (19.9% vs. 8.3%,P<0.001). The association of ABI≤ 0.9 with CRCL was independent from potential confounders such as age, diabetes, hypertension, hypercholesterolemia, smoking, coronary artery disease and stroke history (OR=0.98, 95%CI: 0.98-0.99, P<0.001). Conclusion Results from the present study demonstrateda remarkably high prevalence of PAD (defined as an ABI≤0.9) among patients with renal dysfunction and at high risk. Even after adjustmentfor important confounders such as age, diabetes, and coronary artery and cerebro-vascular diseases etc., persons with lower CRCL were still more likely to have an ABI≤0.9.     

北京市万寿路地区老年人群周围动脉硬化闭塞病横断面调查

目的 了解北京市万寿路居民区老年人口中周围动脉硬化闭塞病(PAOD)的现患率及相关影响因素。方法 在该地区老年居民中进行整群随机抽取2124人(男943人,女1181人),最大年龄95岁,最小年龄60岁,平均年龄68.54岁±5.43岁。以踝肱动脉压比值(AAI)<0.9为此项研究PAOD的诊断标准,确定该地区老年人口PAOD的现患率。在横断面研究中,对与PAOD患病有关的诸多影响因素进行logistic多元回归分析。结果 上述地区老年人口中,PAOD的现患率为15.91％,男11.77％,女19.22％;标准化后16.42％,男12.66％,女18.07％。logistic回归结果显示:高龄(1.06,1.04～1.09)、性别(1.93,1.49～2.48)、合并高血压病(1.48,1.16～1.87)、糖尿病病程(1.04,1.06～1.07)为研究中与PAOD患病有关的重要影响因素。结论 北京市万寿路地区老年人口中PAOD现患率与发达国家老年人口中PAOD现患率近似,且随着年龄的增高PAOD现患率增大,老年女性PAOD现患率高于老年男性。高龄、女性、合并高血压病、糖尿病患病时间延长与老年PAOD的患病有关。     

Nutritional status and body composition in patients with peripheral arterial disease: A cross-sectional examination of disease severity and quality of life

Nutritional and body weight recommendations for cardiovascular diseases are well established, yet there are no equivalent guidelines for peripheral arterial disease (PAD). This cross-sectional study measured the prevalence of cardiovascular-related nutritional and body composition risk factors in sixty PAD patients and their association with PAD severity. A diet that exceeds daily recommended intake of fat and that falls short of recommended intakes of fiber, folate, and vitamin D was associated with increased leg pain and walking difficulty. Increased body fat and waist circumference were associated with diminished walking ability and poorer psychosocial quality of life. Future prospective investigations are merited to inform both PAD clinical care and disease management guidelines.     

Risk reduction with clopidogrel in the management of peripheral arterial disease

Peripheral arterial disease (PAD) is a condition typified by decreased arterial blood flow in the non-coronary branches of the aorta as a result of chronic atherosclerosis. Despite the higher prevalence of PAD compared with other cardiovascular entities such as myocardial infarction and stroke, far less import is given to its diagnosis and treatment. In this review, we highlight principal diagnostic and therapeutic considerations in the management of PAD and its complications. We particularly emphasize the role of clopidogrel in the reduction of risks associated with PAD.     

糖尿病足诊断箱在糖尿病合并血管病变患者中的应用及分析

目的:探讨糖尿病足检测诊断箱在检测糖尿病下肢血管病变的临床意义。方法:采用北京迪美德尔科技有限公司生产的糖尿病足检测诊断箱检测126例2型糖尿病患者。通过多普勒波形、多普勒光标、踝肱血压比值、趾肱血压比值等对下肢血流情况进行判断,得出踝肱指数(ABI)。根据ABI值将受检者分为正常组(ABI≥1)、异常组(ABI<1)。同时检测各组患者的年龄、病程、空腹及餐后2 h血糖、糖化血红蛋白(HbAlc)、收缩压(SBP)及舒张压(DBP)。结果:126例糖尿病患者检测出74例下肢血管病变患者,检出率(58.7%)。下肢血管病变患者的年龄、病程、HbA1c、SBP与正常组相比明显升高,有统计学差异(P<0.05)。结论:糖尿病足检测诊断箱可作为临床早期筛查糖尿病下肢血管病变的有效手段。     

Estimating the risk of peripheral artery disease using different population strategies

Objective

The objective of this study is to compare the clinical performance of different strategies, REASON, PREVALENT, Inter-Society Consensus (ISC), and the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines, in the selection of candidates for peripheral artery disease (PAD) screening using ankle-brachial index (ABI).

Method

Our work is a population-based cross-sectional study conducted in Extremadura (Spain) in 2007–2009. Participants were ≥ 50 years old and free of cardiovascular disease. ABI and cardiovascular risk factors were measured.

Result

In total, 1288 individuals (53% women), with a mean age of 63 years (standard deviation (SD) 9) were included. The prevalence of ABI < 0.9 was 4.9%. REASON risk score identified 53% of the sample to screen with sensitivity of 87.3%, quite similar to that identified in ISC and ACC/AHA strategies (both 90.5%), and specificity of 48.3%, higher than that of the ISC (30.9%) and ACC/AHA (31.1%) strategies. Although the Youden index was 0.4 for both REASON and PREVALENT risk scores, the latter's sensitivity was 60.3%, almost 30 points less than all other strategies.

Conclusion

REASON risk score was the strategy with the highest clinical performance and efficiency, with sensitivity of 87.3% and specificity higher than that of the ISC and ACC/AHA strategies. Although very specific, the PREVALENT strategy had low sensitivity making it difficult to be implemented as a screening tool.     

2型糖尿病患者周围动脉疾病危险因素分析

目的 探讨2型糖尿病患者周围动脉疾病(PAD)的患病率及传统和非传统危险因素对其影响.方法 选择病程超过1年的2型糖尿病患者共420例,以踝臂指数(ABI)≤0.90定义为有PAD,评价年龄、性别、体重指数、吸烟、高血压、糖尿病病程、糖化血红蛋白、血尿酸、三酰甘油、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、高敏C反应蛋白(hs-CRP)、纤维蛋白原、尿白蛋白排泄率(UAER)等危险因素对PAD患病率的影响.结果 2型糖尿病患者PAD患病率为16.4%(69/420),PAD患者年龄偏大、糖尿病病程较长、HDL-C偏低,有高的UAER、hs-CRP和纤维蛋白原,Logistic回归可见年龄、UAER、hs-CRP、纤维蛋白原均为PAD的独立危险因素.PAD患病率在年龄<50岁、50～70岁和>70岁时分别为4.7%(2/43)、12.9%(27/209)和23.8%(40/168),在hs-CRP<1 mg/L、1～3 mg/L和>3 mg/L时分别为7.9%(14/177)、9.3%(11/118)和35.2%(44/125),在UAER正常、微量白蛋白尿和大量白蛋白尿时分别为9.7%(30/310)、34.4%(33/96)和42.9%(6/14),在纤维蛋白原≤4 g/L和>4 g/L时分别为12.1%(43/356)和40.6%(26/64).结论 2型糖尿病患者PAD的患病率较高,一些非传统危险因素也参与PAD的发生.     

The needs of patients dying of chronic obstructive pulmonary disease in the community

BACKGROUND: Ninety percent of the last year of life of a terminally ill patient is spent at home, but possible drawbacks to domicillary terminal care have been suggested. Most previous studies have taken place in secondary care settings, and have often obtained relatives' views of patients' needs rather than those of the patient. OBJECTIVES: Our aim was to determine the needs of patients dying in primary care from chronic obstructive pulmonary disease (COPD). METHODS: Semi-structured interviews were undertaken with 16 patients who were having maximal therapy for COPD, who were thought likely to die in the year following the commencement of the study. RESULTS: Five themes were identified. (i) Patients' information needs and the future course of their illnesses. Information needs were often variable and patients were sometimes unwilling to contemplate the future. (ii) The impact of symptoms on patients' lives. Dyspnoea was a particular problem. (iii) Attitudes towards and opinions on smoking, which many acknowledged as being causal. (iv) Attitudes to help received. Many patients relied on their family; most patients felt their doctors were helpful although some expressed reservations. (v) Patients' expressed needs. These usually focused on mobility, and many patients would not express needs even when prompted. CONCLUSION: Poor symptom control remains an important cause of distress. The low number of expressed needs may reflect patients' unwillingness to appear ungrateful, but the variability of information needs emphasizes the importance of an individual approach to patients with an apparently homogenous disease     

A Spanish translation of the Walking Impairment Questionnaire was validated for patients with peripheral arterial disease

OBJECTIVES: Walking impairment is a common manifestation of peripheral arterial disease (PAD). In this study we present evidence for the validity of our Spanish translation of the Walking Impairment Questionnaire (WIQ). METHODS: The WIQ was translated into Spanish by our team of researchers. Spanish-speaking patients in the Houston, TX, area completed Spanish versions of the WIQ and the SF-36. Evidence for convergent and discriminant validity of the WIQ was obtained from correlations between the WIQ and other measures. Spanish or English as the primary language defined language-speaking status. RESULTS: Among 403 patients, convergent validity evidence was strong for both English- and Spanish-speaking patients. For patients with PAD, the correlation between walking distance and physical functioning was 0.55 (P < .01) for English-speaking patients and 0.85 (P < .01) for Spanish-speaking patients. The correlations of walking impairment with emotional health measures ranged from 0.26 to 0.44 for English-speaking patients (P < .01) and from 0.34 to 0.78 for Spanish-speaking patients. CONCLUSIONS: The WIQ scores correlated well with SF-36 components for both English- and Spanish-speaking patients. Our findings suggested that our translation process did not limit our ability to capture good-quality data. Further research is needed to determine what specific items in the WIQ or the SF-36 questionnaire warrant restructuring to increase their validity for use in diverse populations.