Acurácia do heel rise test na avaliação da capacidade funcional de indivíduos com doença arterial periférica

Abstract

Introduction: Peripheral arterial disease (PAD) leads to functional decline and constant monitoring of the walking ability of individuals is necessary. The Heel Rise Test (HRT) is a test that evaluates the function of the calf muscles, frequently affected in PAD, and is a viable option for use in clinical screening because it does not depend on large spaces or resources for its application. Objective: To define the accuracy of the HRT in assessing the functional capacity of individuals with PAD and to determine the best sensitivity cut-off point to stratify individuals with worse functional capacity. Methods: This was a retrospective methodological study, approved by the Institution's Research Ethics Committee. We included individuals diagnosed with PAD with intermittent claudication, aged over 18 years, regardless of gender. For the analyses we used data from the HRT (number of plantar flexions, execution time and execution rate) and the distance walked in meters in the Incremental Shuttle Walking Test (ISWT). The accuracy analysis and the determination of the sensitivity of the HRT in assessing functional capacity were performed by the Receiver Operating Characteristic curve (ROC curve) based on the following ISWT cutoff point: 380 meters. For all analyses an alpha of 5% was set for statistical significance. Results: A total of 120 subjects were included (64.2% male), with age of 64.2±9.65 years, body mass index of 26.92±4.30 kg/m2, right ankle-brachial index of 0.60±0.18 and left ankle-brachial index of 0.59±0.18. The number of plantar flexions showed better accuracy for functional capacity evaluation, with an area under the curve (AUC) of 0.78 (p = 0.001; 95% CI 0.65 - 0.90). The cut point found with the best sensitivity was 63 plantar flexion (sensitivity 0.952; specificity 0.562), stratifying the individuals with the worst functional capacity. Conclusion: The HRT showed good accuracy, as well as adequate sensitivity and acceptable specificity values to assess the functional capacity of individuals with PAD. This test can be used for screening, clinical management, follow-up of individuals with more limited PAD, priority setting for physical therapy evaluation and vascular rehabilitation programs.