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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 6, November/December 2019
AFRICA
341
The walking estimated limitation stated by history
(WELSH): a visual tool to self-reported walking
impairment in a predominantly illiterate population
Wendsèndaté Yves Sempore, Alassane Ilboudo, Samir Henni, Jeanne Hersant, Myriam Ammi,
Aimé Arsène Yameogo, Nafi Ouedraogo, Téné Marcéline Yameogo, Pierre Abraham
Abstract
Background:
The prevalence of cardiovascular diseases is
increasing in low-income countries. Various questionnaires to
estimate walking capacity in patients are available in multiple
languages but they are not suitable for illiterate patients.
Objective:
The walking estimated limitation stated by history
(WELSH) tool aims at rating individual walking disability
using only drawings and four items.
Methods:
A six-month prospective study was performed on
new patients referred to the Department of Cardiology at
the Centre Hospitalier Universitaire Sourô Sanou in Bobo-
Dioulasso, Burkina Faso. We administered the WELSH tool
after a short oral presentation in the patient’s language or
dialect. Thereafter, patients performed a six-minute walking
test in the hospital corridor under the supervision of a nurse
who was blinded to the results of the WELSH score. We
performed a step-by-step multilinear regression analysis to
determine the factors predicting maximal walking distance
(MWD).
Results:
There were 40 female and 10 male patients in this
study. Their ages ranged from 54.8
±
10.7 years. Only 32% of
the patients had attended primary school. Most patients were
classified as stage I to III of the New York Heart Association
(NYHA) classification. The objective measurement of MWD
during a six-minute walking test showed no association with
the subjects’ educational level, body mass index, NYHA stage
or gender, but a significant correlation with the WELSH
scores. The Spearman
r
-value for the WELSH score-to-
MWD relationship was 0.605 (
p
<
0.001).
Conclusions:
The WELSH tool is feasible and correlated with
measured MWD in a population of predominantly illiterate
patients.
Keywords:
questionnaire, illiteracy, exercise, walking impairment,
quality of life
Submitted 1/2/19, accepted 20/5/19
Published online 30/8/19
Cardiovasc J Afr
2019;
30
: 341–346
www.cvja.co.zaDOI: 10.5830/CVJA-2019-032
The prevalence of diabetes, hypertension and their cardiovascular
complications is increasing in Africa.
1-3
Coronary artery
disease is projected to be the leading cause of disability-
adjusted life years lost in low-income countries by 2030.
4
Estimation of walking disability in routine medical practice
is of major interest, specifically in cardiovascular diseases.
Among other available questionnaires, the walking estimated
limitation calculated by history (WELCH) tool and the walking
impairment questionnaire (WIQ) have been validated in different
languages.
5-10
The WELCH tool compares favourably with the
WIQ in terms of ease of use and scoring.
5,11,12
Unfortunately, all
available questionnaires require the patient and/or healthcare
provider to be able to read. Therefore they are unsatisfactory in
countries with a high prevalence of illiterate people.
To the best of our knowledge, to date no standard
questionnaire to estimate walking impairment has ever been
developed that could be used by healthcare providers (nurses or
technicians) and/or proposed for patients (children or adults)
who are uncomfortable with reading or unable to read. Since
illiteracy is still high in Burkina Faso, as in many sub-Saharan
African countries,
13
we aimed to test an empirical new tool:
the walking estimated limitation stated by history (WELSH).
The WELSH tool is derived from the WELCH but is based on
drawing (text-free). Furthermore, we wanted the WELSH score
to be simple and calculable without the need for a computer.
Centre Muraz, Bobo-Dioulasso, Burkina Faso
Wendsèndaté Yves Sempore, MD
Vascular Medicine, University Hospital Centre of Angers,
Angers Cedex Angers, France
Wendsèndaté Yves Sempore, MD
Samir Henni, MD
Jeanne Hersant, BSc
Pierre Abraham, MD, PhD,
piabraham@chu-angers.frInternal Medicine, Centre Hospitalier Universitaire Sourô
Sanou, Bobo Dioulasso, Burkina Faso
Alassane Ilboudo, MD
Téné Marcéline Yameogo, MD, MPH
Vascular Surgery, University Hospital Centre of Angers,
Angers, France
Myriam Ammi, MD
Cardiology, Centre Hospitalier Universitaire Sourô Sanou,
Bobo Dioulasso, Burkina Faso
Aimé Arsène Yameogo, MD
Physiology, Centre Hospitalier Universitaire Sourô Sanou,
Bobo Dioulasso, Burkina Faso
Nafi Ouedraogo, MD, PhD
UMR CNRS 6214, INSERM 1083, Mitovasc Institute, Angers,
France
Pierre Abraham, MD, PhD