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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 6, November/December 2019
342
AFRICA
The aim of this study was to estimate the applicability of
the WELSH tool in a population of predominantly illiterate or
low-literacy patients in Burkina Faso. The WELSH tool aims
at evaluating walking impairment quickly by history. Although
walking tests remain of interest, they are time consuming and
do not necessarily reflect self-perceived impairment. Correlation
of the New York Heart Association (NYHA) classification
with walking capacity is very poor.
14
The WELSH tool would
not replace the NYHA classification but, once validated as
an applicable tool, it could be proposed as an easy method to
analyse outcome under treatment in future studies.
Methods
A six-month prospective study was performed on new patients
referred to the Department of Cardiology in the Centre
Hospitalier Universitaire Sourô Sanou in Bobo-Dioulasso,
Burkina Faso. The patients were referred for follow up of a
confirmed cardiovascular disease.
Eligibility was age over 18 years, ability to read time on a
clock/watch dial, ability to walk without physical assistance, and
ability to understand the study goal and potential instructions.
We did not include patients classified as NYHA stage IV
14
who
had a recent history of unstable coronary syndrome or recent
myocardial infarction.
In the context of the Burkina Faso healthcare system and due
to the very low accessibility of investigative tools, most diagnoses
remain unconfirmed. For this study we retrieved the diagnosis
at referral and provided results for the few available functional
investigations.
All investigators participating in the study were trained by
the principal investigator on how to perform the investigations,
complete the files and score the questionnaires. The questionnaire
was first explained to the two technicians, who filled a minimum
of 10 files and calculated the score with the principal investigator,
before doing the tests alone.
For each included patient, we recorded general social and
anthropometric characteristics. We used the NYHA classification
as a descriptive tool of self-reported limitation.
15
This tool is
commonly used as a method for functional classification in
patients with heart disease.
14
We used the concept of the WELCH questionnaire to build a
new form based on only simple drawings. The original WELCH
included four items. The first three items proposed various
durations that patients felt they were able to perform at different
walking speeds without stopping, and the fourth item questioned
the usual walking speed. We designed the WELSH tool on the
same concept.
The WELSH tool requires the patients to estimate their
walking time on an empty watch dial from zero to 59 minutes
Fig. 1.
The WELSH tool. On the first page the patient is asked to draw a line on the number of minutes corresponding to the duration
sustainable without stopping for different tasks (see text for explanation). The second page requires the patient to estimate
his/her usual walking pace.