Cardiovascular Journal of Africa: Vol 30 No 6 (November/December 2019)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 6, November/December 2019

AFRICA

345

NYHA scoring by the physician but provide information on self-

perceived impairment, which the NYHA does not do.

Walking disability is observed in a wide variety of diseases.

The WELCH tool (from which the WELSH was inspired)

was validated in only patients with suspected peripheral artery

disease (PAD). The WELSH tool was tested on a population

of patients referred to the cardiology department for various

conditions that unfortunately could not be confirmed.

In Burkina Faso, the prevalence of hypertension is estimated

at 46%, with 27.4% of patients having a medical history of

dilated cardiomyopathy.

From a thesis completed in 2014 in

Bobo Dioulasso on 127 diabetic patients, the most represented

cardiovascular pathologies were hypertension (60.3%), ischaemic

heart disease (26.6%) and cardiomyopathy (3%).

It can be

assumed that our population was similar. Testing the WELSH

tool in more selected patients is necessary but we assume that the

WELSH tool is not PAD-specific.

Limitations

There are limitations to this study and to the use of the WELSH

tool. First, it is important to note that in the context of

Burkina Faso medicine, information on and confirmation of the

cardiovascular disease underlying the patient’s symptoms is rarely

possible. The university hospital in Bobo Dioulasso has only

occasional access to ultrasound and radiology and diagnoses are

based on clinical evidence in most cases. Besides, as no centralised

data files and archives are available, patients are responsible for

their own files and rarely bring them for repeat visits. This could

appear to be a major limitation but the WELSH tool is not

disease-specific and the fact that the population is likely to be

heterogeneous and poorly defined on the basis of para-clinical

confirmation is not, in our opinion, a major limitation.

Second, the WELSH tool cannot be considered a tool that

can be self-completed because initial explanations are needed

to understand how the drawings must be completed. However it

allows for both a standardisation of the estimation of walking

impairment and a simple scoring system.

Third, no validation against treadmill testing could be performed

because no treadmill was available for routine use in the hospital of

Bobo Dioulasso. The six-minute walking test is probably not the

ideal reference tool because of the ceiling effect of the technique.

Other methods of validation not requiring a treadmill could be

used, such as the global positioning system (GPS).

Fourth, we arbitrarily predefined the WELSH scoring,

which is possibly not optimal. It may be changed to improve

the correlation between the WELSH score and objective

measurement of walking impairment, such as the MWD, but

the correlation was already quite high. Future studies are needed

to confirm these results.

Conclusion

The WELSH tool is feasible for use in predominantly illiterate

or low-literacy cardiac patients in Burkina Faso. There was a

good correlation between the WELSH score and the six-minute

walking test. Its applicability in other populations of patients

remains to be tested. Test–retest reproducibility as well as its

sensitivity to therapeutic interventions remain to be assessed in

futures studies.

The study is presented on behalf of the SOCOS group. We thank Abaz

Ouedraogo and Ben Souleyman Wilfred Adjaba for technical help and Ms

Albertine Lucas for grammar and style reviewing.

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