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The walking estimated limitation stated by history (WELSH): a visual tool to self-reported walking impairment in a predominantly illiterate population.

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.