The Reliability and Validity of Manual Palpation to Assess Lower Limb Arterial Occlusion Pressure in Older Adults, for Application in Blood Flow Restriction Exercise

ABSTRACT (A) Investigate test‐retest reliability of posterior tibial pulse palpation to determine arterial occlusion pressure (AOP) and examine validity against hand‐held Doppler ultrasound. (B) Investigate the suitability of using 130% systolic brachial blood pressure for prescribing cuff inflation pressure for blood flow restriction (BFR) exercise. Repeated measures, crossover design. Lower limb AOP was assessed in 20 adults ≥ 60 years using hand‐held Doppler ultrasound and posterior tibial pulse palpation. Brachial systolic blood pressure (bSBP) was measured to predict cuff inflation pressures (bSBP 130% ). On three occasions > 24 hours apart, three AOP measurements were recorded by the same blinded rater to determine intra‐rater reliability. Participants lay supine, with arterial occlusion achieved using a rapid inflation system and a 10‐cm cuff. Reliability was assessed via intraclass correlation coefficients (ICC), coefficients of variation (CV) and Bland–Altman plots, with validity examined via Pearson's product‐moment correlations and Bland–Altman plots. Good to excellent reliability was observed for AOP assessed with Doppler ultrasound (ICC = 0.91, CV = 5.4%) and palpation (ICC = 0.91, CV = 5.8%). A strong positive correlation was observed in AOP values between methods ( r = 0.85–0.92, p < 0.001), though palpation significantly underestimated AOP compared to Doppler ultrasound (−11.8 mmHg ± 8.32; p < 0.001). bSBP 130% was not different to 100% AOP determined with hand‐held Doppler ( p = 0.516). Palpation may provide a reliable and clinically acceptable alternative to hand‐held Doppler ultrasound for assessing lower limb AOP for blood flow restriction exercise. Employing bSBP 130% may result in complete arterial occlusion with a 10 cm cuff, which is not supported by current BFR exercise recommendations for sub‐occlusive pressures.