This issue of Topics in Geriatric Rehabilitation focuses on the significant health issue of peripheral arterial disease (PAD). Peripheral arterial disease, a condition primarily characterized by narrowing of the arteries of the lower extremities, directly affects the function and overall health of a significant number of individuals in the United States. The primary cause of PAD is atherosclerosis. Estimates of prevalence vary from 8 million to 12 million, and almost half are asymptomatic and are likely to be undiagnosed, although PAD has been found in the literature to be predictive of future stroke, myocardial infarction, and all-cause mortality. Peripheral arterial disease is common in older adults, African Americans, adults with a history of cardiovascular disease, diabetes, and obesity, and those who smoke. Peripheral arterial disease is also associated with fatal and nonfatal coronary heart disease and all-cause mortality in people with and without existing clinical coronary artery disease. Rehabilitation providers are uniquely situated to address PAD from primary, secondary, and tertiary health promotion perspectives.

The ankle-brachial index (ABI) is considered the gold standard for noninvasive measurement of PAD and is recommended as part of the assessment of individuals at risk for the disease. Sensitivity and specificity for using the ABI to diagnose PAD are strong and have been well established when a Doppler device was used in the examination. Nurses, physical therapists, physicians, and physician assistants are academically prepared to assess for PAD using the ABI. These health care professionals, along with dieticians, exercise physiologists, nutritionists, occupational therapists, orthotists, pharmacists, prosthetists, and others, work collaboratively to ensure that approaches for the prevention and treatment of PAD are evidence based and exemplify best practices. This focused issue provides the reader with a myriad of articles that highlight the diagnosis and management of PAD.

This issue begins with a commentary focusing on Missed Opportunities in the early identification of PAD in older adults. This article by Steven Chesbro advocates for the screening of PAD, using the ABI by nurses, physical therapists, physicians, and physician assistants, and challenges the common practice of leaving this process to physicians' offices that regularly seek procedure-specific payment for testing. This commentary is followed by an article by Julia Chevan and Angela Campbell that considers the unique risk of PAD in females and makes recommendation for clinicians working with this population.

Effective strategies to the prevention and management of PAD include a variety of approaches. This issue contains articles that focus on areas of exercise, nutrition, pharmacology, prosthetic and orthotic, and wound management interventions. Kristin Lefebvre, Crystal Cody, Erika Longaker, Jennifer Mason, and Rebecca Monaghan present an overview of randomized controlled trials related to exercise interventions for those with PAD. The purpose of this article is to provide the reader with evidence-based protocols for exercise intervention. Spiridon Karavatas provides the reader with a foundational appreciation for the role of nutrition in the management of PAD and provides resources for further investigation. Oluwaranti Akiyode, Tracy Thomas, Salome Weaver, and Sarah Sahraoui present a compelling case for the need to consider pharmacologic intervention for those at risk for, or with, PAD. Their article not only provides a description of commonly used pharmacologic interventions for the disease but also suggests smoking cessation as a key intervention for those who smoke. The authors provide a case study to assist the reader in appreciating the complexity of PAD management. A common condition resulting from PAD is arterial wounds of the lower extremities. Ellen Wruble Hakim and Jill Heitzman provide an article that reviews the cause of these wounds and describes the ideal management of these conditions.

This issue includes 2 research articles. Steven Chesbro, Elmira Asongwed, Emmanuel John, and Nolawit Haile present research on a comparison of standard and vascular blood pressure cuffs in calculating an ABI. This article highlights the need for accurate measurement principles in assessing for the presence of PAD. Cleve Carter, Mirna Martinez, Gentry Purnell, and Steven Chesbro present a study that looked at the practice of screening for PAD in a long-term care setting. This article suggests that there are many opportunities for secondary and tertiary screening of those not currently diagnosed with PAD.

This issue should provide rehabilitation practitioners across the spectrum of care resources to optimize the treatment of their patients with PAD. We hope that the reader finds these articles informative and that the information provided will assist in guiding future clinical management of those with PAD. We encourage rehabilitation providers to appreciate the unique opportunities they have to participate in the screening, examination, evaluation, diagnosis, prognosis, and intervention processes in order to maximize outcomes.

-Steven B. Chesbro, PT, DPT, EdD, GCS

Issue Co-editor

Alabama State University

Montgomery

-Kristin Lefebvre, PT, PhD, CCS

Issue Co-editor

Widener University

Chester, Pennsylvania