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.