For physicians

Interpreting the report

The suite is designed to be read across domains. Most of the clinically useful information is in the combinations, not in any single index.

Read the vascular section as three measurements, not one

The ankle-brachial index, the toe-brachial index and the pulse volume waveform answer the same question by different means, and the disagreements between them are informative.

Pattern	Interpretation
Index reduced, waveform damped, toe index reduced	Consistent with significant arterial disease
Index normal or elevated, waveform damped	Suspect medial calcification with a falsely reassuring index; weight the waveform and the toe index
Index normal, waveform normal, symptoms present	Consider a non-vascular cause — neuropathic, musculoskeletal or venous
Marked left-right asymmetry	Asymmetric disease; the side matters clinically even if both values fall within range

Read the neuropathy section against the right fiber population

Reduced sudomotor conductance in the feet with a normal nerve conduction study is not a contradiction; it is the expected pattern in small-fiber predominant neuropathy. The clinically important combination is reduced foot conductance plus reduced toe-brachial index plus loss of protective sensation — that is a foot at risk, and it warrants action before there is a wound.

Conversely, a normal sudomotor study in a patient with prominent burning does not close the question. It narrows it, and the next step is usually a search for a non-length-dependent or non-metabolic cause.

Read the autonomic section against the medication list

This is the section most often misread, because so many common medications shape it. Beta-blockers blunt the heart rate response to standing and to deep breathing. Anticholinergics and many antidepressants reduce sudomotor output and heart rate variability. Diuretics and antihypertensives exaggerate orthostatic change. A result read without the list is not an interpretation.

The second most common error is reading a single low heart rate variability index as disease. It moves with sleep, alcohol, caffeine, recent exercise and acute illness. Repeat before acting.

Read metabolic rate against lean mass

Resting energy expenditure is produced overwhelmingly by lean tissue, so an absolute value means little without the body composition figure beside it. A low measured expenditure in someone with low lean mass is an expected finding and points at muscle rather than at metabolism.

Read balance and cognition together

Vestibular findings with a normal orthostatic response point one way; a normal vestibular battery with a marked orthostatic drop points somewhere entirely different, and generic vestibular rehabilitation will not help the second patient. Cognitive screening belongs in the same reading because attention and executive function determine whether a postural correction happens in time. Cognitive assessment and fall prevention.

Three interpretive rules

1. A borderline value is a reason to repeat, not to treat. Repeat under controlled conditions before it enters the problem list.
2. Conditions of measurement are part of the result. A reading without its fasting, caffeine, nicotine and medication context is not comparable to anything.
3. The trend outranks the snapshot. The suite exists to be repeated; the second assessment is usually more informative than the first.

For patients: the same subject written for the person having the assessment is at understanding your results.

Common questions

An index above 1.4 — is that good?

It usually indicates incompressible, calcified vessels rather than healthy ones, and the toe index and waveform should be weighted instead. Why a normal index can mislead.

To what extent does medication distort the autonomic section?

Enough that the section should not be read without the list. What the number means.

When should a borderline result be repeated?

Under controlled conditions, before it changes management. Repeat intervals.

Does a normal sudomotor study exclude small-fiber neuropathy?

It reduces the probability rather than excluding it, and the next step depends on the clinical picture. Small-fiber versus large-fiber neuropathy.

References

• Aboyans V, Criqui MH, Abraham P, et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation. 2012;126(24):2890–2909. doi:10.1161/CIR.0b013e318276fbcb
• Pop-Busui R, Boulton AJM, Feldman EL, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136–154. doi:10.2337/dc16-2042
• Novak P. Electrochemical skin conductance: a systematic review. Clinical Autonomic Research. 2019;29(1):17–29. doi:10.1007/s10286-017-0467-x

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, medical director of Measura. Last reviewed August 20, 2026.