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Waddell A, Seed S, Broom DR, McGregor G, Birkett ST, Harwood AE. Safety of home-based exercise for people with intermittent claudication: A systematic review. Vasc Med 2021; 27:186-192. [PMID: 34930062 PMCID: PMC8996308 DOI: 10.1177/1358863x211060388] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intermittent claudication (IC) is a classic symptom of peripheral artery disease,
with first line treatment being supervised exercise therapy (SET). Despite this,
SET is frequently underutilised, and adherence is often poor. An alternative
option are home-based exercise programmes (HBEP). Although HBEPs are well
tolerated, to the authors’ knowledge, no research has assessed their safety. The
aim of this review was to assess the safety of HBEPs in people living with IC.
We performed an electronic search of the MEDLINE, CINAHL, and Cochrane Library
databases. The main parameter of interest was complication rate, calculated as
the number of related adverse events per patient-hours. Subanalysis was
undertaken to determine differences in safety for studies that did and did not
include pre-exercise cardiac screening, and for studies with exercise at low,
moderate, and high levels of claudication pain. Our search strategy identified
8693 results, of which 27 studies were included for full review. Studies
included 1642 participants completing 147,810 patient-hours of home-based
exercise. Four related adverse events were reported, three of which were cardiac
in origin, giving an all-cause complication rate of one event per 36,953
patient-hours. Three of these events occurred following exercise to high levels
of claudication pain, and one occurred with pain-free exercise. One event
occured in a study without cardiac screening. Based on the low number of related
adverse events, HBEPs appear to be a safe method of exercise prescription for
people with IC. Our results strengthen the rationale for providing alternative
exercise options for this population. PROSPERO Registration No.:
CRD42021254581
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Affiliation(s)
- Alexander Waddell
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Sally Seed
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - David R Broom
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Gordon McGregor
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK.,Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stefan T Birkett
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Amy E Harwood
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK
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Hicks CW, Vavra AK, Goldsborough E, Rebuffatti M, Almeida J, Duwayri YM, Haurani M, Ross CB, Shah SK, Shireman PK, Smolock CJ, Yi J, Woo K. Current status of patient-reported outcome measures in vascular surgery. J Vasc Surg 2021; 74:1693-1706.e1. [PMID: 34688398 PMCID: PMC9834908 DOI: 10.1016/j.jvs.2021.05.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/14/2023]
Abstract
A previously published review focused on generic and disease-specific patient-reported outcome measures (PROMs) relevant to vascular surgery but limited to arterial conditions. The objective of this project was to identify all available PROMs relevant to diseases treated by vascular surgeons and to evaluate vascular surgeon perceptions, barriers to widespread implementation, and concerns regarding PROMs. We provide an overview of what a PROM is and how they are developed, and summarize currently available PROMs specific to vascular surgeons. We also report results from a survey of 78 Society for Vascular Surgery members serving on committees within the Policy and Advocacy Council addressing the barriers and facilitators to using PROMs in clinical practice. Finally, we report the qualitative results of two focus groups conducted to assess granular perceptions of PROMS and preparedness of vascular surgeons for widespread implementation of PROMs. These focus groups identified a lack of awareness of existing PROMs, knowledge of how PROMs are developed and validated, and clarity around how PROMs should be used by the clinician as main subthemes for barriers to PROM implementation in clinical practice.
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Affiliation(s)
- Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ashley K Vavra
- Division of Vascular Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill
| | | | - Michelle Rebuffatti
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, Calif
| | - Jose Almeida
- Miami Vein and Division of Vascular and Endovascular Surgery, University of Miami Miller School of Medicine, Miami, Fl
| | - Yazan M Duwayri
- Division of Vascular Surgery and Endovascular Therapy, Emory University, Atlanta, Ga
| | - Mounir Haurani
- Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Charles B Ross
- Vascular Center of Excellence, Piedmont Heart and Vascular Institute, Piedmont Healthcare, Atlanta, Ga
| | - Samir K Shah
- Division of Vascular Surgery, University of Florida, Gainesville, Fl
| | - Paula K Shireman
- Division of Vascular and Endovascular Surgery, Long School of Medicine, University of Texas Health San Antonio, Tex; Department of Surgery, South Texas Veterans Health Care System, San Antonio, Tex
| | - Christopher J Smolock
- Department of Vascular Surgery, Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Jeniann Yi
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado, Aurora, Colo
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, Calif.
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An Updated Systematic Review and Meta-Analysis of Home-based Exercise Programmes for Individuals with Intermittent Claudication. J Vasc Surg 2021; 74:2076-2085.e20. [PMID: 34087396 DOI: 10.1016/j.jvs.2021.03.063] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/26/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Supervised exercise programmes (SEP) are effective for improving walking distance in patients with intermittent claudication (IC) but provision and uptake rates are sub-optimal. Access to such programmes has also been halted by the Coronavirus pandemic. The aim of this review is to provide a comprehensive overview of the evidence for home-based exercise programmes (HEP). DATA SOURCES Medline, EMBASE, CINAHL, PEDro and Cochrane CENTRAL were searched for terms relating to HEP and IC. REVIEW METHODS This review was conducted in according with the published protocol and PRISMA guidance. Randomised and non-randomised trials that compared a HEP to SEP, basic exercise advice or no exercise controls for IC were included. A narrative synthesis was provided for all studies and meta-analyses conducted using data from randomised trials. The primary outcome was maximal walking distance. Sub-group analyses were performed to consider the effect of monitoring. Risk of bias was assessed using the Cochrane tool and quality of evidence via GRADE. RESULTS 23 studies with 1907 participants were included. Considering the narrative review, HEPs were inferior to SEPs which was reflected in the meta-analysis (MD 139m, 95% CI 45 to 232m, p = .004, very-low-quality evidence). Monitoring was an important component, as HEPs adopting this were equivalent to SEPs (MD: 8m, 95% CI -81 to 97, p = .86; moderate-quality evidence). For HEPs versus basic exercise advice, narrative review suggested HEPs can be superior, though not always significantly so. For HEPs versus no exercise controls, narrative review and meta-analysis suggested HEPs were potentially superior (MD: 136m, -2-273m p = .05, very-low-quality evidence). Monitoring was also a key element in these comparisons.Other elements such as appropriate frequency (≥3x a week), intensity (to moderate-maximum pain), duration (20 progressing to 60 minutes) and type (walking) of exercise were important, as was education, self-regulation, goal setting, feedback and action planning. CONCLUSION When SEPs are unavailable, HEPs are recommended. However, to elicit maximum benefit they should be structured, incorporating all elements of our evidence-based recommendations. PROSPERO REGISTRATION NUMBER CRD42018091248.
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Sharath SE, Kougias P, Barshes NR. The influence of pain-related beliefs on physical activity and health attitudes in patients with claudication: A pilot study. Vasc Med 2017; 22:378-384. [DOI: 10.1177/1358863x17709944] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined how pain beliefs are related to symptom severity, expectations of risk/benefits, and baseline physical activity among claudicants. Eligible patients at the Michael E DeBakey Veterans Affairs Medical Center were administered questionnaires that measured: fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire [FABQ]), walking impairment, baseline physical activity, claudication type, and risk/benefit attitudes. Among 20 participants, the median age was 69 years (IQR: 66–75). In our efforts to understand how fear-avoidance beliefs influenced physical activity among people with claudication, we found that 12 out of 19 participants (63%) thought that the primary etiology of their pain was walking, while 18 (out of 20) (90%) people thought that walking would exacerbate their leg symptoms – suggesting that there was some confusion regarding the effects of walking on claudication. Those who expected that walking would benefit their symptoms more than surgery reported fewer fear-avoidance beliefs ( p=0.01), but those who believed that walking would make their leg pain worse expected greater benefit from surgery ( p=0.02). As symptom severity increased, fear-avoidance beliefs also increased ( p=0.001). The association between symptom severity and fear-avoidance beliefs indicates that as pain or impairment increases, the likelihood of avoiding behaviors that are thought to cause pain might also increase. Accounting for pain-related beliefs when recommending physical activity for claudication should be considered.
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Affiliation(s)
- Sherene E Sharath
- Research Service Line, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Panos Kougias
- Division of Vascular Surgery and Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Operative Care Line, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Neal R Barshes
- Division of Vascular Surgery and Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Operative Care Line, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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Abstract
Patient-reported outcomes (PROs) after vascular surgery are becoming increasingly important in the current era of health care reform. Although a number of general quality of life instruments exist, vascular disease-specific instruments may provide more targeted data on how patients feel after specific interventions. Here we provide a review of both generic and disease-specific instruments focused on arterial conditions, including peripheral arterial disease, carotid arterial disease, and aortic disease, which have been described in the literature. While many different tools currently exist, there is a paucity of well-validated, specific instruments that accurately reflect functional and objective measures of patients' arterial disease burden. A full understanding of the existing tools available to assess patients' perceived lifestyle impact of their disease and its treatments is essential for both research and clinical purposes, and to highlight the need for additional work on this topic.
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Affiliation(s)
- Caitlin W Hicks
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, 600 N Wolfe Street, Halsted 668, Baltimore, MD 21287
| | - Ying Wei Lum
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, 600 N Wolfe Street, Halsted 668, Baltimore, MD 21287.
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Supervised vs unsupervised exercise for intermittent claudication: A systematic review and meta-analysis. Am Heart J 2015; 169:924-937.e3. [PMID: 26027632 DOI: 10.1016/j.ahj.2015.03.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/21/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Supervised exercise (SE) is widely accepted as an effective therapy for intermittent claudication (IC), but its use is limited by cost. Unsupervised exercise (UE) represents a less costly alternative. We assessed the comparative effectiveness of SE vs UE in patients with IC. METHODS AND RESULTS We searched PubMed, EMBASE, and the Cochrane Database of Systematic Reviews and identified 27 unique studies (24 randomized controlled trials, 4 observational studies) that evaluated the comparative effectiveness of SE vs UE in 2074 patients with IC. Compared with UE, SE was associated with a moderate improvement in maximal walking distance at 6 months (effect size 0.77, 95% CI 0.36-1.17, P < .001) and 12 months (effect size 0.56, 95% CI 0.34-0.77, P < .001). Supervised exercise also improved claudication distance to a moderate extent compared with UE at 6 months (effect size 0.63, 95% CI 0.40-0.85, P < .001) and 12 months (effect size 0.41, 95% CI 0.18-0.65, P = .001). There was no difference in the Short Form-36 quality of life at 6 months (effect size -0.05, 95% CI -0.50 to 0.41, P = .84) or walking impairment questionnaire distance (effect size 0.24, 95% CI -0.03 to 0.50, P = .08) or speed (effect size 0.26, 95% CI -0.06 to 0.59, P = .11). CONCLUSIONS In claudication patients, SE is more effective than UE at improving maximal walking and claudication distances, yet there is no difference in general quality of life or patient-reported community-based walking. Further studies are needed to investigate the relationship between functional gain and disease-specific quality of life.
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7
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Community walking programs for treatment of peripheral artery disease. J Vasc Surg 2013; 58:1678-87. [PMID: 24103409 DOI: 10.1016/j.jvs.2013.08.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/14/2013] [Accepted: 08/18/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Supervised walking programs offered at medical facilities for patients with peripheral artery disease (PAD) and intermittent claudication (IC), although effective, are often not used due to barriers, including lack of reimbursement and the need to travel to specialized locations for the training intervention. Walking programs for PAD patients that occur in community settings, such as those outside of supervised settings, may be a viable treatment option because they are convenient and potentially bypass the need for supervised walking. This review evaluated the various methods and outcomes of community walking programs for PAD. METHODS A literature review using appropriate search terms was conducted within PubMed/MEDLINE and the Cochrane databases to identify studies in the English language that used community walking programs to treat PAD patients with IC. Search results were reviewed, and relevant articles were identified that form the basis of this review. The primary outcome was peak walking performance on the treadmill. RESULTS Ten randomized controlled trials examining peak walking outcomes in 558 PAD patients demonstrated that supervised exercise programs were more effective than community walking studies that consisted of general recommendations for patients with IC to walk at home. Recent community trials that incorporated more advice and feedback for PAD patients in general resulted in similar outcomes, with no differences in peak walking time compared with supervised walking exercise groups. CONCLUSIONS Unstructured recommendations for patients with symptomatic PAD to exercise in the community are not efficacious. Community walking programs with more feedback and monitoring offer improvements in walking performance for patients with claudication and may bypass some obstacles associated with facility-based exercise programs.
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8
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Kruidenier LM, Viechtbauer W, Nicolaï SP, Büller H, Prins MH, Teijink JAW. Treatment for intermittent claudication and the effects on walking distance and quality of life. Vascular 2012; 20:20-35. [DOI: 10.1258/vasc.2011.ra0048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of the study was to provide an overview of the most common treatments for intermittent claudication and to determine the effectiveness in improving walking distance and quality of life based on a combination of direct and indirect evidence. We included trials that compared: angioplasty, surgery, exercise therapy or no treatment for intermittent claudication. Outcome measurements were walking distance (maximum, pain-free) and quality of life (physical, mental). We used a network meta-analysis model for the combination of direct and indirect evidence. We included 42 studies, presenting 3106 participants. The network meta-analysis showed that supervised exercise therapy (Δ = 1.62, P < 0.01), angioplasty (Δ = 1.89, P < 0.01) and surgery (Δ = 2.72, P = 0.02) increased walking distance significantly more than no treatment. Furthermore, supervised exercise therapy (Δ = 0.60, P < 0.01), angioplasty (Δ = 0.91, P = 0.01) and surgery (Δ = 1.07, P < 0.01) increased physical quality of life more than no treatment. However, in the sensitivity analysis, only supervised exercise therapy had additional value over no symptomatic treatment (Δ = 0.66, P < 0.01). In conclusion, this network meta-analysis indicates that supervised exercise therapy is more effective in both increasing walking distance and physical quality of life, compared with no treatment. Angioplasty and surgery also increase walking distance, compared with no treatment, but results for physical quality of life are less convincing.
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Affiliation(s)
| | - W Viechtbauer
- Department of Statistics, Maastricht University, Maastricht
| | - S P Nicolaï
- Department of Surgery, Maxima Medical Centre, Eindhoven
| | - H Büller
- Department of Internal Medicine, Academic Medical Centre, Amsterdam
| | - M H Prins
- Department of Epidemiology, Maastricht University, Maastricht
| | - J A W Teijink
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
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9
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Influence of peripheral arterial disease and supervised walking on heart rate variability. J Vasc Surg 2011; 54:1352-9. [DOI: 10.1016/j.jvs.2011.05.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 05/12/2011] [Accepted: 05/14/2011] [Indexed: 11/22/2022]
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10
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Stolee P, Lim SN, Wilson L, Glenny C. Inpatient versus home-based rehabilitation for older adults with musculoskeletal disorders: a systematic review. Clin Rehabil 2011; 26:387-402. [DOI: 10.1177/0269215511423279] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: To review and summarize available evidence to compare the outcomes of home-based rehabilitation to inpatient rehabilitation for older patients with musculoskeletal conditions. Data sources: Relevant articles published prior to August 2011 were identified using MEDLINE, CINAHL and the Cochrane Central Register of Controlled Trials databases. Review methods: English-language articles that compared patient outcomes of home-based and inpatient rehabilitation for older adults were included. Outpatient care was not included as home-based or inpatient rehabilitation. Methodological quality of included studies was evaluated by two reviewers using the PEDro scale. Results: A systematic search yielded eight randomized controlled trials and four cohort studies. Older adults who received rehabilitation in the home had equal or higher gains than the inpatient group in function, cognition, and quality of life; they also reported higher satisfaction. Conclusion: Home-based rehabilitation may be an effective alternative for treating older patients with musculoskeletal conditions.
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Affiliation(s)
- Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Sarah N Lim
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lindsay Wilson
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Christine Glenny
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Casillas JM, Troisgros O, Hannequin A, Gremeaux V, Ader P, Rapin A, Laurent Y. Rehabilitation in patients with peripheral arterial disease. Ann Phys Rehabil Med 2011; 54:443-61. [DOI: 10.1016/j.rehab.2011.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 06/28/2011] [Accepted: 07/02/2011] [Indexed: 12/27/2022]
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Bosma J, Turkçan K, Assink J, Wisselink W, Vahl AC. Long-term quality of life and mobility after prosthetic above-the-knee bypass surgery. Ann Vasc Surg 2011; 26:225-32. [PMID: 21945332 DOI: 10.1016/j.avsg.2011.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 03/31/2011] [Accepted: 05/31/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Multiple studies have addressed above-the-knee femoral artery bypass grafting; however, information on late quality of life (QoL) and mobility is scarce. We studied long-term QoL and mobility after above-the-knee bypass surgery. METHODS Consecutive patients presenting with claudication, ischemic rest pain, or gangrene who received above-the-knee prosthetic bypass grafting between December 1997 and January 2003 were included in this observational study. Data used were recorded in a prospectively collected database of patients receiving Dacron and polytetrafluoroethylene (PTFE) supragenicular bypasses for lower limb ischemia. Primary outcomes were QoL and mobility, and secondary outcomes were patency and patient survival. QoL was measured with the EuroQol questionnaire (EQ-5D/EQ-VAS). Mobility was assessed with the Walking Impairment Questionnaire (WIQ) and analyzed in univariate and multivariate models. Patency and survival were computed with Cox regression. RESULTS One hundred forty patients were treated during the study period. Sixty-nine patients (50%) died during follow-up, leaving 71 survivors who were asked (63 [89%] complied) to complete the EQ-5D/EQ-VAS and WIQ questionnaires. None of the primary outcome parameters (WIQ, EQ-5D, EQ-VAS) were affected by primary bypass occlusion (p = 0.34, p = 0.44, and p = 0.27, respectively) or long-term patency (p = 0.07, p = 0.54, and p = 0.36, respectively). Male sex was significantly associated with a better outcome on all primary outcome parameters. Patients with Dacron versus PTFE grafts had WIQ scores of 0.49 and 0.26, respectively (p = 0.01). EQ-5D scores of patients with Dacron and PTFE were 0.576 and 0.409 (p = 0.08) and EQ-VAS scores were 61 and 54, respectively (p = 0.24). Graft type was not independently associated with occlusion, but runoff was. The 5-year and 10-year patient survival rates were 58% and 51%, respectively. CONCLUSIONS In this study, long-term QoL and mobility did not seem to be associated with bypass patency, as assessed in a single late follow-up. Revision of bypasses did not contribute to long-term QoL and walking ability. Therefore, the necessity of graft surveillance and subsequent revision and/or thrombectomy in case of synthetic bypass failure in absence of critical limb ischemia seems to be questionable.
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Affiliation(s)
- Jan Bosma
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
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13
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Mays RJ, Casserly IP, Kohrt WM, Ho PM, Hiatt WR, Nehler MR, Regensteiner JG. Assessment of functional status and quality of life in claudication. J Vasc Surg 2011; 53:1410-21. [PMID: 21334172 DOI: 10.1016/j.jvs.2010.11.092] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 11/05/2010] [Accepted: 11/08/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND Treadmill walking is commonly used to evaluate walking impairment and efficacy of treatment for intermittent claudication (IC) in clinical and research settings. Although this is an important measure, it does not provide information about how patients perceive the effects of their treatments on more global measures of health-related quality of life (HRQOL). METHODS PubMed/Medline was searched to find publications about the most commonly used questionnaires to assess functional status and/or general and disease-specific HRQOL in patients with peripheral artery disease (PAD) who experience IC. Inclusion criteria for questionnaires were based on existence of a body of literature in symptomatic PAD. RESULTS Six general questionnaires and seven disease-specific questionnaires are included, with details about the number of domains covered and how each tool is scored. The Medical Outcomes Study Short Form 36-item questionnaire and Walking Impairment Questionnaire are currently the most used general and disease-specific questionnaires at baseline and after treatment for IC, respectively. CONCLUSIONS The use of tools that assess functional status and HRQOL has importance in both the clinical and research areas to assess treatment efficacy from the patient's perspective. Therefore, assessing HRQOL in addition to treadmill-measured walking ability provides insight as to the effects of treatments on patient outcomes and may help guide therapy.
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Affiliation(s)
- Ryan J Mays
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
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14
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Nicolaï SP, Teijink JA, Prins MH. Multicenter randomized clinical trial of supervised exercise therapy with or without feedback versus walking advice for intermittent claudication. J Vasc Surg 2010; 52:348-55. [DOI: 10.1016/j.jvs.2010.02.022] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 02/01/2010] [Accepted: 02/07/2010] [Indexed: 10/19/2022]
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15
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Exercise-based interventions and health-related quality of life in intermittent claudication: a 20-year (1989–2008) review. ACTA ACUST UNITED AC 2010; 17:140-54. [DOI: 10.1097/hjr.0b013e3283377f08] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Lozano F. Calidad de vida relacionada con la cirugía vascular. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)06001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Câmara LC, Santarém JM, Wolosker N, Dias RMR. Exercícios resistidos terapêuticos para indivíduos com doença arterial obstrutiva periférica: evidências para a prescrição. J Vasc Bras 2007. [DOI: 10.1590/s1677-54492007000300008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A prática regular de exercícios é parte do tratamento clínico inicial para pacientes com doença arterial obstrutiva periférica. Nesse sentido, a utilização de exercícios contra resistência (exercícios resistidos) tem sido amplamente recomendada para diferentes populações, especialmente para pessoas idosas com e sem doenças associadas. Os poucos trabalhos encontrados utilizando essa forma de exercícios em pacientes com doença arterial obstrutiva periférica documentam a sua eficiência terapêutica. No entanto, os efeitos documentados dos exercícios resistidos em outras populações têm evidenciado melhoria da aptidão física e da qualidade de vida, com segurança cardiovascular e músculo-esquelética. Essas informações fornecem indicativos sobre os possíveis benefícios dos exercícios resistidos na terapia de indivíduos com doença arterial obstrutiva periférica. Nesse sentido, esta revisão objetivou apresentar informações científicas que permitam auxiliar a prescrição dos exercícios resistidos para essa população.
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Abstract
Improvement in quality of life is the ultimate goal of healthcare for the treatment of intermittent claudication. Until recently, the measures of success after therapy were those derived from the vascular laboratory, including ankle-brachial indices and ankle and toe pressures. There are now several validated and reliable survey tools that can assess patient-reported quality of life in a generic or disease-specific manner. Major survey instruments are reviewed. The information gathered through these quality-of-life assessment tools is important to all those involved in the care of patients with peripheral arterial disease. Although claudication is neither life- nor limb-threatening, it has a significant negative impact on quality of life, as measured by these instruments. Patients so afflicted report more bodily pain, worse physical function, and worse perceived health, in addition to limited walking ability. These measures of quality of life do not correlate with standard parameters of ankle-brachial index or ankle pressures. Treatment of the claudicant with exercise therapy and percutaneous or open revascularization also impacts quality of life. Each of these modalities is capable of improving quality of life, but some are associated with decline over time. The major benefits and risks to quality of life of these specific forms of treatment for the claudicant are reviewed. This data demonstrates that patients suffering from symptoms of intermittent claudication are best served by therapies that address their major self-reported impediments to quality of life.
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Affiliation(s)
- Sandra Spronk
- Vascular Laboratory, Ikazia Hospital, Rotterdam, The Netherlands, and Department of Surgery, University of Illinois College of Medicine, Chicago, USA.
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