National survey of current practice and opinions on rehabilitation for intermittent claudication in the Danish Public Healthcare System

Supervised exercise-based rehabilitation for people with intermittent claudication-Study protocol for a Danish implementation process (StRiDE)

INTRODUCTION

Intermittent claudication is a peripheral artery disease caused by arteriosclerosis. People with intermittent claudication experience leg cramping during walking, with relief of symptoms during rest. Evidence shows that by participating in supervised exercise therapy and smoking cessation programs, people with intermittent claudication can reduce those symptoms and improve health-related quality of life and maximal walking distance while minimizing the need for an operation. However, implementation of such health-promoting initiatives in clinical practice in Denmark and other countries is limited. This is a protocol presenting the implementation process of supervised exercise therapy and smoking cessation in a region of Denmark.

METHODS AND ANALYSIS

The implementation process is a collaboration between the municipalities in the Region of Zealand and the Department of Vascular Surgery at University Hospital Zealand. The study uses a convergent mixed-methods prospective clinical cohort design, and the theoretical frame of this implementation process follows the framework for Adapting an existing intervention to a new context (ADAPT). The process involves stakeholder engagement, ongoing evaluation through key performance indicators and relevant outcomes that will inform the implementation process across and within each municipality.

DISSEMINATION

Dissemination will happen throughout the process through continued meetings with stakeholders and dissemination of performance indicators and outcome results obtained through a database. All information about the study and material will be freely available. The project is registred on Clinicalgov (NCT06299956).

Primärtherapie der Claudicatio intermittens – Anspruch und Wirklichkeit

Die narrative Übersichtsarbeit fasst die Studienlage zum Thema Gehtraining bei Patienten mit Claudicatio intermittens (CI) zusammen. Eindringlich wird auf die evidenzbasierten Leitlinienempfehlungen und die dahinterstehenden Studien eingegangen. Aspekte zum angiomorphologischen Befund, zu Patientenadhärenz, Langzeitwirkung, Studienqualität und ihre Vergleichbarkeit werden diskutiert. Der Problematik in der Versorgungsrealität mit Abweichungen von den Leitlinien und der oftmals invasiven Erstlinientherapie des PAVK-IIb-Patienten werden besondere Bedeutung geschenkt. Dabei wird die Rolle des Rehasports und die gesundheitspolititsche Bedeutung von Gehtraining in Deutschland erörtert. Gründe für die fehlende Leitlinientreue und deren Umsetzung im Gesundheitssystem werden analysiert. Dementsprechend werden Handlungsempfehlungen, in Anlehnung an internationale Erfahrungen (Niederlande, Dänemark), zur Besserung der Situation in Deutschland formuliert.

Life-style counseling program and supervised exercise improves walking distance and quality of life in patients with intermittent claudication

INTRODUCTION

There are many barriers for patients with intermittent claudication (IC) to complete and maintain the supervised exercise therapy (SET) programs. SET combined with life-style counseling was, therefore, investigated.

OBJECTIVE

This study aimed to report the experience of a single center where SET and life-style counseling targeting the modification of risk factors to treat IC, improved walking distance and quality of life.

METHODS

Thirty-five patients out of 62 referred patients with IC completed the full program of 12 weeks SET and 12 weeks self-training combined with counseling focusing in modifying the risk factors. The pain free walking distance (PFWD) and maximum walking distance (MWD) were measured as primary outcomes. Vascular Quality of Life Questionnaire 6 (VascuQoL-6) and 6-min walk test (6-MWT) were measured as secondary outcomes. Analysis of variance and last value carried forward method was used to compare the outcomes.

RESULTS

Fifteen females and 20 males with mean age of 71.5 years completed the program. PFWD and MWD increased by 116% (P < .001) and 120% (P < .001), respectively, at 24 weeks follow-up. Similarly, there was 14% increase in 6-MWT and VascuQoL-6 overall score increased from 13.1 to 15.9 at 24 week follow-up (P < .001).

CONCLUSION

SET along with life-style counseling can be considered as a package in the treatment of patients with IC.