Evaluation of patient compliance, quality of life impact and cost-effectiveness of a "test in-train out" exercise-based rehabilitation program for patients with intermittent claudication

BACKGROUND

Patients with intermittent claudication (IC) could benefit from low-cost, effective rehabilitative programs. This retrospective study evaluates compliance, impact on Quality of Life (QoL) and cost-effectiveness of a hospital prescribed, at-home performed (Test-in/Train-out) rehabilitative program for patients with IC.

METHODS AND RESULTS

Two-hundred and eighty-nine patients with IC (71 ± 10.1 years, M = 210) were enrolled for a 2-year period. Two daily 10-min home walking sessions at maximal asymptomatic speed were prescribed, with serial check-ups at the hospital. Compliance with the program was assessed by assigning a score of 1 (lowest compliance) to 4 (highest compliance). The SF-36 questionnaire and a constant-load treadmill test were used to evaluate QoL and Initial/Absolute Claudication Distance, respectively. Both direct and indirect costs of the program were considered for cost-effectiveness analysis. Two-hundred and fifty patients (70.5 ± 9.2 years, M = 191), at Fontaine's II-B stage (86%), were included in the study. No adverse events were reported. The average compliance score was 3.1. At discharge, both SF-36 domains and walking performance significantly increased (P < 0.0001). A total of 1,839 in-hospital check-ups (7.36 /patient) were performed. Direct and indirect costs represented 93% and 7% of the total costs, respectively. The average costs of a visit and of a therapy cycle were C68.93 and C507.20, respectively. The cost to walk an additional meter before stopping was C9.22.

CONCLUSIONS

A Test-in/Train-out program provided favourable patient compliance, QoL impact and cost-effectiveness in patients with IC.

Special needs to prescribe exercise intensity for scientific studies

There is clear evidence regarding the health benefits of physical activity. These benefits follow a dose-response relationship with a particular respect to exercise intensity. Guidelines for exercise testing and prescription have been established to provide optimal standards for exercise training. A wide range of intensities is used to prescribe exercise, but this approach is limited. Usually percentages of maximal oxygen uptake (VO₂) or heart rate (HR) are applied to set exercise training intensity but this approach yields substantially variable metabolic and cardiocirculatory responses. Heterogeneous acute responses and training effects are explained by the nonuniform heart rate performance curve during incremental exercise which significantly alters the calculations of %HR_max and %HRR target HR data. Similar limitations hold true for using %VO_2max and %VO₂R. The solution of these shortcomings is to strictly apply objective submaximal markers such as thresholds or turn points and to tailor exercise training within defined regions.

Update on peripheral arterial disease and claudication rehabilitation

The prevalence of peripheral arterial disease is high and will continue to grow with our aging population. It is often under diagnosed and under treated due to a general lack of awareness on the part of the patient and the practitioner. The evidence-base is growing for the optimal medical management of the patient with peripheral arterial disease; in parallel, endovascular revascularization options continue to improve. Exercise training for claudication rehabilitation plays a critical role. Comprehensive care of the peripheral arterial disease patient focuses on the ultimate goals of improving quality of life and reducing cardiovascular morbidity and mortality.

Patient-based outcomes using the Walking Impairment Questionnaire for patients with peripheral arterial occlusive disease treated with Lipo-PGE1

BACKGROUND

Patients with peripheral arterial occlusive disease (PAD) experience deteriorating ambulatory function and consequently impaired quality of life (QOL). QOL in patients receiving prostaglandin E(1) in lipid microspheres (lipo-PGE(1); Liple) for the treatment of PAD has not been evaluated using the Japanese version of the Walking Impairment Questionnaire (WIQ).

METHODS AND RESULTS

Data from 169 patients (98 men, 71 women; mean [median] age, 74+/-10 [74] years) with an ankle-brachial pressure index <0.9 were analyzed. WIQ scores and symptom scores significantly improved after lipo-PGE(1) treatment (P<0.01). Physicians' assessments of global improvement significantly correlated with all 4 WIQ subscales (R< or =0.31).

CONCLUSIONS

WIQ is a valid tool for evaluating therapeutic response in patients with PAD. Lipo-PGE(1) improves QOL as evaluated by patients themselves.