1
|
Yakut H, Karadibak D, Metin SK, Karabay DÖ, Gençpınar T. Predictors of walking capacity in patients with peripheral arterial disease. Wien Klin Wochenschr 2024; 136:94-100. [PMID: 36074178 DOI: 10.1007/s00508-022-02078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/02/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Walking capacity is severely impaired in patients with peripheral arterial disease (PAD). Given the prognostic importance of walking capacity, the level of evidence on possible predictors of walking capacity in patients with PAD is insufficient. AIMS To investigate the predictors of walking capacity in patients with PAD. METHODS A total of 51 patients with PAD were included in this cross-sectional study. Walking capacity was determined with 6‑minute walk test (6MWT) and walking impairment questionnaire (WIQ). Functional mobility was assessed with repeated sit-to-stand test (RSS) and timed up and go test (TUG). Hand-held dynamometer was used to measurement lower extremity muscle strength. Balance was assessed with Biodex Balance System-limit of stability (BBS-LOS). Fatigue was evaluated with fatigue impact scale (FIS). RESULTS There was a strong correlation between 6MWT walking distance and WIQ, two methods of assessing walking capacity (r = 0.835 p < 0.001). The 6MWT was correlated with RSS, TUG, lower extremity muscle strength, BBS-LOS and FIS. The WIQ was correlated with RSS, TUG, BBS-LOS and FIS. The RSS and FIS were independent determinants of the 6MWT and WIQ, accounting for 68% and 57% of the variance, respectively. CONCLUSION This study demonstrated that functional mobility and fatigue were independent predictors of walking capacity in patients with PAD. Both subjective and objective measurement methods can be used for determining the level of walking capacity in the patients with PAD.
Collapse
Affiliation(s)
- Hazal Yakut
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Eskişehir Osmangazi University, Eskişehir, Turkey.
| | - Didem Karadibak
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Sadık Kıvanç Metin
- Department of Cardiovascular Surgery, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Dündar Özalp Karabay
- Department of Cardiovascular Surgery, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Tuğra Gençpınar
- Department of Cardiovascular Surgery, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| |
Collapse
|
2
|
Bapat GM, Bashir AZ, Malcolm P, Johanning JM, Pipinos II, Myers SA. A biomechanical perspective on walking in patients with peripheral artery disease. Vasc Med 2023; 28:77-84. [PMID: 36759931 PMCID: PMC9997455 DOI: 10.1177/1358863x221146207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The most common symptom of peripheral artery disease (PAD) is intermittent claudication, which consists of debilitating leg pain during walking. In clinical settings, the presence of PAD is often noninvasively evaluated using the ankle-brachial index and imaging of the arterial supply. Furthermore, various questionnaires and functional tests are commonly used to measure the severity and negative effect of PAD on quality of life. However, these evaluations only provide information on vascular insufficiency and severity of the disease, but not regarding the complex mechanisms underlying walking impairments in patients with PAD. Biomechanical analyses using motion capture and ground reaction force measurements can provide insight into the underlying mechanisms to walking impairments in PAD. This review analyzes the application of biomechanics tools to identify gait impairments and their clinical implications on rehabilitation of patients with PAD. A total of 18 published journal articles focused on gait biomechanics in patients with PAD were studied. This narriative review shows that the gait of patients with PAD is impaired from the first steps that a patient takes and deteriorates further after the onset of claudication leg pain. These results point toward impaired muscle function across the ankle, knee, and hip joints during walking. Gait analysis helps understand the mechanisms operating in PAD and could also facilitate earlier diagnosis, better treatment, and slower progression of PAD.
Collapse
Affiliation(s)
- Ganesh M Bapat
- Department of Mechanical Engineering, BITS Pilani K K Birla Goa Campus, Goa, India
| | - Ayisha Z Bashir
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Philippe Malcolm
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Jason M Johanning
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, NE, USA
| | - Iraklis I Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, NE, USA
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA.,Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
3
|
Guilleron C, Abraham P, Beaune B, Pouliquen C, Henni S, Durand S. Location of ischemia and ischemic pain intensity affect spatiotemporal parameters and leg muscles activity during walking in patients with intermittent claudication. Sci Rep 2021; 11:6809. [PMID: 33762658 PMCID: PMC7990938 DOI: 10.1038/s41598-021-86351-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 03/07/2021] [Indexed: 12/31/2022] Open
Abstract
The ways in which locations of ischemia and ischemic pain affect spatiotemporal gait parameters and leg electromyographic activity during walking have never been investigated in patients with peripheral arterial disease presenting intermittent claudication. Two groups were classified according to unilateral location of ischemia (distal, n = 10, or proximo-distal, n = 12). Patients described pain and three gait phases-initial pain-free, onset of pain and maximum pain-were analyzed. Patients with proximo-distal ischemia walked less (230 ± 111 m vs 384 ± 220 m), with increased step length, step time (+ 5.4% and + 5.8%) and reduced cadence (- 8.2%), than patients with distal ischemia. In both, the peaks of vertical ground reaction force were reduced in maximum pain (Peak1-distal: - 11.4%, Peak1-proximo-distal: - 10.3%; Peak2-distal: - 11.8%, Peak2-proximo-distal: - 9.0%). In the proximo-distal group, tibialis anterior activation peak and time were lower than in the distal group (- 4.5% and - 19.7%). During the maximum pain phase, this peak decreased only in the proximo-distal group (- 13.0%), and gastrocnemius medialis activation peak and time decreased in both groups (- 2.5% in distal and - 4.5% in proximo-distal). Thus, proximo-distal ischemia leads to more adverse consequences in gait than distal ischemia only. Increasing ischemic pain until maximum, but not onset of pain, induced gait adaptations.
Collapse
Affiliation(s)
- Céline Guilleron
- Le Mans Université, Movement-Interactions-Performance, MIP, EA 4334, 72000, Le Mans, France.,UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France.,Department of Vascular Medicine, University Hospital of Angers, 4 rue Larrey, 49100, Angers, France
| | - Pierre Abraham
- Sports Medicine, University Hospital of Angers, 4 rue Larrey, 49100, Angers, France.,UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France
| | - Bruno Beaune
- Le Mans Université, Movement-Interactions-Performance, MIP, EA 4334, 72000, Le Mans, France
| | - Camille Pouliquen
- Le Mans Université, Movement-Interactions-Performance, MIP, EA 4334, 72000, Le Mans, France
| | - Samir Henni
- UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France.,Department of Vascular Medicine, University Hospital of Angers, 4 rue Larrey, 49100, Angers, France
| | - Sylvain Durand
- Le Mans Université, Movement-Interactions-Performance, MIP, EA 4334, 72000, Le Mans, France. .,Laboratory "Movement, Interactions, Performance", MIP, EA 4334, Le Mans University, Avenue Olivier Messiaen, 72085, Le Mans Cedex 9, France.
| |
Collapse
|
4
|
Guilleron C, Maktouf W, Beaune B, Henni S, Abraham P, Durand S. Coactivation pattern in leg muscles during treadmill walking in patients suffering from intermittent claudication. Gait Posture 2021; 84:245-253. [PMID: 33383535 DOI: 10.1016/j.gaitpost.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 10/26/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND In patients with peripheral arterial disease and presenting intermittent claudication (PAD-IC), the pain due to ischemia impacts gait parameters, particularly in cases of unilateral disease. Deterioration of gait parameters in a pathological context is frequently associated with increased coactivation (simultaneous activation of agonist and antagonist muscles around a joint). RESEARCH QUESTION Does unilateral PAD-IC affect the coactivation pattern during walking? Does the coactivation pattern change with increasing pain intensity? METHOD We evaluated symptomatic and asymptomatic legs in 17 subjects with unilateral PAD-IC and 16 without PAD-IC (control group), during walking. Tibialis anterior (TA) and gastrocnemius medialis (GM) electromyographic activity, and peaks of vertical ground reaction force were recorded in this prospective study. We analyzed the coactivation index (CI(GM/TA)) during three periods (pain-free, pain and maximum pain) and phases of the gait cycle. Statistical analysis was carried out using the ANOVA procedure. RESULTS During single support, CI(GM/TA) increases in the symptomatic leg during the pain period (+28 %) and in the asymptomatic leg during the maximum pain period (+29 %). During second double support, CI(GM/TA) increases in the symptomatic leg only (+49 %). In these gait phases, pain elicits differences in CI(GM/TA) between legs (p < 0.05). Second peak force decreases in the symptomatic leg only (-9%) and is negatively correlated with CI(GM/TA) during the three periods (r = -0.57; -0.76 and -0.78 respectively, p < 0.05). No difference is found in the control group. SIGNIFICANCE The appearance and development of pain in the lower limbs is associated with a higher level of CI(GM/TA), revealing a compensatory gait pattern in PAD-IC patients. Optimal prevention, rehabilitation and re-training strategies for PAD-IC patients should take into consideration neuromuscular compensatory mechanisms between asymptomatic and symptomatic legs.
Collapse
Affiliation(s)
- Céline Guilleron
- Le Mans Université, Movement - Interactions - Performance, MIP, EA 4334, F-72000, Le Mans, France; UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France; Department of Vascular Medicine, University Hospital of Angers, 4 rue Larrey, 49100 Angers, France
| | - Waël Maktouf
- Le Mans Université, Movement - Interactions - Performance, MIP, EA 4334, F-72000, Le Mans, France
| | - Bruno Beaune
- Le Mans Université, Movement - Interactions - Performance, MIP, EA 4334, F-72000, Le Mans, France
| | - Samir Henni
- UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France; Department of Vascular Medicine, University Hospital of Angers, 4 rue Larrey, 49100 Angers, France
| | - Pierre Abraham
- Sports Medicine, University Hospital of Angers, 4 rue Larrey, 49100, Angers, France; UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France
| | - Sylvain Durand
- Le Mans Université, Movement - Interactions - Performance, MIP, EA 4334, F-72000, Le Mans, France.
| |
Collapse
|
5
|
Guilleron C, Durand S, Maktouf W, Henni S, Abraham P, Beaune B. Rearfoot-forefoot profile defined by vertical ground reaction forces during gait is altered in patients with unilateral intermittent claudication. J Biomech 2020; 109:109966. [DOI: 10.1016/j.jbiomech.2020.109966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
|
6
|
Changes in Gait Variables in Patients with Intermittent Claudication. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7276865. [PMID: 31263707 PMCID: PMC6556794 DOI: 10.1155/2019/7276865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/29/2019] [Accepted: 05/19/2019] [Indexed: 11/22/2022]
Abstract
Objective Intermittent claudication (IC) is a pathological symptom with a particular effect on human gait patterns. Therefore, analyzing these patterns can facilitate rehabilitation or treatment through comparison of the values of kinematic and kinetic variables of patients with the normal values of healthy people. Therefore, the aim of this study was to find differences in the values of gait variables between patients with IC and healthy people. Methods The study included 98 patients diagnosed with peripheral arterial disease with IC. The patients traveled a distance of 6 m at a voluntary gait velocity. Ground reaction forces while the foot contacted the ground and kinematic variables of lower limb movements were recorded. The values of normal gait variables were computed based on the results obtained in a group of 30 healthy people. Results Patients used a gait velocity below the norm for healthy people. The velocity during the lower limb swing and the step and stride length in patients with IC were below the norm. Differences were also found in the ranges of motion between patients with IC and healthy people for the pelvic obliquity, pelvic rotation, hip flexion-extension, hip abduction-adduction, hip internal-external rotation, knee flexion-extension, ankle dorsi-plantar flexion, and foot progression angles. Conclusions The presented kinematic and kinetic characteristics measured by gait variables suggest differences between patients with IC and healthy people. Considering kinematic and kinetic gait variables during the rehabilitation process would facilitate the development of a more economic gait technique (with increased stride length and range of motion in the lower limb joints) to obtain the desired rehabilitation effects. Patients with IC should receive rehabilitation oriented towards improving mobility and increasing muscle strength in selected lower limb joints to increase gait velocity and stride length.
Collapse
|
7
|
Effects of Clustered Comorbid Conditions on Walking Capacity in Patients with Peripheral Artery Disease. Ann Vasc Surg 2014; 28:279-83. [DOI: 10.1016/j.avsg.2013.01.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 10/27/2012] [Accepted: 01/15/2013] [Indexed: 11/19/2022]
|
8
|
Farah BQ, Souza Barbosa JPDA, Cucato GG, Chehuen MDR, Gobbo LA, Wolosker N, Forjaz CLDM, Ritti-Dias RM. Predictors of walking capacity in peripheral arterial disease patients. Clinics (Sao Paulo) 2013; 68:537-41. [PMID: 23778336 PMCID: PMC3634952 DOI: 10.6061/clinics/2013(04)16] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 12/28/2012] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To estimate walking capacity in intermittent claudication patients through a prediction model based on clinical characteristics and the walking impairment questionnaire. METHODS The sample included 133 intermittent claudication patients of both genders aged between 30 and 80 years. Data regarding clinical characteristics, the walking impairment questionnaire and treadmill walking test performance were obtained. Multiple regression modeling was conducted to predict claudication onset distance and total walking distance using clinical characteristics (age, height, mass, body mass index, ankle brachial index lower, gender, history of smoking and co-morbid conditions) and walking impairment questionnaire responses. Comparisons of claudication onset distance and total walking distance measured during treadmill tests and estimated by a regression equation were performed using paired t-tests. RESULTS Co-morbid conditions (diabetes and coronary artery disease) and questions related to difficulty in walking short distances (walking indoors - such as around your house and walking 5 blocks) and at low speed (walking 1 block at average speed - usual pace) resulted in the development of new prediction models high significant for claudication onset distance and total walking distance (p<0.001). In addition, non-significant differences from the results obtained by the treadmill test and estimated by the current model (p>0.05) were observed. CONCLUSION The current study demonstrated that walking capacity can be adequately estimated based on co-morbid conditions and responses to the walking impairment questionnaire.
Collapse
|
9
|
King S, Vanicek N, Mockford KA, Coughlin PA. The effect of a 3-month supervised exercise programme on gait parameters of patients with peripheral arterial disease and intermittent claudication. Clin Biomech (Bristol, Avon) 2012; 27:845-51. [PMID: 22663776 DOI: 10.1016/j.clinbiomech.2012.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/09/2012] [Accepted: 05/09/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The management of peripheral arterial disease with intermittent claudication includes angioplasty, pharmaceutical therapy, risk factor modification and exercise therapy. Supervised exercise programmes are used sporadically but may improve the distance that an individual with claudication can walk. The purpose of this study was to evaluate the effectiveness of a 3-month supervised exercise programme on improving gait parameters in patients with intermittent claudication. METHODS 12 participants were recruited (mean (SD) - age: 67.3 (6.8) years, height: 1.67 (0.09) m, mass: 79.4 (14.0) kg, ankle brachial pressure index: 0.73 (0.17)) from the local vascular unit and enrolled in a supervised exercise programme. Kinematic and kinetic data were collected at the following time points: pain-free walking, initial claudication pain, absolute claudication pain and after a patient-defined rest period. Data were collected before and after the 3-month supervised exercise programme. FINDINGS No significant differences were found in any of the gait parameters post-intervention including pain-free walking speed (P=0.274), peak hip extension (P=0.125), peak ankle plantarflexion (P=0.254), or first vertical ground reaction force peak (P=0.654). No significant gait differences were found across different levels of pain pre- or post-intervention. INTERPRETATION The lack of improvement post-intervention observed suggests that the current exercise protocol was not tailored to elicit significant improvements in patients with intermittent claudication, specifically. The results indicate that exercise programmes may show improved results post-intervention if they are longer in duration and varied in intensity. Further research into more detailed muscle and biomechanical adaptations is needed to inform exercise programmes specific to this population.
Collapse
Affiliation(s)
- Stephanie King
- Department of Sport, Health & Exercise Science, University of Hull, UK
| | | | | | | |
Collapse
|
10
|
Mockford KA, Vanicek N, Jordan A, Chetter IC, Coughlin PA. Kinematic adaptations to ischemic pain in claudicants during continuous walking. Gait Posture 2010; 32:395-9. [PMID: 20678939 DOI: 10.1016/j.gaitpost.2010.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 06/24/2010] [Accepted: 06/26/2010] [Indexed: 02/02/2023]
Abstract
Intermittent claudication has been associated with impaired gait and balance. The study aim was to compare gait adaptations over time between claudicants classified with good versus poor balance. Kinematic data were collected from 24 claudicants during continuous walking. Balance was assessed using; Timed Up and Go test (TUG), and Sensory Organisation (SOT) and Motor Control (MCT) Tests using NeuroCom Equitest®. 'Good balance' (GB) was operationally defined as those claudicants achieving normal scores on at least 2 of 3 tests whereas 'poor balance' (PB) claudicants achieved normal scores on 0 or 1 test. Temporal-spatial and sagittal plane joint kinematics were analysed at three time intervals; 'no pain' (prior to onset), 'initial pain' and 'maximal pain' (unable to continue walking). A two-way mixed design ANOVA was performed. Claudicants demonstrated a significant decrease in walking speed, step frequency and increased time in double support (p<0.05). Inter-group analysis showed no differences between GB and PB on any temporal-spatial or kinematic parameters (p>0.05). There was no significant time and group interaction for any temporal-spatial or kinematic variable except hip flexion. GB claudicants demonstrated increased hip flexion as pain progressed but this adaptive strategy was not seen in PB claudicants. Claudicants make adaptations to walking by slowing (down) when in pain. Differences between GB and PB were not seen in temporal-spatial or ankle, knee and pelvic kinematic gait parameters. However adaptation to pain in GB claudicants involved a hip strategy, not seen in PB claudicants.
Collapse
Affiliation(s)
- Katherine A Mockford
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull & East Yorkshire NHS Trust, UK
| | | | | | | | | |
Collapse
|
11
|
Huisinga JM, Pipinos II, Johanning JM, Stergiou N. The effect of pharmacological treatment on gait biomechanics in peripheral arterial disease patients. J Neuroeng Rehabil 2010; 7:25. [PMID: 20529284 PMCID: PMC2892501 DOI: 10.1186/1743-0003-7-25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 06/07/2010] [Indexed: 11/26/2022] Open
Abstract
Background Pharmacological treatment has been advocated as a first line therapy for Peripheral Arterial Disease (PAD) patients suffering from intermittent claudication. Previous studies document the ability of pharmacological treatment to increase walking distances. However, the effect of pharmacological treatment on gait biomechanics in PAD patients has not been objectively evaluated as is common with other gait abnormalities. Methods Sixteen patients were prescribed an FDA approved drug (Pentoxifylline or Cilostazol) for the treatment of symptomatic PAD. Patients underwent baseline gait testing prior to medication use which consisted of acquisition of ground reaction forces and kinematics while walking in a pain free state. After three months of treatment, patients underwent repeat gait testing. Results Patients with symptomatic PAD had significant gait abnormalities at baseline during pain free walking as compared to healthy controls. However, pharmacological treatment did not produce any identifiable alterations on the biomechanics of gait of the PAD patients as revealed by the statistical comparisons performed between pre and post-treatment and between post-treatment and the healthy controls. Conclusions Pharmacological treatment did not result in statistically significant improvements in the gait biomechanics of patients with symptomatic PAD. Future studies will need to further explore different cohorts of patients that have shown to improve significantly their claudication distances and/or their muscle fiber morphology with the use of pharmacological treatment and determine if this is associated with an improvement in gait biomechanics. Using these methods we may distinguish the patients who benefit from pharmacotherapy and those who do not.
Collapse
Affiliation(s)
- Jessie M Huisinga
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, 6001 Dodge Street Omaha, NE, 68182, USA
| | | | | | | |
Collapse
|
12
|
Wolosker N. Hiper-homocisteinemia associada ao aumento no risco de doença vascular obstrutiva periférica: verdade ou mito? J Vasc Bras 2009. [DOI: 10.1590/s1677-54492009000400002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
13
|
Grams ST, Damiano AP, Monte FG, Mandelli MB, Carvalho TD. Marcha de pacientes com doença arterial obstrutiva periférica e claudicação intermitente. REV BRAS MED ESPORTE 2009. [DOI: 10.1590/s1517-86922009000500004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Pacientes com doença arterial obstrutiva periférica (DAOP) e claudicação intermitente (CI) apresentam prejuízo no desempenho de caminhada e alterações nos parâmetros espaço-temporais da marcha, mesmo na ausência de dor. OBJETIVO: Analisar os parâmetros espaço-temporais da marcha de pacientes com DAOP e CI participantes de programa de reabilitação. MÉTODOS: A amostra foi constituída por 12 pacientes com DAOP e CI, sendo 75% do sexo masculino e idade média de 63,3 ± 8,6 anos. Todos os pacientes participavam de programa de reabilitação e apresentavam melhora no desempenho de caminhada após os tratamentos; sete foram avaliados em longo prazo (de seis a 24 meses) e cinco em curto prazo (dois meses). Velocidade, comprimento da passada e cadência foram analisados antes e logo após o início da claudicação em pista de 6m de papel. A claudicação foi induzida por meio de caminhada em esteira ergométrica. As avaliações foram realizadas ao final dos tratamentos e analisadas inter e intragrupos. RESULTADOS: Velocidade de marcha (1,06m/s ± 0,29 vs 1,10m/s ± 0,06), comprimento da passada (1,34m ± 0,27 vs 1,33m ± 0,11) e cadência (93,81 passos/min ± 7,20 vs 99,84 passos/min ± 8,99) foram similares entre os grupos tratados em curto e em longo prazos (p > 0,05). Na avaliação intragrupos, ocorreu diminuição significativa no comprimento da passada dos pacientes tratados em curto prazo após a indução da claudicação (1,34m ± 0,27 vs 1,09m ± 0,03), com p = 0,05. CONCLUSÃO: Não ocorreram diferenças significativas nos parâmetros espaço-temporais da marcha entre os grupos. As características da marcha persistem, inclusive na ausência da dor e com a melhora do desempenho de caminhada, em pacientes participantes de programa de reabilitação.
Collapse
|
14
|
Scott-Pandorf MM, Stergiou N, Johanning JM, Robinson L, Lynch TG, Pipinos II. Peripheral arterial disease affects ground reaction forces during walking. J Vasc Surg 2007; 46:491-9. [PMID: 17826236 DOI: 10.1016/j.jvs.2007.05.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2007] [Accepted: 05/02/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Claudication is the most common manifestation of peripheral arterial disease (PAD), producing significant ambulatory compromise. The gait of claudicating patients has been evaluated using primarily temporal and spatial parameters. With the present study, we used advanced biomechanical measures to further delineate the ambulatory impairment of claudicating patients. We hypothesized that the claudicating legs of PAD patients have an altered kinetic gait pattern compared with normal legs from control subjects. METHODS Ambulation kinetics (ground reaction forces) were evaluated in claudicating patients and compared with age-matched healthy controls. Forces were analyzed in the vertical, anterior-posterior, and medial-lateral directions. Time from heel touch-down to toe-off (stance time) and time spent in double-limb support were also evaluated. RESULTS The study recruited 14 PAD patients (age, 58 +/- 3.4 years; weight, 80.99 +/- 15.64 kg) with femoropopliteal occlusive disease (ankle-brachial index [ABI], 0.56 +/- 0.03) and five controls (age, 53 +/- 3.4 years; weight, 87.38 +/- 12.75 kg; ABI, >or=1.00). Vertical force curve evaluation demonstrated significant flattening in claudicating patients resulting in a lower and less fluctuant center of mass when ambulating. In the anterior-posterior direction, claudicating patients demonstrated significantly decreased propulsion forces. In the medial-lateral direction, they had significantly increased forces consistent with wider steps and an inability to swing their legs straight through. Claudicating patients demonstrated a greater stance time and time in double limb support compared with healthy controls. Most importantly, gait abnormalities were present before the onset of claudication, with gait worsening after the onset of claudication. CONCLUSION Claudicating patients demonstrate significant gait impairments that are present even before they experience any limb discomfort. These alterations may make them feel more stable and secure while attempting to minimize use of the affected limb. Advanced biomechanical analysis, using ambulation kinetics, permits objective and quantitative evaluation of the gaits of claudicating patients. Such evaluation may point to new rehabilitation strategies and provide objective measurement of functional outcomes after medical and surgical therapy.
Collapse
|
15
|
Rosoky RMA, Wolosker N, Puech-Leão P. Performance of patients with intermittent claudication undergoing physical training, with or without an aggravation of arterial disease: retrospective cohort study. Clinics (Sao Paulo) 2006; 61:535-8. [PMID: 17187089 DOI: 10.1590/s1807-59322006000600008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Accepted: 07/18/2006] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This was a retrospective cohort study aiming to investigate the clinical outcome of patients with intermittent claudication undergoing physical training in whom there was an aggravation of the arterial disease. METHOD Three hundred and sixty-four patients with claudication who presented with femoropopliteal or tibioperoneal obstructions in at least 1 of the lower limbs and who did not have aortic or bilateral iliac obstructions were included. Forty patients developed new stenoses in previously spared arterial segments (confirmed by duplex scanning), which were proximal to preexisting lesions, and formed the progression group, in contrast to the stable group of patients (n = 324) who did not exhibit this worsening of the disease. Follow-up was 276 and 277 days for stable and progression groups, respectively. All patients underwent an unsupervised program of submaximal walking 4 days a week. Changes in maximal walking distance at a progressive treadmill test were appraised during follow-up, with special interest directed to the periods between admission, diagnosis of arterial worsening, and the end of follow-up. RESULTS Performance was not significantly different between groups during the entire follow-up period. Furthermore, patients with claudication who evolved with progression of their arteriopathy did not present a reduction of their maximal walking distance in response to the development of new arterial lesions at any time during their follow-up. CONCLUSION Worsening of the peripheral arterial disease in patients with claudication undergoing physical training, manifested as de novo arterial occlusion in proximal and previously spared segments, does not imply in an impairment of their claudication distance.
Collapse
Affiliation(s)
- Ruben M A Rosoky
- Vascular Surgery Division, São Paulo University Medical School, São Paulo, SP, Brazil.
| | | | | |
Collapse
|
16
|
Rosoky R, Wolosker N. Regarding ‘Life-style Modification in Peripheral Arterial Disease’. Eur J Vasc Endovasc Surg 2005; 29:654; author reply 655. [PMID: 15878546 DOI: 10.1016/j.ejvs.2005.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Accepted: 02/16/2005] [Indexed: 10/25/2022]
|