Web-based lifestyle application as support for secondary prevention in patients with intermittent claudication

Background: Patients with intermittent claudication (IC) need lifelong treatment with secondary prevention, including smoking cessation, physical activity, and best medical treatment. The deficiency in existing support indicates a need for new strategies to improve self-management of the disease. However, knowledge of electronic health (e-health) as support for these patients is lacking. The primary aim was to evaluate the effect on secondary prevention outcomes and the usability of a web-based application for patients with IC. The secondary aim was to describe the patients' experiences of using a web-based application. Patients and methods: Patients with IC (n=34) were recruited from a vascular outpatient clinic to a randomized controlled pilot trial. The study population had a mean age of 73 years and 52.9% were women. For three months, the intervention group (n=18) reported information through/via the application about physical activity, smoking, medication therapy, blood pressure, pain after activity, and quality of life (QoL). Primary outcome was walking distance, and the secondary outcome included ankle brachial index (ABI), blood pressure measurements, lifestyle factors, health education, and QoL. A linear mixed model was used to determine how the intervention affected the progression of walking distance, ABI, blood pressure measurements and BMI and Wilcoxon signed ranked test for QoL. After completing the study, the intervention group was interviewed in focus groups. Results: The reporting adherence was high (86-93%). QoL were improved in the intervention group (p=.049), and the level of insight into their condition increased in both intervention- (p=.016) and control group (p=.014). No significant differences in variables walking distance, ABI, blood pressure or BMI were observed between the groups. The interviews show an overall positive experience of using the application. Some patients experienced that the application increased their motivation to adhere to lifestyle recommendations. Conclusions: High reporting adherence and improved QoL, together with the participants experiences, indicate that using e-health may support adherence to secondary prevention in patients with IC but needs to be further studied in a full-scale randomized controlled trial.