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Published on: December 11, 2013
The Circulation Foundation and Society of Vascular Nurses Joint Intermittent Claudication Study: An Observational
Matthew A Popplewell1, Ruth A Benson2, Alison Kite2
1University Hospitals of Coventry and Warwickshire, Coventry, UK; Black Country Vascular Network, New Cross Hospital, Wolverhampton, UK; Department of Applied Health Sciences, University of Birmingham, Birmingham, UK.
Insights
Supervised exercise therapy (SET) uptake remains low for intermittent claudication (IC) patients in the UK due to barriers like travel and preference for home therapy. Despite poor adherence, SET significantly improved walking distance and quality of life.
Area of Science:
- Vascular Medicine
- Rehabilitation Therapy
- Public Health
Background:
- Supervised exercise therapy (SET) is recommended for intermittent claudication (IC) but uptake and adherence in the UK are suboptimal.
- Geographical variations in SET provision and patient engagement exist across UK vascular centres.
Purpose of the Study:
- To assess barriers to SET uptake among patients with IC in the UK.
- To evaluate adherence and effectiveness of SET on walking distance and quality of life.
Main Methods:
- Prospective cohort study across four UK vascular centres (January 2018 - March 2020).
- Screened patients with IC, recorded SET uptake, barriers, and adherence.
- Assessed health-related quality of life (EQ-5D-5L, EQ VAS, VascuQoL) and walking distance at baseline, 3, and 12 months.
Main Results:
- Of 576 eligible patients, only 207 (35.9%) agreed to SET.
- Primary barriers included travel, personal reasons, and preference for home-based therapy.
- SET adherence was 43.9%; however, walking distance significantly improved (p < .001) and quality of life metrics showed sustained gains.
Conclusions:
- Significant barriers hinder access and completion of SET for UK patients with IC.
- Despite challenges, SET demonstrates effectiveness in improving functional capacity and quality of life.
- Addressing barriers like travel and promoting tailored therapy options is crucial for improving SET outcomes.
Objective:
Despite current guidance, the provision and uptake of supervised exercise therapy (SET) in the UK remains poor for patients with intermittent claudication (IC). The aims of this study were to record barriers to uptake and assess adherence and effectiveness of SET at four geographically different vascular centres in the UK.
Methods:
A prospective cohort study was performed, aiming to screen all patients referred to four separate UK vascular centres with IC between 1 January 2018 and 14 March 2020. Uptake and barriers to participation were recorded. In participants undertaking SET the impact on health related quality of life was examined in both generic (EQ 5D 5L, EQ VAS) and disease specific (VascuQoL) domains as well as walking distance at baseline, 3, and 12 months.
Results:
Screening data on 1 197 participants were returned from three of the four centres. Of these, 957 patients had a diagnosis of PAD (79.9%), of whom 576 were potentially eligible for SET. From these eligible patients, 207 agreed to SET (35.9%). The main barriers to participation were travel, personal reasons, and a preference toward home based therapy. Adherence to SET was poor ((2 003 of 4 560 sessions attended, 43.9%). Walking distance improved from a median of 130 m (interquartile range [IQR] 60, 200) at baseline to 290 m (IQR 130, 555) and 340 m (IQR 110, 485) at 3 and 12 months, respectively (p < .001). There were continued improvements in EQ 5D 5L at 3 and 12 months from baseline (p < .001).
Conclusion:
Many patients with IC in the UK still struggle to access and complete a course of SET despite best practice guidance, with over one third of SET eligible patients agreeing to participate in SET in the current study. Barriers to SET are numerous, with travel distance, personal reasons, and a preference for home based therapy being the most frequent.
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