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Quality of life in patients with intermittent claudication
H S Khaira1, R Hanger, C P Shearman
1Department of Vascular Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, U.K.
Insights
Intermittent claudication (IC) significantly impacts patients' quality of life, affecting energy, mobility, and emotional well-being. Further research is needed to compare treatments using quality of life measures alongside efficacy.
Area of Science:
- Vascular Medicine
- Health Economics
- Quality of Life Research
Background:
- Intermittent claudication (IC) management often involves conservative treatment due to infrequent progression to limb loss.
- Percutaneous transluminal angioplasty (PTA) is a newer intervention for IC, raising questions about its cost-effectiveness and resource implications.
- Objective medical criteria alone do not fully capture patient well-being, necessitating quality of life (QoL) assessments.
Purpose of the Study:
- To assess the impact of IC on patients' quality of life.
- To establish a basis for resource allocation by understanding the patient-centered outcomes of IC.
- To advocate for the inclusion of QoL measures in evaluating IC treatments.
Main Methods:
- The Nottingham Health Profile questionnaire was administered via post to patients with IC and age/sex-matched controls.
- A response rate of 70% was achieved in both groups.
- Exclusion criteria included recent intervention for claudicants and any leg pain on walking for controls.
Main Results:
- Claudicants reported significantly greater problems with energy, pain, emotional reactions, sleep, and physical mobility compared to controls (p < 0.05).
- The claudicant group showed a significantly higher positive response rate regarding problems with activities of daily living (0.05 > p > 0.02).
Conclusions:
- IC substantially diminishes patients' quality of life across multiple domains.
- Given the significant QoL impact and potential resource implications of new treatments like PTA, QoL measures are crucial for treatment evaluation.
- Further trials comparing IC treatments should incorporate QoL assessments alongside traditional efficacy and safety parameters.
Objective:
As intermittent claudication (IC) infrequently progresses to limb loss many clinicians adopt a conservative approach to treatment. Recently percutaneous transluminal angioplasty (PTA) has been applied to patients with IC. If this were to become the first line treatment for IC it would have major implications in terms of hospital facilities as well as cost. A measure is required, therefore, to decide on rationing of limited financial resources. "Quality of life" may be more influential in determining demand on services since objective medical criteria cannot give an insight into the patients feelings of well being.
Design:
We applied the Nottingham Health Profile, by post, to a group of claudicants and age/sex matched controls. 70% responded from both groups. Claudicants who had recently received intervention were excluded, as were controls complaining of any leg pains on walking.
Results:
The results showed that claudicants have greater perceived problems in the areas of energy, pain, emotional reactions, sleep, and physical mobility compared to controls (p < 0.05; Mann-Whitney Test). This was reflected by a significantly greater positive response rate to problems with activities of daily living (0.05 > p > 0.02; Chi-square Test) in the claudicant group.
Conclusion:
Because of the cost and resource implications of introducing measures such as PTA to the treatment of vast numbers of patients with IC, we suggest that trials are needed to compare various treatments using quality of life measurements in addition to traditional efficacy/safety parameters.