PICO
Patient/Population
Newly diagnosed Intermittent Claudication (IC) using clinical assessment and ankle brachial index; age > 18 years.
(n=118)
Intervention
- Usual care
- Courses in smoking and diet
- Supervised exercise training
- Pedometer and logbook for self-report walking behavior and steps
Comparison
- Usual care
Outcomes
Maximum walking distance
Pain free walking distance
Daily physical activity
- Diet
Translatability: (3/3) Easy
Comments: specialized community-based cardiac rehabilitation program for patients with IC showed statistically and clinically significant effects on maximum walking distance, physical activity, quality of life, and healthy diet, but not on pain free walking distance and smoking, compared with usual care without rehabilitation.
Limitations: about one third of potentially eligible patients were randomized and this may represent bias.
Appraisals:
PEDro Scale – (7/10) Blind subjects: No; Blind therapists: No;Adequate follow-up: No. (by PEDro – confirmed)
Trustworthiness – The study contains 2 weaknesses (the control group may not be similar to the intervention group; more than 20% of the subjects drop out). Based on this result you should conclude that the trustworthiness of the study is moderated (80%). This means there is a 20% chance that alternative explanations for the effect found are possible. The effect size was medium and 95% CI was OK. (by CAT)
BTB
Intervention – 1
- Usal care
Dose
- One intervention
Periodicity
- —
Local/Technic:
Standard procedure for patients treated for IC (European Society for Vascular Surgery) and received the department of vascular surgery’s usual, brief advice about walking exercise and smoking cessation, and were given preventive medical treatment with antiplatelet therapy and statins. The patients received written information about medication, walking exercise, and a logbook for self-reporting walking behavior.
Intervention – 2
- Courses in smoking + diet
Dose
- 2h+2h
Periodicity
- 1 + 1
Local/Technic:
Group course (spouses were invited) about the pathophysiology of IC, medications, health behavior, and disease management. Group sessions and the individual consultation were performed by an experienced nurse with specific knowledge of IC, based on guidelines. A clinical dietician ran a group session bout healthy diet and atherosclerosis and offered individual consultations.
Intervention – 3
- Supervised exercise training
Dose
- at least 30 min/day
Periodicity
- 2 times a week for 12 weeks.
Local/Technic:
Patients were required to actively engage in groups of up to 10 patients. The exercises, with a primary focus on the leg muscles, (in accordance to guidelines) included varied forms of physical exercise combined to accommodate the patients’ own goals regarding walking distance. To increase or sustain daily physical exercise at a level of at least 30 min/day, pedometer and self-reported walking behavior were included in the discussions with patients at their individual consultations.
Citation:
Siercke M et al., Cardiovascular Rehabilitation Increases Walking Distance in Patients With Intermittent Claudication. Results of the CIPIC Rehab Study: A Randomised Controlled Trial, European Journal of Vascular and Endovascular Surgery, https://doi.org/10.1016/j.ejvs.2021.04.004