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ABSTRACT: Eine der klinischen Manifestationen der peripheren arteriellen Verschlusskrankheit (PAVK) ist die Claudicatio intermittens,
wobei nur eine begrenzte Gehstrecke aufgrund belastungsabhängiger Krämpfe bewältigt werden kann. Die konservative Standardtherapie
ist das Lauftraining (LT). Untersuchungen ergaben, dass durch LT mit Supervision (SLT) eine signifikante Verlängerung der
Gehstrecke erreicht wird im Vergleich mit nicht supervisiertem LT. Weil es in unserem Krankenhaus, Atrium MC Heerlen, logistische
Probleme gab, SLT allen Claudicatio-Patienten anzubieten, haben wir ein Netzwerk gegründet, sodass Patienten im ambulanten
Setting und in patientennaher Umgebung trainieren können: das Netzwerk Lauftherapie Parkstad (NLTP). NLTP beinhaltet SLT für
Patienten mit PAVK, durchgeführt von speziell hierfür ausgebildeten Physiotherapeuten in deren Praxen. Die 1-Jahres-Resultate
zeigen, dass ambulantes SLT ebenso effektiv ist wie SLT im Krankenhaus.
Patients with peripheral arterial disease (PAD) often experience intermittent claudication: muscle aching or cramp during
walking. The main conservative treatment, which has also proven to be effective, is exercise therapy (ET). Research shows
that supervised exercise therapy (SET) results in a significant improvement in walking distance compared with non-supervised
ET. Because we experienced some logistical problems at our hospital (Atrium MC Heerlen) providing all patients with SET, we
established a network whereby patients can exercise on an outpatient basis close to their home address: Network Exercise Therapy
Parkstad (NETP). NETP provides PAD patients with SET by specially qualified physiotherapists in their practices. The 1-year
results show that outpatient SET for intermittent claudication is as effective as clinic-based therapy.
Der Kardiologe 04/2012; 3(4):333-338.
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ABSTRACT: OBJECTIVE: To investigate whether supervised exercise therapy (SET) with or without daily feedback via an accelerometer is more effective than verbal advice only for improving walking distance and quality of life in patients with intermittent claudication during a 1-year period. DESIGN: Randomised clinical multicentre trial (www.clinicaltrials.gov; NCT00279994). METHOD: Patients with intermittent claudication and eligible for exercise therapy were randomised to one of three groups: verbal advice, SET, or SET with feedback via an accelerometer. SET was provided by a local physiotherapist. The primary outcome measure was the change in maximal walking distance. Secondary outcome measures were the change in functional walking distance and results of the Walking Impairment Questionnaire (WIQ) and Short-Form 36 (SF-36) Health Survey. RESULTS: In total 102, 109, and 93 patients in 11 Dutch hospitals were included in the verbal advice group, the SET group, and the SET group with feedback, respectively. Data for 83, 93, and 76 patients, respectively, were available for analysis; data from both SET groups were analysed together. The median (interquartile range) change in walking distance from baseline to 12 months was 110 m (0-300) in the verbal advice group and 350 m (152-810) in the SET groups (p < 0.001). WIQ scores and relevant domains of the SF-36 improved significantly in the SET groups. CONCLUSION: SET provided by local physiotherapists was more effective than verbal advice in improving walking distance, WIQ scores, and quality of life for patients with intermittent claudication.
Nederlands tijdschrift voor geneeskunde 01/2011; 155(2):A2643.
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ABSTRACT: The Exercise Therapy in Peripheral Arterial Disease (EXITPAD) study has shown supervised exercise therapy (SET) to be more effective regarding walking distance and quality of life than a 'go home and walk' advice (WA) for patients with intermittent claudication. The present study aims to assess the cost-effectiveness of SET versus WA.
Data from the EXITPAD study, a 12-month randomised controlled trial in 304 patients with claudication, was used to study the proportion of costs to walking distance and quality of life. Two different incremental cost-effectiveness ratios (ICERs) were calculated for SET versus WA: costs per extra metre on the treadmill test, and costs per quality-adjusted life year (QALY). QALYs were based on utilities derived from the EuroQoL-5 dimensions (EQ-5D).
Mean total costs were higher for SET than for WA (3407 versus 2304 Euros), mainly caused by the costs of exercise therapy. The median walking distance was 620 m for SET and 400 m for WA. QALYs were 0.71 for SET and 0.67 for WA. All differences were statistically significant. The ICER for cost per extra metre on the 12-month treadmill test was € 4.08. For cost per QALY, the ICER was € 28,693.
At a willingness-to-pay threshold of € 40,000 per QALY, SET likely is a cost-effective therapeutic option for patients with claudication.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 01/2011; 41(1):97-103. · 2.92 Impact Factor
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ABSTRACT: To assess the need to wear compression stockings for 4 weeks after inversion stripping of the great saphenous vein (GSV) from the groin to the level of the knee.
Randomised controlled trial.
A total of 104 consecutive patients with primary complete incompetence of the GSV treated by inversion stripping of the GSV.
Postoperatively treated limbs underwent elastic bandaging for 3 days. Volunteers were randomised to wear a compression stocking for additional 4 weeks (intervention group) or no compression stocking (control group). The primary outcome was limb oedema as assessed by photoelectric leg volume measurement. Secondary outcome measures were pain scores, postoperative complications and return to full work.
The control leg volume was 3657ml (standard deviation, SD 687) preoperatively and 3640ml (SD 540) 4 weeks postoperatively (non significant, N.S.). The stocking leg volume was 3629ml (SD 540) preoperatively, falling to 3534ml (SD 543) (P<0.01) 4 weeks postoperatively. The difference in leg volume between both the groups was not statistically significant. Patients in the control group resumed work earlier (control 11 days, stocking 15 days, P=0.02, Mann-Whitney test). No difference was observed in the number and type of complication and in pain scores during the 4-week follow-up period.
Wearing an elastic compression stocking has no additional benefit following elastic bandaging for 3 days in postoperative care after stripping of the great saphenous vein as assessed by control of limb oedema, pain, complications and return to work.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 07/2009; 38(3):387-91. · 2.92 Impact Factor
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ABSTRACT: To identify predictor variables for results after supervised exercise therapy (SET), and to develop a clinical prediction model that aims to predict a target walking distance for individual patients.
Retrospective analyses on prospectively collected data.
Patients with intermittent claudication who participated in a SET programme.
SET was conducted according to the guidelines of the Royal Dutch Society for Physiotherapy. The main outcome measurement was the absolute claudication distance (ACD) after 6 months of SET. Linear regression analyses were conducted to identify independent predictor variables for ACD.
In this cohort, 437 patients were analysed. Independent predictor variables for post-treatment ACD were baseline ACD (P<0.001), smoking behaviour (P=0.012) and body-mass index (P=0.041). A better baseline ACD was associated with a longer post-treatment ACD whereas current smoking and a higher body-mass index were associated with a shorter post-treatment ACD. The final regression equation included baseline ACD, age, body-mass index, smoking and pulmonary disease, and was translated into several clinical prediction models. However, only 24.8-33.6% of the patients had an ACD within the calculated target range.
Predictive variables for post-treatment ACD after SET are baseline ACD, age, body-mass index, pulmonary disease and smoking behaviour. However, translating the regression equation into a clinical prediction model did not lead to a valid model for use in clinical practice.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 06/2009; 38(4):449-55. · 2.92 Impact Factor
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ABSTRACT: The prevalence of obesity is rising. Because obesity is positively associated with many health related risks and negatively associated with life expectancy this is a threat to public health. Physical exercise is a well known method to lose fat mass. Due to shame of their appearance, bad general condition and social isolation, starting and continuing physical exercise tends to be problematic for obese adults. A supervised training program could be useful to overcome such negative factors. In this study we hypothesized that offering a supervised exercise program for obese adults would lead to greater benefits in body fat and total body mass reduction than a non-specific oral advice to increase their physical activity.
Thirty-four participants were randomised to a supervised exercise program group (N.=17) and a control group (N.=17). Fifteen candidates in the intervention group and 12 in the control group appeared for baseline measurements and bought an all inclusive sports pass to a health club for Euro 10, per month. The control group just received the oral advice to increase their physical activity at their convenience. The supervised exercise group received biweekly exercise sessions of 2 hours with an estimated energy expenditure of 2 500 kJ per hour. Both groups received no dietary advice.
After 4 months the overall decrease in body mass in the intervention group was 8.0 kg (SD 6.2) and the decrease in body fat was 6.2 kg (SD 4.5). The control group lost 2.8 kg overall (SD 4.2) and the decrease in body fat was 1.7 kg (SD 3.1). Correction for differences between groups in gender and age by multiple linear regression analysis showed significantly greater loss of total body mass (P = 0.001) and fat mass (P =0.002) in the intervention group compared with the control group.
Stimulation of physical activity alone seems to result in a slight short term body mass and fat mass reduction in obese adults who are eager to lose weight. Supervised exercise under supervision of a qualified fitness instructor leads to a larger decrease.
The Journal of sports medicine and physical fitness 04/2009; 49(1):85-90. · 0.85 Impact Factor
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ABSTRACT: The Walking Impairment Questionnaire (WIQ) is a frequently used questionnaire to evaluate patients with intermittent claudication (IC). The aim of this study is to validate the Dutch WIQ for the European situation using the metric system.
Validation study.
After translation and cultural adaptation of the WIQ, 130 patients with IC completed the Dutch WIQ, the RAND-36, and the EuroQol questionnaire. Walking distances were determined by treadmill testing.
Correlations between the WIQ, the two quality of life questionnaires, and walking distances were calculated to determine validity. Reliability and internal consistency were determined using the intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively.
Significant correlations were found between the WIQ and the absolute claudication distance (ACD) (0.52), EuroQol (0.33) and seven domains of the RAND-36. Test-retest reliability expressed by the ICC was 0.89. The internal consistency determined by Cronbach's alpha was 0.92 for the total WIQ score. Furthermore, a lower WIQ score corresponds to a shorter ACD.
This study shows that the Dutch version of the WIQ using the European metric system is a valid, reliable and clinically relevant instrument for assessing walking impairment in patients with intermittent claudication.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 12/2008; 37(1):56-61. · 2.92 Impact Factor
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ABSTRACT: Although exercise therapy is considered to be of significant benefit to people with intermittent claudication, almost half of those affected do not undertake any exercise therapy. The purpose of this review is to evaluate the effects of supervised exercise therapy (SET) for people with intermittent claudication.
SET will be compared with non-supervised exercise therapy programs and the superiority of SET will be demonstrated. The development and implementation of a new community-based concept of SET will be addressed, whereas the first results of this new concept will be presented and compared with the results of SET programs provided in clinical settings, as described in literature.
SET programs have significant benefits compared with non-supervised programs. Community-based SET has both economic and logistic advantages over clinic-based SET. Furthermore, community-based SET programs seems to be as effective as SET provided in a clinic-based setting and is a promising approach to providing conservative treatment for patients with intermittent claudication.
SET in a community-based setting should ideally be the initial standard of care for patients with intermittent claudication. However, a study of the cost-effectiveness should be awaited.
Acta chirurgica Belgica 107(6):616-22. · 0.43 Impact Factor
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ABSTRACT: Background The reference standard for diagnosing peripheral arterial disease in primary care is the ankle brachial index (ABI). Various methods to measure ankle and brachial blood pressures and to calculate the index are described. Aim To compare the ABI measurements performed in primary care with those performed in the vascular laboratory. Furthermore, an inventory was made of methods used to determine the ABI in primary care. Design of study Cross-sectional study. Setting Primary care practice and outpatient clinic. Method Consecutive patients suspected of peripheral arterial disease based on ABI assessment in primary care practices were included. The ABI measurements were repeated in the vascular laboratory. Referring GPs were interviewed about method of measurement and calculation of the index. From each patient the leg with the lower ABI was used for analysis. Results Ninety-nine patients of 45 primary care practices with a mean ABI of 0.80 (standard deviation [SD] = 0.27) were included. The mean ABI as measured in the vascular laboratory was 0.82 (SD = 0.26). A Bland–Altman plot demonstrated great variability between ABI measurements in primary care practice and the vascular laboratory. Both method of blood pressure measurements and method of calculating the ABI differed greatly between primary care practices. Conclusion This study demonstrates that the ABI is often not correctly determined in primary care practice. This phenomenon seems to be due to inaccurate methods for both blood pressure measurements and calculation of the index. A guideline for determining the ABI with a hand-held Doppler, and a training programme seem necessary.
