Research Report Abstracts - Gesundheit

eS402
Research Report Poster Display
Number: RR-PO-202-15-Wed Wednesday 22 June 12:00
RAI: Exhibit Halls 2&3
PREDICTORS OF WALKING DISTANCE AFTER
SUPERVISED EXERCISE THERAPY IN PATIENTS
WITH INTERMITTENT CLAUDICATION
Gerardu V. 1 , Lauret G.-J. 1 , Kruidenier L. 2 , Nicolaï S. 3 ,
Hendriks E.J.M. 4,5 , Prins R.A. 4,5 , Teijink J. 1,5
1Catharina Hospital, Surgery, Eindhoven, Netherlands,
2Orbis Medisch Centrum, Surgery, Sittard, Netherlands,
3Maxima Medisch Centrum, Surgery, Veldhoven,
Netherlands, 4Maastricht University, Department of epidemiology,
Maastricht, Netherlands, 5Maastricht University,
Caphri Research Institute, Maastricht, Netherlands
Purpose: 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.
Relevance: Research on patient-related factors that could
influence the results of SET is scarce. However, if clinical
variables that influence the results of SET can be identified,
it may be possible to identify a subgroup of patients that will
not benefit from SET. As a consequence, an alternative course
of treatment could be planned for these patients.
Participants: Patients with intermittent claudication who
participated in a community based SET program.
Methods: 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.
Analysis: Univariable and multivariable linear regression
analyses were conducted to identify variables predictive of
the absolute post treatment ACD and the percentage increase
in ACD. Pre-specified variables that were included in the
regression models were baseline ACD, age, smoking behavior,
ABI, BMI, DM, pulmonary disease, neurological disease,
cardiac disease and orthopedic disease.
Results: Four-hundred-and-thirty-seven patients were analyzed.
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-massindex
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.
Conclusions: Predictive variables for post-treatment ACD
after SET are baseline ACD, age, body-mass-index, pulmonary
disease, and smoking behavior. However, translating
the regression equation into a clinical prediction model did
not lead to a valid model for use in clinical practice.
Implications: In general, SET is a safe and effective treatment
for patients with intermittent claudication, although not
all patients benefit from a training program. If we could identify
a group of patients that are less likely to benefit from
SET, early adaptations to the treatment plan could be made.
However, our study shows that a valid prediction of the SET
results is not possible based on simple clinical baseline variables.
As long as we cannot adequately predict if patients will
or will not benefit from SET, starting with SET as the primary
treatment should be the first option for all patients with intermittent
claudication. When SET does not lead to sufficient
relief of symptoms, other treatment options are still available.
Keywords: Supervised exercise therapy; Intermittent claudication;
Predictor variables
Funding acknowledgements: None.
Ethics approval: No ethics approval was required.
Research Report Poster Display
Number: RR-PO-303-17-Tue Tuesday 21 June 12:00
RAI: Exhibit Halls2&3
EXTENDING THE RANGE OF TREADMILL
TESTING FOR PATIENTS WITH INTERMITTENT
CLAUDICATION
Gerardu V. 1 , Nicolaï S. 2 , Kruidenier L. 3 , Hendriks
E.J.M. 4,5 , de Bie R.A. 4,5 , Teijink J.A.W. 1,5
1Catharina Hospital, Surgery, Eindhoven, Netherlands,
2Maxima Medisch Centrum, Surgery, Veldhoven,
Netherlands, 3Orbis Medisch Centrum, Surgery, Sittard,
Netherlands, 4Maastricht University, Department of epidemiology,
Maastricht, Netherlands, 5Maastricht University,
Caphri Research Institute, Maastricht, Netherlands
Purpose: There is a need to evaluate patients with peripheral
arterial disease (PAD) with a limited or extended walking
distance. This group cannot be tested with the frequently used
graded (3.2 km/hour, 2% increase per 2 minutes) protocol,
because this standard protocol is too strenuous or too easy.
Relevance: The physiotherapist has an important role in
the treatment of patients with claudication intermittens. The
effect of supervised exercise therapy is measured by the maximum
painfree walking distance on a treadmill. It is preferable
that one standardized test protocol will be used to enable comparison
of test results within and between patients and also
across studies that evaluate treatments for patients with PAD.
Participants: Patients with PAD who were referred for community
based supervised exercise therapy after confirmation
of the diagnosis with an ankle brachial index (ABI) measurement
below 0.9 at rest or an ABI decrease of more than 0.15
after exercise were selected. Patients were eligible if they followed
at least 3 months of supervised exercise therapy and
if the increase in their walking distance had levelled off to