Claudicating patients with peripheral artery disease have meaningful improvement in walking speed after supervised exercise therapy

Authors

Hafizur Rahman, University of Nebraska at OmahaFollow
Iraklis Pipinos, Department of Surgery, Veterans Affairs Medical Center and University of Nebraska Medical Center, Omaha, NE USAFollow
Jason M. Johanning, University of Nebraska Medical CenterFollow
George P. Casale, University of Nebraska Medical Center
Mark A. Williams, Creighton University, School of Medicine
Jonathan R. Thompson, University of Nebraska Medical Center
Yohanis O'Neill-Casto, University of Nebraska Medical Center
Sara A. Myers, University of Nebraska at OmahaFollow

Author ORCID Identifier

Myers - https://orcid.org/0000-0002-2934-2624

Pipinos - https://orcid.org/0000-0001-6873-6346

Document Type

Article

Publication Date

11-19-2021

Abstract

Objective

Supervised exercise therapy (SET) is a first-line treatment for patients with peripheral artery disease (PAD). The efficacy of SET is most commonly expressed by significant statistical improvement of parameters that do not clarify how each individual patient will benefit from SET. This study examined the minimal clinically important difference (MCID) in walking speed in claudicating patients with PAD after SET.

Methods

A total of 63 patients with PAD-related claudication (Fontaine stage II PAD) participated in a 6-month SET program. Self-selected walking speed was measured before and after SET. Distribution and anchor-based approaches were used to estimate the MCID for small and substantial improvement. The ability to walk one block and the ability to climb one flight of stairs questions were chosen as anchor questions from the Medical Outcomes Study 36-item Short Form questionnaire. Receiver operating characteristics curve analyses were performed to detect the threshold for MCID in walking speed after treatment.

Results

The distribution-based method estimated 0.03 m/s as a small improvement and 0.08 m/s as a substantial improvement after SET. Small and substantial improvements according to the anchor question walking one block were 0.05 m/s and 0.15 m/s, respectively. For the climbing one flight of stairs anchor question, 0.10 m/s was a small improvement. Receiver operating characteristics curve analyses identified an increase of 0.04 m/s and 0.03 m/s for improvement based on walking one block and climbing one flight of stairs, respectively.

Conclusions

We report our findings for the MCID for walking speed among claudicating patients receiving SET. Claudicating patients who increase walking speed of 0.03 m/s or greater are more likely to experience a meaningful improvement in walking impairment than those who do not. The MCID reported in this study can serve as a benchmark for clinicians to develop goals and interpret clinically meaningful progress in the care of claudicating patients with PAD.

Comments

This is an Accepted Manuscript of an article published by Elsevier in Journal of Vascular Surgery on November 19, 2021, available online: https://doi.org/10.1016/j.jvs.2021.04.069

Journal Title

Journal of Vascular Surgery

Volume

74

Issue

6

First Page

1987

Last Page

1995

Recommended Citation

Rahman H, Pipinos II, Johanning JM, Casale G, Williams MA, Thompson JR, O”Neill-Castro Y, Myers SA. Claudicating patients with peripheral artery disease have meaningful improvement in walking speed after supervised exercise therapy. Journal of Vascular Surgery, 74(6), 1987-1995. https://doi.org/10.1016/j.jvs.2021.04.069

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.