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J A Michaels - One of the best experts on this subject based on the ideXlab platform.
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pentoxifylline for Intermittent Claudication
Cochrane Database of Systematic Reviews, 2015Co-Authors: Kareem Salhiyyah, Rachel Forster, Eshan Senanayake, Mohammed Abdelhadi, Andrew Booth, J A MichaelsAbstract:Background Intermittent Claudication (IC) is a symptom of peripheral arterial disease (PAD) and is associated with high morbidity and mortality. Pentoxifylline, one of many drugs used to treat IC, acts by decreasing blood viscosity, improving erythrocyte flexibility and promoting microcirculatory flow and tissue oxygen concentration. Many studies have evaluated the efficacy of pentoxifylline in treating individuals with PAD, but results of these studies are variable. This is an update of a review first published in 2012.
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the cost effectiveness of supervised exercise for the treatment of Intermittent Claudication
European Journal of Vascular and Endovascular Surgery, 2013Co-Authors: S L Bermingham, C.p. Shearman, K Sparrow, R Mullis, A W Bradbury, J A MichaelsAbstract:Background Supervised exercise (SE) is thought to result in improvements in walking distance and quality of life compared with unsupervised exercise (USE) in people with Intermittent Claudication. However, the cost-effectiveness of SE is unclear. As a result, many patients are currently unable to access supervised programmes. Methods We searched MEDLINE, Embase, Cochrane, and Cinahl databases to identify randomised controlled trials comparing USE with SE in adults with Intermittent Claudication. A Markov model was developed to estimate costs and quality adjusted life years (QALYs) from an NHS and personal social services perspective. Quality of life was obtained from the included clinical trials. Resource use was modelled on current programmes and unit costs were based on published sources. Results Depending on estimated rates of compliance, SE was cost-effective in over 75% of model simulations, with an incremental cost-effectiveness ratio of £711 to £1,608 per QALY gained. The model was sensitive to long-term effects of exercise on cardiovascular risk and quality of life. Conclusions SE is more cost-effective than USE for the treatment of people with Intermittent Claudication. Supervised programmes should be made widely available and offered as a first line treatment to people with Intermittent Claudication.
G. A. Tew - One of the best experts on this subject based on the ideXlab platform.
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Systematic review of home-based exercise programmes for individuals with Intermittent Claudication
European Journal of Vascular and Endovascular Surgery, 2013Co-Authors: W. Al-jundi, K. Madbak, J. D. Beard, Sadat Nawaz, G. A. TewAbstract:We aimed to conduct a systematic review of the evidence for structured, home-based exercise programmes (HEPs) in patients with Intermittent Claudication. The Medline, PsycINFO, EMBASE, and Cochrane databases were searched up to April 2013 for terms related to walking, self-management, and Intermittent Claudication. Descriptive, methodological and outcome data were extracted from eligible articles. Trial quality was assessed using the GRADE system. Seventeen studies were included with 1,457 participants. Six studies compared HEPs with supervised exercise training, five compared HEPs with usual care/observation control, and seven evaluated HEPs in a single-group design. Trial heterogeneity prevented meta-analysis. Nevertheless, there was "low-level" evidence that HEPs can improve walking capacity and quality of life in patients with Intermittent Claudication when compared with baseline or in comparison to usual care/observation control. In addition, improvements with HEPs may be inferior to those evoked by supervised exercise training. Considerable uncertainty exists regarding the long-term clinical and cost effectiveness of HEPs in patients with Intermittent Claudication. Thus, more robust trials are needed to build evidence about these interventions. Nevertheless, clinicians should consider using structured interventions to promote self-managed walking in patients with Intermittent Claudication, as opposed to simple "go home and walk" advice, when supervised exercise training is unavailable or impractical. © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
W. Al-jundi - One of the best experts on this subject based on the ideXlab platform.
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Systematic Review of Home-based Exercise Programmes for Individuals with Intermittent Claudication
European Journal of Vascular and Endovascular Surgery, 2013Co-Authors: W. Al-jundi, K. Madbak, Jonathan Beard, Shah NawazAbstract:WHAT THIS PAPER ADDS This article describes the first comprehensive systematic review of structured, home-based exercise programmes (HEPs) for individuals with Intermittent Claudication. There is “low-level” evidence that HEPs can improve walking capacity and quality of life in patients with Intermittent Claudication, albeit probably to a lesser extent than supervised exercise training.We recommend that HEPs should be used to promote walking in patients with Intermittent Claudication when supervised training is unavailable or impractical. Further research is warranted to establish long-term clinical and cost effectiveness, and optimal programme design. We aimed to conduct a systematic review of the evidence for structured, home-based exercise programmes (HEPs) in patients with Intermittent Claudication.The Medline, PsycINFO, EMBASE, and Cochrane databases were searched up to April 2013 for terms related to walking, self-management, and Intermittent Claudication. Descriptive, methodological and outcome data were extracted from eligible articles. Trial quality was assessed using the GRADE system. Seventeen studies were included with 1,457 participants. Six studies compared HEPs with supervised exercise training, five compared HEPs with usual care/observation control, and seven evaluated HEPs in a single-group design. Trial heterogeneity prevented meta-analysis. Nevertheless, there was “low-level” evidence that HEPs can improve walking capacity and quality of life in patients with Intermittent Claudication when compared with baseline or in comparison to usual care/observation control. In addition, improvements with HEPs may be inferior to those evoked by supervised exercise training. Considerable uncertainty exists regarding the long-term clinical and cost effectiveness of HEPs in patients with Intermittent Claudication. Thus, more robust trials are needed to build evidence about these interventions. Nevertheless, clinicians should consider using structured interventions to promote self-managed walking in patients with Intermittent Claudication, as opposed to simple “go home and walk” advice, when supervised exercise training is unavailable or impractical.
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Systematic review of home-based exercise programmes for individuals with Intermittent Claudication
European Journal of Vascular and Endovascular Surgery, 2013Co-Authors: W. Al-jundi, K. Madbak, J. D. Beard, Sadat Nawaz, G. A. TewAbstract:We aimed to conduct a systematic review of the evidence for structured, home-based exercise programmes (HEPs) in patients with Intermittent Claudication. The Medline, PsycINFO, EMBASE, and Cochrane databases were searched up to April 2013 for terms related to walking, self-management, and Intermittent Claudication. Descriptive, methodological and outcome data were extracted from eligible articles. Trial quality was assessed using the GRADE system. Seventeen studies were included with 1,457 participants. Six studies compared HEPs with supervised exercise training, five compared HEPs with usual care/observation control, and seven evaluated HEPs in a single-group design. Trial heterogeneity prevented meta-analysis. Nevertheless, there was "low-level" evidence that HEPs can improve walking capacity and quality of life in patients with Intermittent Claudication when compared with baseline or in comparison to usual care/observation control. In addition, improvements with HEPs may be inferior to those evoked by supervised exercise training. Considerable uncertainty exists regarding the long-term clinical and cost effectiveness of HEPs in patients with Intermittent Claudication. Thus, more robust trials are needed to build evidence about these interventions. Nevertheless, clinicians should consider using structured interventions to promote self-managed walking in patients with Intermittent Claudication, as opposed to simple "go home and walk" advice, when supervised exercise training is unavailable or impractical. © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Joep A.w. Teijink - One of the best experts on this subject based on the ideXlab platform.
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Effect of Supervised Exercise Therapy for Intermittent Claudication in Patients With Diabetes Mellitus
Annals of Vascular Surgery, 2012Co-Authors: Lotte M. Kruidenier, Saskia P.a. Nicolaï, Martin H. Prins, Fred H. M. Nieman, Joep A.w. TeijinkAbstract:Background Primary treatment for patients with Intermittent Claudication is exercise therapy. Diabetes mellitus (DM) is a frequently occurring comorbidity in patients with Intermittent Claudication, and in these patients, exercise tolerance is decreased. However, there is little literature about the increase in walking distance after supervised exercise therapy (SET) in patients with both Intermittent Claudication and DM. The objective of this study was to determine the effectiveness of SET for Intermittent Claudication in patients with DM. Methods Consecutive patients with Intermittent Claudication who started SET were included. Exclusion criteria were Rutherford stage 4 to 6 and the inability to perform the standardized treadmill test. SET was administered according to the guidelines of the Royal Dutch Society for Physiotherapy. At baseline and at 1, 3, and 6 months of follow-up, a standardized treadmill exercise test was performed. The primary outcome measurement was the absolute Claudication distance (ACD). Results We included 775 patients, of whom 230 had DM (29.7%). At 6 months of follow-up, data of 440 patients were available. Both ACD at baseline and at 6 months of follow-up were significantly lower in patients with DM ( P P = 0.48) between the DM group and the non-DM group (270 m and 400 m, respectively). Conclusion In conclusion, SET for patients with Intermittent Claudication is equally effective in improving walking distance for both patients with and without DM, although ACD remains lower in patients with DM.
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From the Cochrane library: Ginkgo biloba for Intermittent Claudication.
Vasa-european Journal of Vascular Medicine, 2010Co-Authors: Saskia P.a. Nicolaï, Lotte M. Kruidenier, V. C. Gerardu, Martin H. Prins, Joep A.w. TeijinkAbstract:Background: Patients with Intermittent Claudication suffer from pain in the muscles of the legs during exercise that is relieved by a short rest. Ginkgo biloba extract is a vasoactive agent used for symptomatic relief in Intermittent Claudication. In this article a meta-analysis is discussed that assessed the effect of Ginkgo biloba on walking capacity in patients with Intermittent Claudication. Patients and methods: The Cochrane Peripheral Vascular Diseases Group searched their Trials Register and the Cochrane Central Register of Controlled Trials in The Cochrane Library. Furthermore MEDLINE/PUBMED (until May 2008) and EMBASE (until May 2008) were searched and manufacturers of Ginkgo biloba extract were contacted. Randomized controlled trials of Ginkgo biloba extract versus placebo in people with Intermittent Claudication were included. Two authors independently assessed trials for selection, assessed study quality and extracted data. To standardize walking distance or time, caloric expenditures were use...
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Ginkgo biloba for Intermittent Claudication.
The Cochrane database of systematic reviews, 2009Co-Authors: Saskia P.a. Nicolaï, Bianca L. W. Bendermacher, Lotte M. Kruidenier, Martin H. Prins, Joep A.w. TeijinkAbstract:People with Intermittent Claudication suffer from pain in the muscles of the leg occurring during exercise which is relieved by a short period of rest. Symptomatic relief can be achieved by (supervised) exercise therapy and pharmacological treatments. Ginkgo biloba is a vasoactive agent and is used to treat Intermittent Claudication. To assess the effect of Ginkgo biloba on walking distance in people with Intermittent Claudication. The Cochrane Peripheral Vascular Diseases (PVD) Group searched their Trials Register (last searched 3 February 2009) and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (last searched 2009, Issue 1). We searched MEDLINE/PUBMED (January 1966 to May 2008) and EMBASE (January 1985 to May 2008) and contacted manufacturers. Randomised controlled trials of Ginkgo biloba extract, irrespective of dosage, versus placebo in people with Intermittent Claudication. Two authors independently assessed trials for selection, assessed study quality and extracted data. We extracted number of patients, mean walking distances or times and standard deviations. To standardise walking distance or time, caloric expenditures were used to express the difference between the different treadmill protocols, which were calculated from the speed and incline of the treadmill. Fourteen trials with a total of 739 participants were included. Eleven trials involving 477 participants compared Ginkgo biloba with placebo and assessed the absolute Claudication distance. Following treatment with Ginkgo biloba at the end of the study the absolute Claudication distance increased with an overall effect size of 3.57 kilocalories (confidence interval -0.10 to 7.23, P = 0.06), compared with placebo. This translates to an increase of just 64.5 (confidence interval -1.8 to 130.7) metres on a flat treadmill with an average speed of 3.2 km/h. Publication bias leading to missing data or "negative" trials is likely to have inflated the effect size. Overall, there is no evidence that Ginkgo biloba has a clinically significant benefit for patients with peripheral arterial disease.
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Supervised exercise therapy for Intermittent Claudication.
Acta Chirurgica Belgica, 2007Co-Authors: Bianca L. W. Bendermacher, Lotte M. Kruidenier, Saskia P.a. Nicolaï, R.j.th.j. Welten, Joep A.w. TeijinkAbstract:Purpose of the review : 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. Materials and methods : 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. Main results : 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. Conclusions : 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.
J. D. Beard - One of the best experts on this subject based on the ideXlab platform.
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Systematic review of home-based exercise programmes for individuals with Intermittent Claudication
European Journal of Vascular and Endovascular Surgery, 2013Co-Authors: W. Al-jundi, K. Madbak, J. D. Beard, Sadat Nawaz, G. A. TewAbstract:We aimed to conduct a systematic review of the evidence for structured, home-based exercise programmes (HEPs) in patients with Intermittent Claudication. The Medline, PsycINFO, EMBASE, and Cochrane databases were searched up to April 2013 for terms related to walking, self-management, and Intermittent Claudication. Descriptive, methodological and outcome data were extracted from eligible articles. Trial quality was assessed using the GRADE system. Seventeen studies were included with 1,457 participants. Six studies compared HEPs with supervised exercise training, five compared HEPs with usual care/observation control, and seven evaluated HEPs in a single-group design. Trial heterogeneity prevented meta-analysis. Nevertheless, there was "low-level" evidence that HEPs can improve walking capacity and quality of life in patients with Intermittent Claudication when compared with baseline or in comparison to usual care/observation control. In addition, improvements with HEPs may be inferior to those evoked by supervised exercise training. Considerable uncertainty exists regarding the long-term clinical and cost effectiveness of HEPs in patients with Intermittent Claudication. Thus, more robust trials are needed to build evidence about these interventions. Nevertheless, clinicians should consider using structured interventions to promote self-managed walking in patients with Intermittent Claudication, as opposed to simple "go home and walk" advice, when supervised exercise training is unavailable or impractical. © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
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nordic poles immediately improve walking distance in patients with Intermittent Claudication
European Journal of Vascular and Endovascular Surgery, 2008Co-Authors: Claire Oakley, J. D. Beard, Irena Zwierska, John M SaxtonAbstract:Abstract Objectives To investigate the immediate effects of Nordic pole walking (NPW) on walking distance and cardiopulmonary workload in patients with Intermittent Claudication. Methods Using a standardised treadmill test (3.2kmh −1 at 4% gradient), walking distance, cardiopulmonary responses, leg pain and perceived exertion during NPW were compared to responses evoked by normal walking in 20 patients with Intermittent Claudication. The distance to onset of Claudication pain (Claudication distance: CD) and to maximum walking distance (MWD), heart rate (HR), expired gas parameters, leg pain (Borg's CR-10 Scale) and perceived exertion (Borg's Rating of Perceived Exertion: RPE Scale) were compared. Results CD increased significantly from a median (range) distance of 77m (28–503) to 130m (41–1080) and MWD increased significantly from 206m (81–1078) to 285m (107–1080) when patients used the Nordic poles ( P =0.000). The level of leg pain at MWD was also significantly reduced during NPW ( P =0.002). Perceived exertion at MWD did not increase despite an increase in cardiopulmonary work, as indicated by an increase in oxygen consumption (16.5%; P =0.000). Conclusion These results show that NPW immediately enables patients with Intermittent Claudication to walk further with less pain, despite a higher workload. NPW might also be a useful exercise strategy for improving the cardiovascular fitness of patients with Intermittent Claudication.