Relevance: Pain which limits physical activity (PA) is a major problem in individuals with Peripheral Arterial Disease (PAD) and Intermittent Claudication (IC). Interventions that improve PA will be of clinical value potentially providing a range of positive health benefits. Patient education is an intervention which may provide such improvements. Purpose: To investigate the effective components of patient education interventions for improving PA in patients with PAD and IC. Methods/analysis: A comprehensive electronic search was performed in nine relevant databases up to January 2016, to identify studies investigating effect of patient edu-cation on PA of patients with PAD and IC, or those which investigated patients' perceptions or experience with these interventions. Primary outcomes were change in PA capac-ity or change in free living PA; and adherence to PA improvement for interventions with follow-up. Secondary outcomes included physical function scores, pain, psycholog-ical outcomes, patients' perceptions and quality of life. The Cochrane Consumers and Communication Review Group Data Extraction Template, and the Cochrane Collaborative risk of bias tool were employed to extract data from the RCTs and assess risk of bias in individual studies respectively. Data were analysed using a narrative synthesis due to substantial heterogeneity in the included studies. Results: A total of 5707 studies were initially identified and, after screening titles, abstracts, and full-text articles, 10 were eligible for inclusion in the narrative synthesis. The 10 included studies, all of which were RCTs, in total con-tributed data on 1767participants. There was no issue of selective reporting in the included studies; however only one of the included studies blinded outcome assessments. Seven out of the ten studies were rated as high-quality trials and adjudged to have low risk index. Generally, the majority of the interventions involved a complex form of education with behavioural-change techniques as major components. Results were inconclusive regarding effect of interventions on pain free walking distance, maximal walking distance and daily steps walked. The two studies which examined outcomes related to walking time to onset of pain reported improvement. Reports that investigated general or disease specific quality of life were contradictory and inconclusive. Two studies investigated acceptance and satisfaction with interventions, and patients found these interventions accept-able and satisfactory. Discussion and conclusions: Patient education with behaviour change techniques as major components have the potential to improve the PA of individuals with IC, as evi-denced by improvements in walking time to the onset of pain. However, homogenous high quality research is needed before clinical recommendations for their use can be made. Particularly, future studies should blind outcome assessment to remove potential observer bias, and should specifically target free-living PA outcomes. Impact and implications: This review examined the existing evidence regarding the effect on PA of patient education interventions. Due to the heterogeneity of the included studies and the contradictory findings, there are no direct clinical implications. However, findings will allow the identification of potentially effective components, which can be tested in future research, and particularly in respect to the effect on free-living PA in patients with IC.
- peripheral arterial disease
- intermittent claudication
- patient education
Abaraogu, U. O., Dall, P. M., & Seenan, C. A. (2016). Patient education interventions to improve physical activity in patients with intermittent claudication: a systematic literature review: The 4th European Congress of the European Region of the World Confederation of Physical Therapy (ER-WCPT) Abstracts, Liverpool, UK, 11-12 November 2016. Physiotherapy, 102, Supplement 1, e10. https://doi.org/10.1016/j.physio.2016.10.015