An analysis of relationship between quality of life indices and clinical improvement following intervention in patients with intermittent claudication due to femoropopliteal disease

Mazari, Fayyaz; Carradice, Daniel; Rahman, Mohd Norhisham Azmi Abdul; Khan, Junaid; Mockford, Katherine; Mehta, Tapan; McCollum, P. T.; Chetter, Ian

doi:10.1016/j.jvs.2010.01.085

Cited by 40 publications

(42 citation statements)

References 33 publications

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“…ICD may be a better indicator of walking capacity in daily life than MWD. This is also consistent with findings by Mazari et al 29 of a strong correlation between ICD and HRQoL indicators. We reported previously that revascularization, compared with noninvasive treatment, significantly reduced claudication pain as a reason to stop during treadmill testing while not significantly improving maximum walking function on the graded treadmill.…”

Section: Discussionsupporting

confidence: 93%

Improved Quality of Life After 1 Year With an Invasive Versus a Noninvasive Treatment Strategy in Claudicants

et al. 2014

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I ntermittent claudication (IC) is the most common symptomatic presentation in peripheral arterial disease, and ≈20 to 40 million individuals in the world experience classic IC symptoms.1 IC may also cause a substantial loss of walking function and thereby reduce health-related quality of life (HRQoL). As a manifestation of atherosclerosis, IC confers an increased risk for cardiovascular and cerebrovascular events and premature death. 2,3 This risk can be modified by medical intervention, and the leg symptoms can be reduced by exercise; thus, the generally accepted first-line treatment in patients with IC is risk factor modification, medical treatment, and exercise training. 4,5 Exercise training under supervision of a physiotherapist is often recommended because this approach has been shown to provide better short-term results (6-12 months) than with structured training advice alone. 6,7 However, current practice is different. Supervised exercise training programs are largely unavailable in most countries; hence, the majority of claudicants in Europe do not receive this treatment option. 8 Furthermore, a recent systematic review (National Institute for Health and Clinical Excellence) showed uncertain and probably very poor compliance to supervised training. 9 Health-economic modeling demonstrated that supervised training is cost-effective only when HRQoL results are extrapolated beyond the end of existing trial data and under the assumption of activity-induced benefits in terms of mortality and cardiovascular events. Editorial see p 929 Clinical Perspective on p 947Background-The quality of evidence for invasive revascularization in intermittent claudication is low or very low. This prospective, randomized, controlled study tested the hypothesis that an invasive treatment strategy versus continued noninvasive treatment improves health-related quality of life after 1 year in unselected patients with intermittent claudication. Methods and Results-After clinical and duplex ultrasound assessment, unselected patients with intermittent claudication requesting treatment for claudication were randomly assigned to invasive (n=79) or noninvasive (n=79) treatment groups. The quality of evidence for invasive interventions in IC is still low or very low.9 Most available studies evaluating invasive treatment have used rather selective inclusion criteria, enrolling patients with vascular lesions (eg, in specific vessel segments, of a certain length and severity, and with suitable anatomy for endovascular treatment). [10][11][12][13] The low proportion of all referred claudicants included in most IC interventional trials makes it difficult to generalize results to the majority of IC patients.14 In this context, we sought to perform a "real world" study to test the hypothesis that an invasive (surgical or endovascular) treatment strategy compared with continued medical therapy improves HRQoL in relatively unselected IC patients receiving best medical treatment and structured (nonsupervised) training advice. Methods General Des...

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Section: Discussionsupporting

confidence: 93%

Improved Quality of Life After 1 Year With an Invasive Versus a Noninvasive Treatment Strategy in Claudicants

et al. 2014

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“…One month 1 month after completion of LDL-A treatment seen in clinical indicators of lower limb ischemia is not reflected in these scores. These findings support the use of composite outcome measures with independent assessment of QOL as an independent outcome measure in intervention studies in these patients [29]. However, to our knowledge, this questionnaire has not been applied to assess LDL-A treatment effects on PAD in dialysis patients.…”

Section: Discussionsupporting

confidence: 58%

“…However, there are not a few patients whose symptom is relieved for a longer period without significant improvement of microcirculation parameters, maybe because of a number of complex local microcirculatory responses, which may contribute to rest pain and trophic changes [3,9]. Most of the prospective study to assess the treatment of PAD select some parameters among the blood flow measurement (SPP, ABI), exercise ability (walking distance), and QOL survey (Vascu-QOL, SF-36) as main outcomes [28,29]. It means that there is no gold standard method to evaluate the response to the therapy.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of vascular quality of life questionnaire in dialysis patients with peripheral arterial disease treated by low-density lipoprotein apheresis

Nagai

Harada

Yokota³

et al. 2016

Ren Replace Ther

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Background: Peripheral arterial disease (PAD) is a common complication in dialysis patients. Early diagnosis and treatment are recommended. Low-density lipoprotein apheresis (LDL-A) is a potential therapy to improve PAD. However, the mechanism has yet to be fully clarified due to lack of established quantitative methods to assess the therapeutic effects of LDL-A treatment. Improvement of skin perfusion pressure (SPP) or ankle brachial index (ABI) is a representative therapy goal, but clinical symptoms were not always consistent with the values of SPP/ABI. Vascular quality of life questionnaire (VascuQOL) was proposed as a disease-specific QOL score, getting validated recently. The possibility of VascuQOL to reflect the severity of PAD in dialysis patients and evaluate the therapeutic effects of LDL-A has yet to be elucidated. Methods: This is an observational study. LDL-A treatment was performed in 32 dialysis patients with PAD. They were divided to critical limb ischemia (CLI) group (17 subjects) and non-CLI group (15 subjects) according to their clinical manifestations. We examined the relationship of PAD severity with SPP, ABI, VascuQOL, and lipid profile such as apoB/apoA-I ratio, malondialdehyde-modified LDL, and remnant-like particles cholesterol. Furthermore, we evaluated these parameters successively to find out a suitable therapeutic marker just after the first LDL-A, at tenth LDL-A, and 1 month after completion of LDL-A treatment. Results: All of the lipid markers were higher in CLI patients, but not significantly different from those in the non-CLI group. They decreased significantly just after LDL-A, although no changes were observed 1 month after completion of LDL-A treatment. ABI was significantly different between the CLI and non-CLI groups, but did not improve by LDL-A treatment. By contrast, SPP was ameliorated significantly and the peak was at tenth LDL-A. Among VascuQOL domains, "Symptom" and "Emotional" domains were significantly different between the CLI and non-CLI groups. The average score of VascuQOL increased successively until 1 month after completion of LDL-A treatment. Conclusions: Several domains of VascuQOL can reflect the severity of PAD in dialysis patients. VascuQOL was a useful marker to show the prolonged therapeutic effects of LDL-A treatment in dialysis patients with PAD, independent of SPP.

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“…16 Questionnaires are either general tools used in a variety of diseases (eg, Short Form-36, European Quality of Life Questionnaire) or PADspecific questionnaires (eg, Walking Impairment Questionnaire, Peripheral Artery Questionnaire) and are reviewed in detail elsewhere. 16 Changes in quality-of-life scores as a result of successful PAD therapies relate to changes in measures of walking function (eg, treadmill walking distance) in many trials 16,19,24,[74][75][76] but are divergent in others, 30 suggesting that quality-of-life scores measure dimensions of PAD not always captured by functional measures.…”

Section: Quality-of-life Questionnairesmentioning

confidence: 99%

Outcomes for Clinical Studies Assessing Drug and Revascularization Therapies for Claudication and Critical Limb Ischemia in Peripheral Artery Disease

Kinlay

2013

Circulation

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An analysis of relationship between quality of life indices and clinical improvement following intervention in patients with intermittent claudication due to femoropopliteal disease

Cited by 40 publications

References 33 publications

Improved Quality of Life After 1 Year With an Invasive Versus a Noninvasive Treatment Strategy in Claudicants

Improved Quality of Life After 1 Year With an Invasive Versus a Noninvasive Treatment Strategy in Claudicants

Evaluation of vascular quality of life questionnaire in dialysis patients with peripheral arterial disease treated by low-density lipoprotein apheresis

Outcomes for Clinical Studies Assessing Drug and Revascularization Therapies for Claudication and Critical Limb Ischemia in Peripheral Artery Disease

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