Quantification of Daily Physical Activity and Sedentary Behavior of Claudicating Patients

Hernandez, Hernan; Myers, Sara A.; Schieber, Molly; Ha, Duy M.; Baker, Sarah; Koutakis, Panagiotis; Kim, Kyung Soo; Mietus, Constance J.; Casale, George P.; Pipinos, Iraklis I.

doi:10.1016/j.avsg.2018.06.017

Cited by 27 publications

(43 citation statements)

References 40 publications

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“…Previous studies found that patients with PAD have increased amount and altered temporal structure of gait variability compared with healthy controls [7,8]. Gait alterations in patients with PAD are consistently present prior to the onset of claudication pain and even from the initial steps of the patient when the oxygen levels in the legs have not been challenged yet [6–8,42]. Our current study is the first to attempt to dissect the potential contribution of reduced blood flow which many investigators feel is a key mechanism operating to produce the gait alterations of PAD.…”

Section: Discussionmentioning

confidence: 99%

“…The most common symptom is intermittent claudication, a cramping pain that occurs in the calves, thighs and/or buttocks brought on by physical activity and relieved with rest. Patients with PAD are also significantly compromised by decreased physical activity and a higher prevalence of falls [4–6]. Advanced biomechanical evaluations have been undertaken to elucidate the mechanisms responsible for these problems [7–12].…”

Section: Introductionmentioning

confidence: 99%

“…Advanced biomechanical evaluations have been undertaken to elucidate the mechanisms responsible for these problems [7–12]. The results of these works demonstrate that the gait changes are driven by pathophysiological alterations that occur long before intermittent claudication symptoms drive patients to see a physician for pain during walking [6,13,14].…”

Section: Introductionmentioning

confidence: 99%

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Gait variability is affected more by peripheral artery disease than by vascular occlusion

Rahman

Pipinos

Johanning

et al. 2020

Preprint

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Background Patients with peripheral artery disease (PAD) have altered gait variability from the first step they take, well before the onset of claudication pain. The mechanisms underlying these gait alterations are poorly understood. Aims This study sought to isolate the effect of reduced blood flow on gait variability by comparing healthy older controls and patients with PAD. We also determined the diagnostic value of gait variability parameters to identify the presence of PAD. Methods Thirty healthy older controls and thirty patients with PAD walked on a treadmill at their self-selected speed in rested (normal walking for controls; pain free for PAD) and reduced blood flow (post vascular occlusion with thigh tourniquet for controls; pain for PAD) conditions. Gait variability was assessed using the largest Lyapunov exponent, approximate entropy, standard deviation, and coefficient of variation of ankle, knee, and hip joints range of motion. Receiver operating characteristics curve analyses of the rested condition were performed to determine the optimal cut-off values for separating individuals with PAD from those without PAD. Results and Discussion Patients with PAD have increased amount of variability for knee and hip ranges of motion compared with healthy older group. Comparing for conditions, reduced blood flow demonstrated increased amount of variability compared with rested blood flow. Significant interactions between group and condition occurred at the ankle for Lyapunov exponent, approximate entropy, and coefficient of variation. A combination of gait variability parameters correctly identifies PAD disease 70% of the time or more. Conclusions Gait variability is affected both by PAD and by the mechanical induction of reduced blood flow.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gait variability is affected more by peripheral artery disease than by vascular occlusion

Rahman

Pipinos

Johanning

et al. 2020

Preprint

Self Cite

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“…The most common symptom is intermittent claudication, a cramping pain that occurs in the calves, thighs and/or buttocks brought on by physical activity and relieved with rest. Patients with peripheral artery disease who experience intermittent claudication (PAD-IC) are also significantly compromised by decreased physical activity and a higher prevalence of falls [4][5][6]. Advanced biomechanical evaluations have been undertaken to elucidate the mechanisms responsible for these problems [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…Advanced biomechanical evaluations have been undertaken to elucidate the mechanisms responsible for these problems [7][8][9][10][11][12]. The results of these works demonstrate that the gait changes are driven by pathophysiological alterations that occur long before intermittent claudication symptoms drive patients to see a physician for pain during walking [6,13,14].…”

Section: Introductionmentioning

confidence: 99%

Gait variability is affected more by peripheral artery disease than by vascular occlusion

et al. 2021

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Background Patients with peripheral artery disease with intermittent claudication (PAD-IC) have altered gait variability from the first step they take, well before the onset of claudication pain. The mechanisms underlying these gait alterations are poorly understood. Aims To determine the effect of reduced blood flow on gait variability by comparing healthy older controls and patients with PAD-IC. We also determined the diagnostic value of gait variability parameters to identify the presence of PAD. Methods A cross-sectional cohort design was used. Thirty healthy older controls and thirty patients with PAD-IC walked on a treadmill at their self-selected speed in pain free walking (normal walking for healthy older controls; prior to claudication onset for PAD) and reduced blood flow (post vascular occlusion with thigh tourniquet for healthy older controls; pain for PAD) conditions. Gait variability was assessed using the largest Lyapunov exponent, approximate entropy, standard deviation, and coefficient of variation of ankle, knee, and hip joints range of motion. Receiver operating characteristics curve analyses of the pain free walking condition were performed to determine the optimal cut-off values for separating individuals with PAD-IC from those without PAD-IC. Results and discussion Patients with PAD-IC have increased amount of variability for knee and hip ranges of motion compared with the healthy older control group. Regarding the main effect of condition, reduced blood flow demonstrated increased amount of variability compared with pain free walking. Significant interactions between group and condition at the ankle show increased values for temporal structure of variability, but a similar amount of variability in the reduced blood flow condition. This demonstrates subtle interactions in the movement patterns remain distinct between PAD-IC versus healthy older controls during the reduced blood flow condition. A combination of gait variability parameters correctly identifies PAD-IC disease 70% of the time or more. Conclusions Gait variability is affected both by PAD and by the mechanical induction of reduced blood flow. Gait variability parameters have potential diagnostic ability, as some measures had 90.0% probability of correctly identifying patients with PAD-IC.

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Assessing wear time and perceptions of wearing an ankle foot orthosis in patients with peripheral artery disease

Dinkel

Hassan

Rech

et al. 2022

PM&R

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Background Peripheral artery disease (PAD) is a cardiovascular disease that affects walking ability. An ankle foot orthosis (AFO) may improve walking distances in those with PAD. Little research has explored if those with PAD wear a prescribed AFO and their perceptions of wearing the device. Objective To assess wear time of an AFO and explore perceptions of wearing the device in patients with PAD. Design Convergent mixed methods. Setting The study was conducted through a tertiary care medical center, and the research participants used the device in the community. Participants Thirty‐six patients, all older adult males, were enrolled in this study. Fourteen patients completed the study and 11 supplied sufficient accelerometer data to include in the analysis. Interventions An AFO was worn for 3 months. An accelerometer was placed on the AFO for 7 days at the midpoint (1.5 months) and endpoint of the intervention (3 months) to assess wear time. Semi‐structured interviews explored patients' perceptions of wearing the AFO. Main Outcome Measure The primary outcome measure was wear time measured objectively via accelerometer and subjectively via interview. Results Patients (n = 14) wore the AFO approximately 8 hours/day. Patients reported barriers such as challenges wearing the AFO during daily household activities (using stairs, being on uneven terrain), discomfort, clothing or footwear issues, and driving challenges. Positive effects of wearing the AFO were also reported, primarily the ability to walk further. Conclusions An AFO may be an acceptable therapeutic intervention to improve perceived walking performance in older adult males with PAD. Addressing participants' perceptions of the AFO and barriers to wear are essential to increasing the positive effect the device has on participants' ambulatory activity.

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Quantification of Daily Physical Activity and Sedentary Behavior of Claudicating Patients

Cited by 27 publications

References 40 publications

Gait variability is affected more by peripheral artery disease than by vascular occlusion

Gait variability is affected more by peripheral artery disease than by vascular occlusion

Gait variability is affected more by peripheral artery disease than by vascular occlusion

Assessing wear time and perceptions of wearing an ankle foot orthosis in patients with peripheral artery disease

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