The Effect of Structured Patient Education on Physical Activity in Patients with Peripheral Arterial Disease and Intermittent Claudication: A Systematic Review

Abaraogu, Ukachukwu Okoroafor; Dall, Philippa M.; Seenan, Chris

doi:10.1016/j.ejvs.2017.04.003

Cited by 30 publications

(25 citation statements)

References 20 publications

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“…One way of making use of this opportunity might be a well-designed structured education programme made available for patients irrespective of their choice of treatment. This has been implemented in diabetes[ 44 ] and has been advocated for adoption for patients with PAD[ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Living a burdensome and demanding life: A qualitative systematic review of the patients experiences of peripheral arterial disease

et al. 2018

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BackgroundPeripheral arterial disease (PAD) has a significant negative impact on the quality of life of individuals. Understanding the experiences of people living with PAD will be useful in developing comprehensive patient-centred secondary prevention therapies for this population.AimThe aim of this study is to identify first-hand accounts of patients’ experiences of living with PAD.MethodsSix databases (CINALH, PsyclNFO, MEDLINE, AMED, EMBASE, Social citation index/Science citation index via Web of Science (WOS)) and reference lists of identified studies were searched until September 2017 (updated February 2018). Qualitative studies reporting patients’ account of living with PAD were eligible for inclusion. A framework thematic synthesis was implemented.ResultsFourteen studies with 360 participants were included. Pain and walking limitation were recurrent among the varied symptom descriptions. Patients’ ignorance and trivialisation of symptoms contributed to delays in diagnosis. Inadequate engagement in disease understanding and treatment decisions meant patients had poor attitudes towards walking treatments and unrealistic expectations about surgery. Depending on symptom progression, patients battle with walking impairment, powerlessness, and loss of independence which were a source of burden to them. Lack of disease understanding is central through patients’ journey with PAD and, although they subsequently began adaptation to long term living with PAD, many worried about their future.ConclusionsDisease understanding is vital across the illness trajectory in patients with PAD. Although certain experiences are common throughout patient journey, some might be unique to a particular stage (e.g. unrealistic expectation about surgery, or rationale of walking in spite of pain in a supervised exercise program). Given that PAD is an overarching construct ranging from the mildest form of intermittent claudication to severe critical limb ischemia with ulceration and gangrene, consideration of important patient constructs specific to each stage of the disease may enhance treatment success. Systematic review registration CRD42017070417.

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Section: Discussionmentioning

confidence: 99%

Living a burdensome and demanding life: A qualitative systematic review of the patients experiences of peripheral arterial disease

et al. 2018

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“…Within the conceptual framework of self-management interventions, evidence indicates that the inclusion of behavior-change techniques contribute to the improvement of pain free walking ability, self-reported walking ability and daily walking activity in individuals with IC[ 20 – 22 ]. Several important behavioral change techniques such as barrier identification with problem-solving[ 20 , 23 ], self-monitoring[ 21 , 23 ], feedback on performance[ 21 , 23 ], goal setting[ 20 , 23 ], social support[ 23 ], action planning[ 20 ], and structured patients education[ 24 ] have been highlighted. However, to develop targeted evidence-based self-management interventions informed by behavioral change strategies, a clear understating of the multifactorial barriers and enablers common to IC patients’ participation in walking exercise is required.…”

Section: Introductionmentioning

confidence: 99%

Barriers and enablers to walking in individuals with intermittent claudication: A systematic review to conceptualize a relevant and patient-centered program

et al. 2018

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BackgroundWalking limitation in patients with peripheral arterial disease (PAD) and intermittent claudication (IC) contributes to poorer disease outcomes. Identifying and examining barriers to walking may be an important step in developing a comprehensive patient-centered self-management intervention to promote walking in this population.AimTo systematically review the literature regarding barriers and enablers to walking exercise in individuals with IC.MethodsA systematic review was conducted utilizing integrative review methodology. Five electronic databases and the reference lists of relevant studies were searched. Findings were categorized into personal, walking activity related, and environmental barriers and enablers using a social cognitive framework.ResultsEighteen studies including quantitative (n = 12), qualitative (n = 5), and mixed method (n = 1) designs, and reporting data from a total of 4376 patients with IC, were included in the review. The most frequently reported barriers to engaging in walking were comorbid health concerns, walking induced pain, lack of knowledge (e.g. about the disease pathology and walking recommendations), and poor walking capacity. The most frequently reported enablers were cognitive coping strategies, good support systems, and receiving specific instructions to walk. Findings suggest additionally that wider behavioral and environmental obstacles should be addressed in a patient-centered self-management intervention.ConclusionsThis review has identified multidimensional factors influencing walking in patients with IC. Within the social cognitive framework, these factors fall within patient level factors (e.g. comorbid health concerns), walking related factors (e.g. claudication pain), and environmental factors (e.g. support systems). These factors are worth considering when developing self-management interventions to increase walking in patients with IC. Systematic review registration CRD42018070418.

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“…Eligibility questions and forms for the screening of the studies included within the review were (Table 8.5a of the Cochrane Handbook for Systematic Reviews of Interventions) was used to assess the articles in six key domains: 1) selection bias (random sequence generation, allocation concealment); 2) performance bias (blinding of personnel and participants); 3) detection bias (blinding of outcome assessments); 4) bias due to attrition (incomplete outcome data, including dropouts and withdrawals); 5) reporting bias (selective reporting); and 6) other bias (other sources of bias not elsewhere addressed) [17]. Articles were rated as 'high risk' or 'low risk' following a well-described procedure ( [17,23]. Again, any disagreement in the decision between reviewers was resolved by discussion and consultation with the third author (O.A.E.…”

Section: Study Record Selection Process and Data Managementmentioning

confidence: 99%

The effects of aerobic exercises on high sensitivity C-reactive protein and depression in patients living with HIV infection; a systematic review with meta-analysis

Anieto

Uduonu

Ezeukwu

et al. 2019

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Background HIV infection and chronic use of highly active antiretroviral therapy have been associated with increased expression of pro-inflammatory biomarkers (e.g. high-sensitivity C-reactive protein) and major affective disorders (e.g. depression). There is a growing research interest in aerobic exercise as an adjunct therapy on inflammatory outcomes and depression in people living with HIV (PLHIV) who are undergoing antiretroviral therapy. Synthesizing and appraising available evidence may be essential to guide practice and future research on exercise intervention to this population. This review evaluated the effects of aerobic exercises on serum levels of high-sensitivity C-reactive protein (hs-CRP) and depressive symptoms in PLHIV. Methods Cochrane Central Register of Controlled Trials, MEDLINE, PEDRO, EMBASE, AMED, CINAHL, and Web of Science were systematically searched to include clinical trials that investigated the effects of aerobic exercises on hs-CRP and/or depression in PLWH. Two reviewers independently screened all the articles for eligibility and also evaluated the risk of bias using the Cochrane Collaboration risk of bias assessment tool. Data were extracted and meta-analyses conducted using Review Manager Software. Results Six studies (261 participants) met the inclusion criteria and were included in the review. Four of the studies reported on depressive symptoms and two on hs-CRP outcome The meta-analysis result showed a significant (Z=3.78, p<0.0002) decrease in depression scores in PLWH; implying that aerobic exercise interventions reduce depressive symptoms among PLWH. The two studies that reported on hs-CRP outcome, found no significant effect of aerobic exercise on hs-CRP. Overall, the GRADE evidence for this review was of moderate quality. Conclusion There was evidence that aerobic exercises of about 24-60 minutes duration, two to five times per week can lead to a significant improvement in depression level but not hs-CRP in PLWH. However, it should not be concluded as ‘no evidence of effect’ because the included trials do not have sufficient power to detect treatment effects. Thus, further homogenous research with enough “power” is necessary for a conclusive estimate of effects.

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The Effect of Structured Patient Education on Physical Activity in Patients with Peripheral Arterial Disease and Intermittent Claudication: A Systematic Review

Cited by 30 publications

References 20 publications

Living a burdensome and demanding life: A qualitative systematic review of the patients experiences of peripheral arterial disease

Living a burdensome and demanding life: A qualitative systematic review of the patients experiences of peripheral arterial disease

Barriers and enablers to walking in individuals with intermittent claudication: A systematic review to conceptualize a relevant and patient-centered program

The effects of aerobic exercises on high sensitivity C-reactive protein and depression in patients living with HIV infection; a systematic review with meta-analysis

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