PMID- 17142065
OWN - NLM
STAT- MEDLINE
DCOM- 20070315
LR  - 20070122
IS  - 1078-5884 (Print)
IS  - 1078-5884 (Linking)
VI  - 33
IP  - 2
DP  - 2007 Feb
TI  - A non-randomised controlled trial of the clinical and cost effectiveness of a 
      Supervised Exercise Programme for claudication.
PG  - 202-7
AB  - OBJECTIVES: The main aims of treatment in patients with intermittent claudication 
      (IC) are to improve the clinical indicators of lower limb ischaemia and patients' 
      quality of life (QoL). The aims of this study were assess the clinical and cost 
      effectiveness of a supervised exercise programme (SEP) in patients with IC. 
      DESIGN: Non-randomised, controlled trial. SETTING: University teaching hospital. 
      PATIENTS AND METHODS: Two groups of patients with IC were studied. Seventy 
      patients were sequentially recruited before and after the establishment of a 
      Supervised Exercise Programme at our unit. Thirty-seven patients (median age 69 
      years, 26 men) received conservative medical therapy (CMT) and 33 patients 
      (median age 67 years, 22 men) received CMT plus a 3 month SEP of graduated 
      physical exercise for sixty minutes, three times each week. Patients were 
      assessed prior to and at 6 months following treatment. At each assessment patient 
      reported walking distances (PRWD), treadmill claudication and maximal distances 
      (ICD and MWD), ankle brachial pressure indices (ABPI) pre & post exercise and 
      patient reported QoL using the SF36 questionnaire were assessed. RESULTS: Prior 
      to intervention the two groups were well matched. Following treatment, CMT 
      patients demonstrated no significant change in PRWD or ICD but did record a small 
      but significant improvement in MWD. CMT was also associated with a negative 
      effect size in the SF36 index and in 7 of the 8 SF36 QoL domains, effect size 
      >-0.5 for the domains of Physical Function and Emotional Role. SEP patients 
      demonstrated significant improvement in PRWD, ICD and MWD. SEP was associated 
      with a positive effect size in the SF36 index and in 2 SF36 QoL domains but a 
      negative effect size in a further 2 domains. However, all QoL effect sizes 
      following SEP were < +/-0.5. Intergroup differences in effect sizes were >0.5 for 
      the SF36 domains of Physical Function, Physical Role, Emotion Role and SF36 
      index. SEP resulted in a 0.027 quality adjusted life year (QALY) gain over CMT in 
      the first year post-treatment thus the cost/QALY gained of SEP is pound1780 at 1 
      year. CONCLUSIONS: Compared to CMT, SEP increases walking distances, improves QoL 
      and is a highly cost-effective treatment for IC.
FAU - Lee, H L D
AU  - Lee HL
AD  - Academic Vascular Surgical Unit, Vascular Laboratory, Alderson House, Hull Royal 
      Infirmary, Hull, UK.
FAU - Mehta, T
AU  - Mehta T
FAU - Ray, B
AU  - Ray B
FAU - Heng, M S T
AU  - Heng MS
FAU - McCollum, P T
AU  - McCollum PT
FAU - Chetter, I C
AU  - Chetter IC
LA  - eng
PT  - Controlled Clinical Trial
PT  - Journal Article
DEP - 20061204
PL  - England
TA  - Eur J Vasc Endovasc Surg
JT  - European journal of vascular and endovascular surgery : the official journal of 
      the European Society for Vascular Surgery
JID - 9512728
SB  - IM
MH  - Aged
MH  - Cost-Benefit Analysis
MH  - Exercise Therapy/*economics/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - *Intermittent Claudication/economics/physiopathology/therapy
MH  - Male
MH  - Middle Aged
MH  - Quality of Life
MH  - Treatment Outcome
MH  - Walking/*physiology
EDAT- 2006/12/05 09:00
MHDA- 2007/03/16 09:00
CRDT- 2006/12/05 09:00
PHST- 2006/06/11 00:00 [received]
PHST- 2006/08/29 00:00 [accepted]
PHST- 2006/12/05 09:00 [pubmed]
PHST- 2007/03/16 09:00 [medline]
PHST- 2006/12/05 09:00 [entrez]
AID - S1078-5884(06)00497-7 [pii]
AID - 10.1016/j.ejvs.2006.08.005 [doi]
PST - ppublish
SO  - Eur J Vasc Endovasc Surg. 2007 Feb;33(2):202-7. doi: 10.1016/j.ejvs.2006.08.005. 
      Epub 2006 Dec 4.