Collins Tracie C, Johnson Shawna L, Souchek Julianne
Division of General Internal Medicine, Department of Medicine, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55455, USA.
Ann Behav Med. 2007 Jun;33(3):318-24. doi: 10.1007/BF02879914.
Although only a small percentage of patients with peripheral arterial disease (PAD) have claudication, many more suffer from atypical leg symptoms.
This pilot trial evaluated a risk-factor modification program to improve walking ability in patients with PAD and leg symptoms other than intermittent claudication.
Patients 18 years or older with an ankle-brachial index (ABI) of 0.50 to 0.89 completed a baseline assessment of current walking ability, physical activity level, health-related quality of life, glycosylated hemoglobin values, and fasting lipid profiles. Patients were randomized to usual care (control group) versus usual care plus an educational intervention on risk-factor management (intervention group). We compared functional outcomes between and within groups using the Student's t test and control and intervention group outcomes at 12 weeks using analysis of covariance with the baseline value as the covariate.
We randomized 50 patients into two treatment arms. There was no difference in the mean age of patients in each group. At baseline, mean ABI for the control versus the intervention group was 0.72 (SD = 0.10) and 0.75 (SD = 0.10), respectively, and mean stair-climbing values did not differ between groups. At 12 weeks, mean stair-climbing values were 40.2 (SD = 30.2) for the control and 61.2 (SD = 32.8) for the intervention group. The difference in adjusted mean walking distance between groups at 12 weeks was not significant. Analysis of covariance associated assignment to the intervention versus the control arm with a significant increase at 12 weeks in the ABI (p = .008) and stair-climbing ability (p = .02).
Patients in the intervention group improved objective measures of blood flow and reported stair-climbing ability.
尽管只有一小部分外周动脉疾病（PAD）患者有间歇性跛行，但更多患者存在非典型腿部症状。
本试点试验评估了一项风险因素修正计划，以改善患有PAD且有间歇性跛行以外腿部症状患者的步行能力。
年龄在18岁及以上、踝臂指数（ABI）为0.50至0.89的患者完成了对当前步行能力、身体活动水平、健康相关生活质量、糖化血红蛋白值和空腹血脂谱的基线评估。患者被随机分为常规护理组（对照组）和常规护理加风险因素管理教育干预组（干预组）。我们使用学生t检验比较组间和组内的功能结局，并使用协方差分析以基线值作为协变量比较12周时对照组和干预组的结局。
我们将50名患者随机分为两个治疗组。每组患者的平均年龄无差异。基线时，对照组与干预组的平均ABI分别为0.72（标准差=0.10）和0.75（标准差=0.10），两组间的平均爬楼梯值无差异。在12周时，对照组的平均爬楼梯值为40.2（标准差=30.2），干预组为61.2（标准差=32.8）。两组在12周时调整后的平均步行距离差异不显著。协方差分析显示，与对照组相比，干预组在12周时ABI（p = 0.008）和爬楼梯能力（p = 0.02）有显著提高。
干预组患者改善了血流的客观指标，并报告了爬楼梯能力。
