Kruidenier Lotte M, Nicolaï Saskia P, Hendriks Erik J, Bollen Ewald C, Prins Martin H, Teijink Joep A W
Department of Surgery, Atrium Medical Centre Parkstad, Heerlen, The Netherlands.
J Vasc Surg. 2009 Feb;49(2):363-70. doi: 10.1016/j.jvs.2008.09.042. Epub 2008 Nov 22.
This study describes the results and functioning of community-based supervised exercise therapy (SET) at one year of follow-up.
We conducted a prospective cohort study of community-based SET in regional physiotherapeutic practices. Consecutive patients with intermittent claudication referred for community-based SET were included. Exclusion criteria for SET were pain at rest or tissue loss. All patients received a diagnostic workup consisting of an ankle-brachial index at rest and after exercise. Interventions were exercise therapy according to the guidelines of the Royal Dutch Society for Physiotherapy. The primary outcome measurement was the increase in absolute claudication distance (ACD), assessed using a standardized treadmill protocol by a physiotherapist at baseline and at four, 12, 26, and 52 weeks of SET.
From January 2005 through September 2006, 349 patients were referred by vascular surgeons for community-based SET. A total of 272 patients with intermittent claudication began the program. Of the 349 initially referred patients, 52 could not perform a standard treadmill test but did start community-based SET at a lower level, and 25 patients never started the program. At one year, 129 of the original 272 patients who began community-based SET (47.4%) were available for analysis of walking distance. In the interim, 143 patients discontinued the program for the following reasons: satisfaction with the acquired walking distance (n = 19); unsatisfying results (n = 26); not motivated (n = 22); (non)vascular intercurrent disease (n = 48); and other reasons (n = 28). ACD increased significantly from a median of 400 m at baseline to 1100 m after 12 months of follow-up (P < .001), corresponding to a median increase of 107.8%.
Community-based SET seems as effective as SET in a hospital-based approach in improving walking distance, however, it has a high dropout rate.
本研究描述了社区监督下运动疗法（SET）在随访一年时的结果及运行情况。
我们在区域物理治疗机构中对基于社区的SET进行了一项前瞻性队列研究。纳入了因间歇性跛行而被转诊接受社区SET的连续患者。SET的排除标准为静息痛或组织缺失。所有患者均接受了包括静息及运动后踝肱指数在内的诊断性检查。干预措施为根据荷兰皇家物理治疗协会指南进行的运动疗法。主要结局指标为绝对跛行距离（ACD）的增加，由物理治疗师在基线以及SET的第4、12、26和52周时使用标准化跑步机方案进行评估。
从2005年1月至2006年9月，血管外科医生转诊了349例患者接受基于社区的SET。共有272例间歇性跛行患者开始了该项目。在最初转诊的349例患者中，52例无法进行标准跑步机测试，但以较低强度开始了社区SET，25例患者从未开始该项目。一年时，最初开始社区SET的272例患者中有129例（47.4%）可用于步行距离分析。在此期间，143例患者因以下原因退出该项目：对获得的步行距离满意（n = 19）；结果不满意（n = 26）；缺乏动力（n = 22）；（非）血管并发疾病（n = 48）；以及其他原因（n = 28）。随访12个月后，ACD从基线时的中位数400米显著增加至1100米（P < .001），对应中位数增加107.8%。
基于社区的SET在改善步行距离方面似乎与基于医院的SET一样有效，然而，其退出率较高。
