Sheffield Vascular Institute, Northern General Hospital, Sheffield, UK.
Eur J Vasc Endovasc Surg. 2013 Dec;46(6):690-706. doi: 10.1016/j.ejvs.2013.09.004. Epub 2013 Sep 11.
We aimed to conduct a systematic review of the evidence for structured, home-based exercise programmes (HEPs) in patients with intermittent claudication. The Medline, PsycINFO, EMBASE, and Cochrane databases were searched up to April 2013 for terms related to walking, self-management, and intermittent claudication. Descriptive, methodological and outcome data were extracted from eligible articles. Trial quality was assessed using the GRADE system. Seventeen studies were included with 1,457 participants. Six studies compared HEPs with supervised exercise training, five compared HEPs with usual care/observation control, and seven evaluated HEPs in a single-group design. Trial heterogeneity prevented meta-analysis. Nevertheless, there was "low-level" evidence that HEPs can improve walking capacity and quality of life in patients with intermittent claudication when compared with baseline or in comparison to usual care/observation control. In addition, improvements with HEPs may be inferior to those evoked by supervised exercise training. Considerable uncertainty exists regarding the long-term clinical and cost effectiveness of HEPs in patients with intermittent claudication. Thus, more robust trials are needed to build evidence about these interventions. Nevertheless, clinicians should consider using structured interventions to promote self-managed walking in patients with intermittent claudication, as opposed to simple "go home and walk" advice, when supervised exercise training is unavailable or impractical.
我们旨在对间歇性跛行患者的结构化家庭运动方案（HEPs）进行系统评价。检索了 Medline、PsycINFO、EMBASE 和 Cochrane 数据库，截至 2013 年 4 月，检索词与步行、自我管理和间歇性跛行有关。从合格的文章中提取描述性、方法学和结局数据。使用 GRADE 系统评估试验质量。纳入了 17 项研究，共 1457 名参与者。6 项研究将 HEP 与监督锻炼训练进行了比较，5 项研究将 HEP 与常规护理/观察对照进行了比较，7 项研究在单组设计中评估了 HEP。由于试验异质性，无法进行荟萃分析。然而，有“低水平”证据表明，与基线或常规护理/观察对照相比，HEPs 可以改善间歇性跛行患者的步行能力和生活质量。此外，HEP 引起的改善可能不如监督锻炼训练引起的改善。对于间歇性跛行患者的 HEP 的长期临床和成本效益存在相当大的不确定性。因此，需要更有力的试验来建立这些干预措施的证据。尽管如此，当无法进行或不实际进行监督锻炼训练时，临床医生应考虑使用结构化干预措施来促进间歇性跛行患者的自我管理步行，而不是简单的“回家散步”建议。
