Department of Biomechanics, University of Nebraska at Omaha, Omaha, Neb; Department of Surgery and Research Service, Veterans' Affairs Medical Center of Nebraska and Western Iowa, Omaha, Neb.
Department of Surgery and Research Service, Veterans' Affairs Medical Center of Nebraska and Western Iowa, Omaha, Neb; Department of Surgery, University of Nebraska Medical Center, Omaha, Neb.
J Vasc Surg. 2021 Dec;74(6):1987-1995. doi: 10.1016/j.jvs.2021.04.069. Epub 2021 May 31.
Supervised exercise therapy (SET) is a first-line treatment for patients with peripheral artery disease (PAD). The efficacy of SET is most commonly expressed by significant statistical improvement of parameters that do not clarify how each individual patient will benefit from SET. This study examined the minimal clinically important difference (MCID) in walking speed in claudicating patients with PAD after SET.
A total of 63 patients with PAD-related claudication (Fontaine stage II PAD) participated in a 6-month SET program. Self-selected walking speed was measured before and after SET. Distribution and anchor-based approaches were used to estimate the MCID for small and substantial improvement. The ability to walk one block and the ability to climb one flight of stairs questions were chosen as anchor questions from the Medical Outcomes Study 36-item Short Form questionnaire. Receiver operating characteristics curve analyses were performed to detect the threshold for MCID in walking speed after treatment.
The distribution-based method estimated 0.03 m/s as a small improvement and 0.08 m/s as a substantial improvement after SET. Small and substantial improvements according to the anchor question walking one block were 0.05 m/s and 0.15 m/s, respectively. For the climbing one flight of stairs anchor question, 0.10 m/s was a small improvement. Receiver operating characteristics curve analyses identified an increase of 0.04 m/s and 0.03 m/s for improvement based on walking one block and climbing one flight of stairs, respectively.
We report our findings for the MCID for walking speed among claudicating patients receiving SET. Claudicating patients who increase walking speed of 0.03 m/s or greater are more likely to experience a meaningful improvement in walking impairment than those who do not. The MCID reported in this study can serve as a benchmark for clinicians to develop goals and interpret clinically meaningful progress in the care of claudicating patients with PAD.
监督下的运动疗法（SET）是外周动脉疾病（PAD）患者的一线治疗方法。SET 的疗效最常通过参数的显著统计学改善来表示，这些参数并不能说明每个患者将如何受益于 SET。本研究检查了 PAD 间歇性跛行患者接受 SET 后行走速度的最小临床重要差异（MCID）。
共有 63 名 PAD 相关间歇性跛行（Fontaine Ⅱ期 PAD）患者参加了 6 个月的 SET 计划。在 SET 前后测量自我选择的行走速度。使用分布和基于锚定的方法来估计微小和实质性改善的 MCID。从医疗结局研究 36 项简短形式问卷中选择了能够走一个街区和爬一段楼梯的问题作为锚定问题。进行了受试者工作特征曲线分析，以检测治疗后行走速度 MCID 的阈值。
基于分布的方法估计 SET 后 0.03m/s 为微小改善，0.08m/s 为实质性改善。根据步行一个街区的锚定问题，小的和实质性的改善分别为 0.05m/s 和 0.15m/s。对于爬一段楼梯的锚定问题，0.10m/s 为微小改善。受试者工作特征曲线分析确定，基于步行一个街区和爬一段楼梯，改善分别增加 0.04m/s 和 0.03m/s。
我们报告了接受 SET 的间歇性跛行患者行走速度 MCID 的发现。与未增加行走速度的患者相比，行走速度增加 0.03m/s 或更多的间歇性跛行患者更有可能在行走障碍方面经历有意义的改善。本研究报告的 MCID 可以作为临床医生为间歇性跛行 PAD 患者制定目标和解释临床有意义进展的基准。
