Radboud university medical center, IQ Health science department, Nijmegen, The Netherlands.
Chronisch ZorgNet, Eindhoven, The Netherlands.
BMJ Open Qual. 2024 Feb 20;13(1):e002594. doi: 10.1136/bmjoq-2023-002594.
To support the optimisation of supervised exercise therapy (SET) in patients with intermittent claudication, we developed personalised outcomes forecasts (POFs), which visualise estimated walking distance and quality of life for individual patients. The POFs may enable healthcare professionals, such as physical and exercise therapists, to improve shared decision-making and patient outcomes.
To assess differences in patient outcomes (functional walking distance, maximal walking distance and health-related quality of life) and the level of shared decision-making before and after the implementation of POFs in the conservative treatment of patients with intermittent claudication.
An interrupted time series design was used to compare preimplementation and postimplementation differences on patient outcomes. Using routinely collected data, differences from baseline to 6 months were compared between patients before and patients after the implementation. To compare levels of shared decision-making, we conducted observations of initial consults within a sample of physical or exercise therapists both before and after the implementation. Audiorecords of observations were scored on shared decision-making using the OPTION-5 instrument.
Differences in improvements between patients with whom POFs were discussed (n=317) and patients before the implementation of POFs (n=721) did not reach statistical significance for both functional walking distance (experimental vs. control=+23%, p=0.11) and maximal walking distance (experimental vs. control=+21%, p=0.08). For health-related quality of life, the POFs-informed patients showed a statistically significant greater improvement of 4% (p=0.04). Increased levels of shared decision-making were observed in postimplementation consults (n=20) when compared with preimplementation consults (n=36), as the median OPTION-5 total score showed a statistically significant increase from 45 to 55 points (p=0.01).
Integrating POFs into daily practice of SET for patients with intermittent claudication could assist in improving health-related quality of life and enhancing patient involvement. Using POFs did not result in statistically significant different improvements between groups on walking distances.
NL8838.
为了支持间歇性跛行患者的监督运动治疗（SET）的优化，我们开发了个性化结果预测（POF），可以为个体患者可视化估计的步行距离和生活质量。POF 可以使物理治疗师和运动治疗师等医疗保健专业人员能够改善共同决策和患者结果。
评估 POF 在间歇性跛行患者保守治疗中的实施前后患者结局（功能性步行距离、最大步行距离和健康相关生活质量）和共同决策水平的差异。
使用中断时间序列设计比较患者结局的实施前后差异。使用常规收集的数据，将患者实施前后的基线至 6 个月的差异进行比较。为了比较共同决策水平，我们在实施前后对物理治疗师或运动治疗师的初始咨询进行了观察。使用 OPTION-5 工具对观察结果的共享决策进行评分。
在讨论 POF 的患者（n=317）和未实施 POF 的患者（n=721）之间，功能性步行距离（实验组与对照组的差异为+23%，p=0.11）和最大步行距离（实验组与对照组的差异为+21%，p=0.08）的改善差异均无统计学意义。在健康相关生活质量方面，POF 告知的患者表现出统计学上显著的 4%的改善（p=0.04）。与实施前的咨询相比，实施后的咨询中观察到共享决策水平的提高（n=20），因为 OPTION-5 总分中位数从 45 分增加到 55 分（p=0.01）。
将 POF 整合到间歇性跛行患者的 SET 日常实践中可以帮助提高健康相关生活质量并增强患者参与度。使用 POF 并未导致步行距离上组间的统计学上显著改善差异。
NL8838。
