TY - JOUR
T1 - The Effect of Supervised Exercise, Home Based Exercise and Endovascular Revascularisation on Physical Activity in Patients With Intermittent Claudication
T2 - A Network Meta-analysis
AU - van den Houten, Marijn M. L.
AU - Hageman, David
AU - Gommans, Lindy N. M.
AU - Kleijnen, Jos
AU - Scheltinga, Marc R. M.
AU - Teijink, Joep A. W.
N1 - Funding Information:
We would like to thank Gill Worthy from Kleijnen Systematic Reviews Ltd (York, UK) for her efforts and support in carrying out the Bayesian analyses.
Publisher Copyright:
© 2019 European Society for Vascular Surgery
PY - 2019/9
Y1 - 2019/9
N2 - Background: It is unclear whether supervised exercise therapy (SET), home based exercise therapy (HBET), and endovascular revascularisation (ER) for intermittent claudication (IC) have a meaningful impact on physical activity, despite extensive research on their effect on walking performance.Methods: Multiple databases were searched systematically up to May 2018 for randomised controlled trials with objective measurements of physical activity in patients with IC. A Bayesian network meta-analysis was performed comparing the change in physical activity between baseline and follow up between treatments (SET, HBET, ER) and control (usual care). The standardised mean difference (SMD) with 95% credible interval (CI) was calculated as a summary statistic and converted into steps per day to aid interpretation.Results: Eight trials involving 656 patients with IC investigating the short-term effect of treatment on daily physical activity were included. Both SET (SMD 0.41, 95% CI 0.10-0.72: this corresponds to a difference of 803 steps/day on a pedometer) and HBET (SMD 0.50, 95% CI 0.18-0.88: 980 steps/day) displayed a benefit over control, based on evidence of moderate and low quality, respectively. The benefit of ER compared with control was SMD 0.36 (95% CI -0.22 to 0.99: 705 steps/day), but only one trial supplied direct evidence, resulting in a low rating of the quality of evidence. Comparisons between treatments yielded no statistically significant differences. The results were robust to several sensitivity analyses.Conclusion: SET improves daily physical activity levels in patients with IC over control. HBET may have a similar benefit, while invasive treatment failed to lead to a statistically significant improvement of physical activity compared with control. However, the underlying quality of evidence for comparisons with ER and HBET is low, impeding definite conclusions.
AB - Background: It is unclear whether supervised exercise therapy (SET), home based exercise therapy (HBET), and endovascular revascularisation (ER) for intermittent claudication (IC) have a meaningful impact on physical activity, despite extensive research on their effect on walking performance.Methods: Multiple databases were searched systematically up to May 2018 for randomised controlled trials with objective measurements of physical activity in patients with IC. A Bayesian network meta-analysis was performed comparing the change in physical activity between baseline and follow up between treatments (SET, HBET, ER) and control (usual care). The standardised mean difference (SMD) with 95% credible interval (CI) was calculated as a summary statistic and converted into steps per day to aid interpretation.Results: Eight trials involving 656 patients with IC investigating the short-term effect of treatment on daily physical activity were included. Both SET (SMD 0.41, 95% CI 0.10-0.72: this corresponds to a difference of 803 steps/day on a pedometer) and HBET (SMD 0.50, 95% CI 0.18-0.88: 980 steps/day) displayed a benefit over control, based on evidence of moderate and low quality, respectively. The benefit of ER compared with control was SMD 0.36 (95% CI -0.22 to 0.99: 705 steps/day), but only one trial supplied direct evidence, resulting in a low rating of the quality of evidence. Comparisons between treatments yielded no statistically significant differences. The results were robust to several sensitivity analyses.Conclusion: SET improves daily physical activity levels in patients with IC over control. HBET may have a similar benefit, while invasive treatment failed to lead to a statistically significant improvement of physical activity compared with control. However, the underlying quality of evidence for comparisons with ER and HBET is low, impeding definite conclusions.
KW - Endovascular revascularisation
KW - Exercise
KW - Intermittent claudication
KW - Peripheral arterial disease
KW - Physical activity
KW - PERIPHERAL ARTERY-DISEASE
KW - BRIEF PSYCHOLOGICAL INTERVENTION
KW - WALKING PERFORMANCE
KW - DAILY-LIFE
KW - CAPACITY
KW - OUTCOMES
KW - PROGRAM
KW - TRIAL
KW - THERAPY
KW - PEOPLE
U2 - 10.1016/j.ejvs.2018.12.023
DO - 10.1016/j.ejvs.2018.12.023
M3 - (Systematic) Review article
C2 - 31235306
SN - 1078-5884
VL - 58
SP - 383
EP - 392
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
IS - 3
ER -