Fear of falling in claudicants and its relationship to physical ability, balance, and quality of life.

OBJECTIVES: Intermittent claudication is associated with poor physical function, quality of life (QoL), and balance impairment. Fear of falling (FoF) is a recognized contributing factor to poor physical ability. Any link between claudication and FoF is yet to be determined. This study aimed to explore the prevalence of FoF in claudicants and its relationship with physical function and QoL. METHODS: A prospective observational study was performed. Fear of falling was determined using the Activities-specific Balance Confidence (ABC) questionnaire and the categorical question "Are you afraid of falling?" Physical ability and QoL (Short Form 36 and Vascular QoL) were determined. RESULTS: A total of 161 claudicants (118 men, median age of 69 years) were assessed; 83 answered the categorical question "Are you afraid of falling?" By receiver-operating characteristic curve analysis, an ABC threshold <74% denoted a FoF, which was associated with poorer physical function and QoL. CONCLUSION: Fear of falling is associated with poor physical, social, and psychological function, addressing this may improve all aspects of health.

Percutaneous transluminal angioplasty results in improved physical function but not balance in patients with intermittent claudication.

OBJECTIVE: The aim of this study was to identify whether revascularization by percutaneous transluminal angioplasty (PTA) for patients with intermittent claudication improved measures of functional performance including balance. METHODS: A prospective observational study was performed at a single tertiary vascular center. Patients with symptomatic intermittent claudication (Rutherford grades 1-3) were recruited to the study. Participants were assessed at baseline (pre-PTA) and then 3, 6, and 12 months post-PTA for markers of (1) lower limb ischemia (treadmill walking distances and ankle-brachial pressure index), (2) physical function (6-minute walk, Timed Up and Go, and chair stand time), (3) balance impairment using computerized dynamic posturography with the Sensory Organization Test, and (4) quality of life (VascuQoL and Short Form Health Survey [SF-36]). RESULTS: Forty-three participants underwent PTA. Over 12 months, a significant improvement was demonstrated in initial (P = .04) and maximum treadmill walking distance (P = .019). Physical functional ability improved across all outcome measures (P < .02), and some domains of both generic (P < .03) and disease-specific quality of life (P < .01). No significant improvement in balance was demonstrated by the Sensory Organization Test (P = .24). CONCLUSIONS: Balance impairment is common in claudicants and does not improve with revascularization. Further research regarding effective treatment of balance impairment is required in this specific group of patients.

Balance impairment, physical ability, and its link with disease severity in patients with intermittent claudication.

BACKGROUND: To determine whether increasing claudication severity is associated with impaired balance and physical functional ability. METHODS: A prospective observational study in claudicants was performed. Disease severity was determined according to Rutherford's criteria. Patient's balance was assessed objectively using computerized dynamic posturography (CDP-Sensory Organization Test [SOT]; NeuroCom). "Bedside" assessment of balance was performed using the Timed Up and Go (TUG) test (dynamic balance) and the Full Tandem Stance test (static balance). Physical function was assessed using the Summary Physical Performance Battery (SPPB) score. RESULTS: 185 claudicants were assessed (median age of 69 [IQR 63-74] years; 137 [74.1%] men). Fourteen claudicants were classified as Rutherford grade 0, 26 as grade I, 76 as grade II, and 69 as grade III. All Rutherford groups were comparable for age, gender, BMI, and comorbidities. Increasing Rutherford grade was associated with a significant deterioration in objective balance as determined by a failed SOT test: 3 (21.4%) in grade 0; 9 (34.6%) in grade I; 39 (52.7%) in grade II; and 41 (59.4%) in grade III (chi-squared 9.693, df 3, P = 0.021). A significant difference was also found with dynamic balance (TUG test), but not static balance (full tandem stance). Increasing claudication severity was also associated with significantly worse physical function: SPPB score. CONCLUSIONS: Specific objective tests demonstrate impaired balance and physical function are common in claudicants and become more frequent with increasing severity of claudication. Simple "bedside" measures may be sufficiently sensitive to detect this.

The effect of a 3-month supervised exercise programme on gait parameters of patients with peripheral arterial disease and intermittent claudication.

BACKGROUND: The management of peripheral arterial disease with intermittent claudication includes angioplasty, pharmaceutical therapy, risk factor modification and exercise therapy. Supervised exercise programmes are used sporadically but may improve the distance that an individual with claudication can walk. The purpose of this study was to evaluate the effectiveness of a 3-month supervised exercise programme on improving gait parameters in patients with intermittent claudication. METHODS: 12 participants were recruited (mean (SD) - age: 67.3 (6.8) years, height: 1.67 (0.09) m, mass: 79.4 (14.0) kg, ankle brachial pressure index: 0.73 (0.17)) from the local vascular unit and enrolled in a supervised exercise programme. Kinematic and kinetic data were collected at the following time points: pain-free walking, initial claudication pain, absolute claudication pain and after a patient-defined rest period. Data were collected before and after the 3-month supervised exercise programme. FINDINGS: No significant differences were found in any of the gait parameters post-intervention including pain-free walking speed (P=0.274), peak hip extension (P=0.125), peak ankle plantarflexion (P=0.254), or first vertical ground reaction force peak (P=0.654). No significant gait differences were found across different levels of pain pre- or post-intervention. INTERPRETATION: The lack of improvement post-intervention observed suggests that the current exercise protocol was not tailored to elicit significant improvements in patients with intermittent claudication, specifically. The results indicate that exercise programmes may show improved results post-intervention if they are longer in duration and varied in intensity. Further research into more detailed muscle and biomechanical adaptations is needed to inform exercise programmes specific to this population.

Computerized dynamic posturography in the objective assessment of balance in patients with intermittent claudication.

One-third of all elderly patients fall each year and impaired balance has been recognized as a specific risk factor. Intermittent claudication is common among the elderly population, affecting approximately 5% of the population over the age of 50. The aim of this proof-of-concept study was to assess the prevalence of impaired balance among elderly claudicants and to assess each patient's insight into their own risk of falling. A total of 58 claudicants (45 men), median age of 70 (interquartile range = 65-73) years, underwent objective balance assessment by using computerized dynamic posturography. As compared with 195 (5%) historic controls, 24 (41%) of the claudicants demonstrated abnormal balance when the Sensory Organization Test (SOT) was used. Vestibular dysfunction occurred in 52% of the claudicants. Abnormalities including somatosensory (22%), visual function (17%), and preferential reliance on inaccurate visual cues (17%) occurred less often. Prolonged Motor Control Test latency times were uncommon (n = 13) and were in most cases evenly distributed between those with normal (n = 7) and abnormal (n = 6) composite SOT scores. There was a significant difference in history of falling between claudicants with abnormal and normal SOT scores (p = 0.003), with a higher number of patients with abnormal SOT having experienced falling in the past year. However, no correlation between fear of falling and composite SOT score was found (Spearman rank correlation, r = 0.124; p = 0.381). Impaired balance, particularly secondary to vestibular problems, is very common among claudicants and may predispose to a high incidence of falls. Claudicants with abnormal balance are more likely to have a history of falls but not a fear of falling, thus potentially rendering these patients to be at a greater risk.

Kinematic adaptations to ischemic pain in claudicants during continuous walking.

Intermittent claudication has been associated with impaired gait and balance. The study aim was to compare gait adaptations over time between claudicants classified with good versus poor balance. Kinematic data were collected from 24 claudicants during continuous walking. Balance was assessed using; Timed Up and Go test (TUG), and Sensory Organisation (SOT) and Motor Control (MCT) Tests using NeuroCom Equitest®. 'Good balance' (GB) was operationally defined as those claudicants achieving normal scores on at least 2 of 3 tests whereas 'poor balance' (PB) claudicants achieved normal scores on 0 or 1 test. Temporal-spatial and sagittal plane joint kinematics were analysed at three time intervals; 'no pain' (prior to onset), 'initial pain' and 'maximal pain' (unable to continue walking). A two-way mixed design ANOVA was performed. Claudicants demonstrated a significant decrease in walking speed, step frequency and increased time in double support (p<0.05). Inter-group analysis showed no differences between GB and PB on any temporal-spatial or kinematic parameters (p>0.05). There was no significant time and group interaction for any temporal-spatial or kinematic variable except hip flexion. GB claudicants demonstrated increased hip flexion as pain progressed but this adaptive strategy was not seen in PB claudicants. Claudicants make adaptations to walking by slowing (down) when in pain. Differences between GB and PB were not seen in temporal-spatial or ankle, knee and pelvic kinematic gait parameters. However adaptation to pain in GB claudicants involved a hip strategy, not seen in PB claudicants.