Impact of psychological factors on objective ambulatory measures in patients with intermittent claudication.

OBJECTIVE: The purpose of this study was to evaluate the difference in objective measures of ambulation and psychosocial factors in patients with intermittent claudication (IC) stratified by type D personality, which incorporates elements of social inhibition and negative affectivity. METHODS: During a 1-year period, routine history and physical examination, ankle-brachial index, and pulse volume recording were performed on IC patients. Questionnaires assessing type D personality and psychosocial factors were also collected. The 6-minute walk test (6MWT) was performed, assessing symptoms and distance walked. Univariate and multivariate methods were used to assess the association between ambulation and type D personality. RESULTS: Seventy-one patients were enrolled (mean age, 62.5 ± 1.1 years; mean ankle-brachial index, 0.55 ± 0.03). Mean distance to symptoms and total distance walked were 83.7 ± 80.1 m and 206.5 ± 126.3 m, respectively. Type D personality was present in 29.6% of the population (n = 21). On 6MWT, 83.1% of all patients developed symptoms, and 57.4% quit because of symptoms. Univariate analysis of objective measures of ambulation demonstrated lower distance to symptoms in the type D group and trends toward lower total distance walked and quitting the 6MWT. Multivariate models showed increased odds of quitting the 6MWT (odds ratio, 7.71; P = .01) and less total distance walked by an average of 33.2 ± 13.3 m (P = .02) for the type D group. CONCLUSIONS: Despite equivalent demographic, medical, and psychosocial factors, the type D group was limited in ambulation, suggesting that type D personality is a strong predictor of disease impact in patients with IC.

An Exploration of the Impact of the "Open Gym" Scheduling Model of Cardiovascular Rehabilitation on Completion, Attendance, and Health Outcomes.

PURPOSE: To explore the effects of implementation of the "Open Gym" (OG) scheduling model of cardiovascular rehabilitation administration on the rate of patient engagement and change in commonly measured clinical outcomes. Little data exist on the potential benefits of the OG model on patient completion, attendance, and clinical outcomes. METHODS: A retrospective chart review was conducted that included the 1-y period both before and after OG model implementation. Bootstrapped regression and analysis of variance were utilized to determine (1) whether the scheduling model is associated with number of sessions attended and program completion, and (2) among those who meet their goals and thus complete the program, if the scheduling model predicts change in cardiovascular rehabilitation clinical outcomes (ie, percent weight change, 6-min walk distance, and peak metabolic equivalents during exercise) when controlling for baseline values. Follow-up analyses controlled for and explored interactions related to age, race, and sex. RESULTS: In this racially diverse sample (34% nonwhite), patients under either the OG model (n = 125) or the Traditional model (n = 82) attended an equivalent number of sessions and were just as likely to complete their treatment. However, clinical outcomes favored the Traditional model, even as more patients participated in the OG model, especially racial minority patients. CONCLUSIONS: Although the OG model is more consistent with patient-centered care, gains in functional capacity may be diminished. Furthermore, better controlled experiments are needed to examine the effects of implementing the OG model and should include measures of possible mechanisms influencing racial differences.