Exercise therapy for chronic symptomatic peripheral artery disease.

All guidelines worldwide strongly recommend exercise as a pillar in the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended to promote and assist the set up of comprehensive exercise programmes and best advice for patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are described based on the current best evidence. The document ends by highlighting supervised exercise programme access disparities across Europe and the evidence gaps requiring further research.

Exercise therapy for chronic symptomatic peripheral artery disease.

All guidelines worldwide strongly recommend exercise as a pillar of the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended for clinicians to promote and assist for the set-up of comprehensive exercise programmes to best advice in patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are narratively described based on the current best evidence. The document ends by highlighting disparities in access to supervised exercise programmes across Europe and the series of gaps for evidence requiring further research.

Exercise Therapy for Chronic Symptomatic Peripheral Artery Disease: A Clinical Consensus Document of the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases in Collaboration With the European Society of Vascular Medicine and the European Society for Vascular Surgery.

All guidelines worldwide strongly recommend exercise as a pillar in the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended to promote and assist the set up of comprehensive exercise programmes and best advice for patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are described based on the current best evidence. The document ends by highlighting supervised exercise programme access disparities across Europe and the evidence gaps requiring further research.

Cocreators' experiences and effectiveness of cocreated interventions in improving health behaviours of adults with non-communicable diseases: a systematic review protocol.

INTRODUCTION: Improved health behaviours and help-seeking behaviour reduce morbidity and mortality from non-communicable diseases (NCDs). Compliance with the recommendations of lifestyle changes for the management of NCDs has been challenging, as patients find it difficult to change and sustain lifestyle behaviours for a long period of time. Studies have reported that cocreated interventions are promising in addressing negative health behaviours and improving health outcomes in people with NCDs; however, no conclusive evidence exists. Therefore, this review aims to evaluate cocreators' experiences and the effectiveness of cocreated interventions in improving the health behaviours of individuals with NCDs. METHODS AND ANALYSIS: This review will follow the recommendations described in the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement for the synthesis of qualitative data. The following databases: Co-creation Database (https://zenodo.org/record/6773028%23.Y9h2sezP1pg), MEDLINE (via OVID), Cumulative Index to Nursing and Allied Health Literature (via EBSCO Host), EMBASE (via OVID), PsycINFO (via OVID), Scopus, Web of Science, Cochrane Library and grey literature will be searched. The identified studies will be independently screened by two reviewers to determine their eligibility. The review will target to include studies that investigated the experiences of cocreators and/or the effectiveness of cocreated interventions on the health behaviour and/or health outcomes of adults with NCDs. Two independent reviewers will also appraise the quality of the included studies, as well as data extraction. A narrative synthesis will be used to summarise the findings. Thematic synthesis and meta-analysis will be conducted for the qualitative and quantitative data, respectively. The qualitative and quantitative findings will be integrated using the parallel result convergent synthesis. ETHICS AND DISSEMINATION: Ethics approval is not applicable because the review will only use data from the published studies. The findings will be disseminated through publication in peer-reviewed journals and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42023391746.

Impact of PPAM aid use on the time to prosthetic limb delivery in patients with unilateral transtibial amputation: A retrospective analysis.

BACKGROUND: The pneumatic postamputation mobility (PPAM) aid is the most commonly used early walking aid in the United Kingdom in transtibial amputation (TTA) and promotes wound healing and prepares the stump for prosthetic limb fitting. Optimal guidelines for PPAM aid use and how these factors affect achievement of rehabilitation milestones have not yet been conclusively established. OBJECTIVE: To investigate the relationship between PPAM aid use and the time taken to achieve rehabilitation milestones in patients undergoing unilateral TTA. STUDY DESIGN: Retrospective case note analysis. METHODS: Case notes of patients from one National Health Service amputation rehabilitation center who were identified as having a unilateral TTA in 2017-2018 and fitted with a prosthesis were reviewed. RESULTS: One hundred seven patients (67.5% male; mean age of 59.9 years) were identified. Use of PPAM aid during inpatient physiotherapy was associated with the days to reach referral, casting, delivery of prosthetic limb, and inpatient discharge dates (r (105) =-0.345; -0.400; -0.423; 0.546, respectively, all P < 0.05). Frequency of PPAM aid use was associated with the time to reach casting (r (105) =-0.533, P < 0.05) and delivery (r (105) =-0.513, P < 0.05). The days to being PPAM aid use and the frequency of PPAM aid use were predictive of the days to reach referral, casting, delivery, and inpatient discharge. CONCLUSIONS: The use of the PPAM aid is associated with a reduction in the time taken to reach rehabilitation milestones. Early and more frequent use of PPAM aid during rehabilitation will decrease the time fit and delivery of the prosthetic limb.

Credibility, Accuracy, and Comprehensiveness of Readily Available Internet-Based Information on Treatment and Management of Peripheral Artery Disease and Intermittent Claudication: Review.

BACKGROUND: Peripheral artery disease (PAD) affects millions of people worldwide, and a core component of management of the condition is self-management. The internet is an important source of health information for many people. However, the content of websites regarding treatment recommendations for PAD has not been fully evaluated. OBJECTIVE: This study aimed to assess the credibility, accuracy, and comprehensiveness of websites found via a common search engine, by comparing the content to current guidelines for treatment and management of PAD and intermittent claudication (IC). METHODS: A review of websites from hospitals, universities, governments, consumer organizations, and professional associations in the United States and the United Kingdom was conducted. Website recommendations for the treatment of PAD and IC were coded in accordance with the guidelines of the National Institute for Health and Care Excellence (NICE) and the American Heart Association (AHA). Primary outcomes were website credibility (4-item Journal of the American Medical Association benchmark), website accuracy (in terms of the percentage of accurate recommendations), and comprehensiveness of website recommendations (in terms of the percentage of guideline recommendations that were appropriately covered). Secondary outcomes were readability (Flesch-Kincaid grade level) and website quality (Health On the Net Foundation's code of conduct). RESULTS: After screening, 62 websites were included in this analysis. Only 45% (28/62) of websites met the credibility requirement by stating they were updated after the NICE guidelines were published. Declaration of authorship and funding and the presence of reference lists were less commonly reported. Regarding accuracy, 81% (556/685) of website recommendations were deemed accurate on following NICE's and the AHA's recommendations. Comprehensiveness was low, with an average of 40% (25/62) of guideline treatment recommendations being appropriately covered by websites. In most cases, readability scores revealed that the websites were too complex for web-based consumer health information. CONCLUSIONS: Web-based information from reputable sources about the treatment and management of PAD and IC are generally accurate but have low comprehensiveness, credibility, and readability.

International, multi-disciplinary, cross-section study of pain knowledge and attitudes in nursing, midwifery and allied health professions students.

BACKGROUND: Persistent pain is a highly prevalent, global cause of disability. Research suggests that many healthcare professionals are not well equipped to manage pain, and this may be attributable at least in part to undergraduate education. The primary aim of this study was to quantify and compare first and final year nursing, midwifery and allied health professional (NMAHP) students' pain related knowledge and attitudes. The secondary aim was to explore what factors influence students' pain related knowledge and attitudes. METHODS: In this cross-sectional study, 1154 first and final year healthcare students, from 12 universities in five different countries completed the Revised Neurophysiology of Pain Quiz (RNPQ) [knowledge] and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS) [attitudes]. RESULTS: Physiotherapy was the only student group with statistically and clinically improved pain related knowledge [mean difference, 95% CI] (3.4, 3.0 to 3.9, p = 0.01) and attitudes (-17.2, -19.2 to 15.2, p = 0.01) between first and final year. Pain education teaching varied considerably from course to course (0 to 40 h), with greater levels of pain related knowledge and attitudes associated with higher volumes of pain specific teaching. CONCLUSIONS: There was little difference in pain knowledge and attitudes between all first and final year NMAHP students other than physiotherapy. This suggests that for most NMAHP disciplines, undergraduate teaching has little or no impact on students' understanding of pain. There is an urgent need to enhance pain education provision at the undergraduate level in NMAHPs. TRIAL REGISTRATION: The study protocol was prospectively registered at ClinicalTrials.Gov NCT03522857 .

The introduction of advanced paramedics into primary care in Northern Ireland: a qualitative descriptive study of the experiences of general practitioners.

BACKGROUND: Primary care is dealing with an ever-increasing workload. The causes are multi-factorial but include a decreasing number of General Practitioners (GPs), combined with increased numbers of patients with multiple co-morbidities and an ageing population. As a result of these pressures, nursing and allied health professionals are now working within a growing number of advanced practice roles delivering community-based care. One such example is paramedics taking up advanced roles within General Practice settings in Northern Ireland. What is not known, however, is what GPs' experiences are of these developments. AIMS: To examine the experiences of GPs who have introduced an advanced paramedic into their primary care team in Northern Ireland. DESIGN: A qualitative descriptive design was chosen as the most suitable approach to allow participants to relay their experiences in their own words within the loose confines of a semi-structured interview. METHODS: Semi-structured interviews were conducted with a group of four purposively selected GPs who had direct experience of the phenomena of interest. These interviews were transcribed verbatim, anonymised and then analysed thematically. RESULTS: The thematic analysis produced three superordinate themes of alleviating pressure, acceptance and psychological well-being. These were underpinned by seven ordinate themes that were supported using verbatim quotes. These were then discussed and contextualised with themes from existing literature. CONCLUSION: Generally, there was widespread support from the GPs for the introduction of advanced paramedics into primary care teams. The reasons were multi-factorial but the reduction in GP workload featured prominently. The participants reported benefits in terms of increased resilience and work-life balance. The capacity to provide a clinician with experience of dealing with acute and emergency presentations, in combination with managing routine procedures, was also reported to be of great importance.

Exercise therapy in routine management of peripheral arterial disease and intermittent claudication: a scoping review.

BACKGROUND: Little is known about the extent to which routine care management of peripheral arterial disease (PAD) and intermittent claudication (IC) align with best practice recommendations on exercise therapy. We conducted a scoping review to examine the published literature on the availability and workings of exercise therapy in the routine management of patients with PAD and IC, and the attitude and practice of health professionals and patients. METHODS: A systematic search was conducted in February 2018. The Cumulative Index of Nursing and Allied Health Literature, Ovid MEDLINE, Allied and Complementary Medicine Database, ScienceDirect, Web of Science and the Directory of Open Access Repositories were searched. Hand searching of reference lists of identified studies was also performed. Inclusion criteria were based on study aim, and included studies that reported on the perceptions, practices, and workings of routine exercise programs for patients with IC, their availability, access, and perceived barriers. RESULTS: Eight studies met the eligibility criteria and were included in the review. Studies conducted within Europe were included. Findings indicated that vascular surgeons in parts of Europe generally recognize supervised exercise therapy as a best practice treatment for IC, but do not often refer their patients for supervised exercise therapy due to the unavailability of, or lack of access to supervised exercise therapy programs. Available supervised exercise therapy programs do not implement best practice recommendations, and in the majority, patients only undergo one session per week. Some challenges were cited as the cause of the suboptimal program implementation. These included issues related to patients' engagement and adherence as well as resource constraints. CONCLUSION: There is a dearth of published research on exercise therapy in the routine management of PAD and IC. Available data from a few countries within Europe indicated that supervised exercise is underutilized despite health professionals recognizing the benefits. Research is needed to understand how to improve the availability, access, uptake, and adherence to the best exercise recommendations in the routine management of people with PAD and IC.

Knowledge, Attitudes, and the Practice of Health Promotion among Physiotherapists in Nigeria.

Purpose: In spite of the growing epidemic of non-communicable diseases in Nigeria and the compelling need for the active participation of physiotherapists in health promotion activities around the world, there is no evidence that physiotherapists in Nigeria are engaged in health promotion activities. This study aimed to investigate the knowledge of, attitudes toward, and practice of health promotion among physiotherapists practising in Nigeria. Method: This was a cross-sectional study. We contacted members of the Nigeria Society of Physiotherapy (n = 368) by email; the message contained a link to an online questionnaire. Results: A total of 229 (62%) physiotherapists responded. Most demonstrated a good knowledge of health promotion (approximately 70%) and indicated that they often incorporated aspects of health promotion into their patients' treatment (63%). However, fewer than one-fifth strongly agreed that health promotion was taught in their entry-level programme and had equipped them with the necessary health promotion skills. Conclusions: The majority of the physiotherapists surveyed demonstrated good knowledge and often incorporated health promotion into their routine daily practice. Nevertheless, the respondents stated that their entry-level physiotherapy education had not sufficiently equipped them for health promotion practice. These findings provide a baseline reference that can be used to track capacity building for health promotion practices. The results also highlight important gaps in the physiotherapy entry-level curriculum and the health promotion training needs of physiotherapists in Nigeria.

Objectif : malgré l'épidémie croissante de maladies non transmissibles au Nigeria et le besoin pressant de compter sur la participation active de physiothérapeutes aux activités de promotion de la santé dans le monde, rien n'indique que les physiothérapeutes du Nigeria s'investissent dans la promotion de la santé. La présente étude visait à examiner les connaissances, les attitudes et la pratique des physiothérapeutes qui exercent au Nigeria en matière de promotion la santé. Méthodologie : le présent sondage transversal a été distribué aux membres de la société de physiothérapie du Nigeria (n = 368) dans un message courriel contenant un lien vers un questionnaire en ligne. Résultats : au total, 229 physiothérapeutes (62 %) ont répondu. La plupart ont démontré une bonne connaissance de la promotion de la santé (environ 70 %) et indiqué qu'ils en intégraient souvent des aspects au traitement de leurs patients (63 %). Cependant, moins du cinquième était fortement en accord avec l'affirmation selon laquelle leur programme de base leur avait inculqué les compétences nécessaires en promotion de la santé. Conclusions : la majorité des physiothérapeutes sondés ont démontré de bonnes connaissances en promotion de la santé, qu'ils intégraient souvent à leur pratique quotidienne. Les répondants ont tout de même indiqué que leur formation de base en physiothérapie ne les outillait pas suffisamment pour qu'ils exercent des activités de promotion de la santé. Ces constatations serviront de référence à des mesures de renforcement des capacités dans les pratiques de promotion de la santé. Elles démontrent également des lacunes importantes dans le programme de base et la formation en promotion de la santé des physiothérapeutes du Nigeria.

Living a burdensome and demanding life: A qualitative systematic review of the patients experiences of peripheral arterial disease.

BACKGROUND: Peripheral arterial disease (PAD) has a significant negative impact on the quality of life of individuals. Understanding the experiences of people living with PAD will be useful in developing comprehensive patient-centred secondary prevention therapies for this population. AIM: The aim of this study is to identify first-hand accounts of patients' experiences of living with PAD. METHODS: Six databases (CINALH, PsyclNFO, MEDLINE, AMED, EMBASE, Social citation index/Science citation index via Web of Science (WOS)) and reference lists of identified studies were searched until September 2017 (updated February 2018). Qualitative studies reporting patients' account of living with PAD were eligible for inclusion. A framework thematic synthesis was implemented. RESULTS: Fourteen studies with 360 participants were included. Pain and walking limitation were recurrent among the varied symptom descriptions. Patients' ignorance and trivialisation of symptoms contributed to delays in diagnosis. Inadequate engagement in disease understanding and treatment decisions meant patients had poor attitudes towards walking treatments and unrealistic expectations about surgery. Depending on symptom progression, patients battle with walking impairment, powerlessness, and loss of independence which were a source of burden to them. Lack of disease understanding is central through patients' journey with PAD and, although they subsequently began adaptation to long term living with PAD, many worried about their future. CONCLUSIONS: Disease understanding is vital across the illness trajectory in patients with PAD. Although certain experiences are common throughout patient journey, some might be unique to a particular stage (e.g. unrealistic expectation about surgery, or rationale of walking in spite of pain in a supervised exercise program). Given that PAD is an overarching construct ranging from the mildest form of intermittent claudication to severe critical limb ischemia with ulceration and gangrene, consideration of important patient constructs specific to each stage of the disease may enhance treatment success. Systematic review registration CRD42017070417.

Barriers and enablers to walking in individuals with intermittent claudication: A systematic review to conceptualize a relevant and patient-centered program.

BACKGROUND: Walking limitation in patients with peripheral arterial disease (PAD) and intermittent claudication (IC) contributes to poorer disease outcomes. Identifying and examining barriers to walking may be an important step in developing a comprehensive patient-centered self-management intervention to promote walking in this population. AIM: To systematically review the literature regarding barriers and enablers to walking exercise in individuals with IC. METHODS: A systematic review was conducted utilizing integrative review methodology. Five electronic databases and the reference lists of relevant studies were searched. Findings were categorized into personal, walking activity related, and environmental barriers and enablers using a social cognitive framework. RESULTS: Eighteen studies including quantitative (n = 12), qualitative (n = 5), and mixed method (n = 1) designs, and reporting data from a total of 4376 patients with IC, were included in the review. The most frequently reported barriers to engaging in walking were comorbid health concerns, walking induced pain, lack of knowledge (e.g. about the disease pathology and walking recommendations), and poor walking capacity. The most frequently reported enablers were cognitive coping strategies, good support systems, and receiving specific instructions to walk. Findings suggest additionally that wider behavioral and environmental obstacles should be addressed in a patient-centered self-management intervention. CONCLUSIONS: This review has identified multidimensional factors influencing walking in patients with IC. Within the social cognitive framework, these factors fall within patient level factors (e.g. comorbid health concerns), walking related factors (e.g. claudication pain), and environmental factors (e.g. support systems). These factors are worth considering when developing self-management interventions to increase walking in patients with IC. Systematic review registration CRD42018070418.

Transcutaneous Electrical Nerve Stimulation Improves Walking Performance in Patients With Intermittent Claudication.

The purpose of this study was to investigate the effects of 2 types of transcutaneous electrical nerve stimulation (TENS) on walking distance and measures of pain in patients with peripheral arterial disease (PAD) and intermittent claudication (IC). In a phase 2a study, 40 participants with PAD and IC completed a graded treadmill test on 2 separate testing occasions. Active TENS was applied to the lower limb on the first occasion; and placebo TENS, on the second. The participants were divided into 2 experimental groups. One group received high-frequency TENS; and the other, low-frequency TENS. Measures taken were initial claudication distance, functional claudication distance, and absolute claudication distance. The McGill Pain Questionnaire (MPQ) vocabulary was completed at the end of the intervention, and the MPQ-Pain Rating Index score was calculated. Four participants were excluded from the final analysis because of noncompletion of the experimental procedure. Median walking distance increased with high-frequency TENS for all measures (P < .05, Wilcoxon signed rank test, all measures). Only absolute claudication distance increased significantly with low-frequency TENS compared with placebo (median, 179-228; Ws = 39; z = 2.025; P = .043; r = 0.48). No difference was observed between reported median MPQ-Pain Rating Index scores: 21.5 with placebo TENS and 21.5 with active TENS (P = .41). Transcutaneous electrical nerve stimulation applied to the lower limb of the patients with PAD and IC was associated with increased walking distance on a treadmill but not with any reduction in pain. Transcutaneous electrical nerve stimulation may be a useful adjunctive intervention to help increase walking performance in patients with IC.

Preparing students to work effectively in interprofessional health and social care teams.

Interprofessional education (IPE) has 'learning to work effectively in interprofessional teams' as one of its central learning outcomes. Whilst much is made in IPE of allocating health and social care students into interprofessional teams and setting them a task to complete, it has proved difficult to find a fair and equitable method of assessing how effective each individual has been in contributing to the task. This difficulty is compounded when the module is delivered predominantly online. This paper describes the recent push to establish meaningful educational outcomes for those involved in delivering IPE to pre-registration health and social care students. It then describes the use of a web-based peer assessment tool (Web PA) developed at Loughborough and Hull Universities (UK) which has been adapted by Glasgow Caledonian University (UK) for assessing the outcome of contributing effectively to IPE-related online group tasks. The paper outlines how the process of web-based peer assessment operates in theory and how it has been received in practice. An illustration is given that shows how the process successfully discriminates between those that are working effectively in interprofessional teams and those that are not. The value of the process is discussed.

Modification of experimental, lower limb ischemic pain with transcutaneous electrical nerve stimulation.

INTRODUCTION: Transcutaneous electrical nerve stimulation (TENS) has been shown to be effective for the reduction of experimentally induced ischemic pain in the upper limb. No studies have been published on the effects of TENS for lower limb ischemic pain. OBJECTIVES: To investigate the pain-modifying effect of TENS on experimentally induced ischemic pain in the lower limb. METHODS: A modified Submaximal Effort Tourniquet Test-induced ischemic pain in the nondominant lower limb of 27 healthy volunteers. Each of the participants completed a baseline modified Submaximal Effort Tourniquet Test (No TENS) and 1 of the experimental conditions: either high-frequency TENS (HF-TENS) or placebo TENS (P-TENS). The outcome measures were the time taken (in seconds) for the participants to report pain threshold and pain tolerance. Pain endurance was calculated as the difference between these points. Pain intensity during ischemia was assessed using a numerical rating scale. The McGill Pain Questionnaire recorded participants' retrospective description of 'intolerable' induced pain. The differences in scores between these measures at the baseline and TENS intervention was calculated and used for the analysis. RESULTS: Paired Student t-tests found significant increases in time to pain tolerance and pain endurance in both the TENS groups (P<0.001 HF-TENS and P<0.05 for P-TENS, respectively). When compared with baseline, time to pain threshold increased significantly only with HF-TENS (P<0.01). The independent Student t-tests detected greater increases in pain threshold, tolerance, and endurance in the HF-TENS group compared with the P-TENS group (P<0.05, 0.002, and 0.003, respectively). Compared with P-TENS, HF-TENS significantly reduced the pain intensity between the fifth and eigth minutes. Both HF-TENS and P-TENS significantly reduced the mean McGill Pain Questionnaire Pain Rating Index scores, but did not show a between-group difference. CONCLUSIONS: HF-TENS had stronger modifying effects on several aspects of laboratory-induced ischemic pain than did P-TENS. HF-TENS delayed the onset of pain, reduced pain levels, and delayed the onset of extreme pain over a period of several minutes.