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[Effectiveness of therapeutic physical exercise in patients with intermittent claudication due to peripheral arterial disease: a review]

Bibliographic details: Cebria Iranzo MA, Sentandreu Mano T, Baviera Ricart MC, Igual Camacho C.  [Effectiveness of therapeutic physical exercise in patients with intermittent claudication due to peripheral arterial disease: a review]. [Efectividad del ejercicio fisico terapeutico en pacientes con claudicacion intermitente por enfermedad arterial periferica: una revision.] Fisioterapia 2010; 32(4): 172-182

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Effects of walking and strength training on walking capacity in individuals with claudication: meta-analysis

Bibliographic details: Miranda AS, Rodrigues LB, Rodrigues SL, Cardoso Junior CG, Menacho MO, Christofaro DG, Ritti-Dias RM.  Effects of walking and strength training on walking capacity in individuals with claudication: meta-analysis. Jornal Vascular Brasileiro 2013; 12(2): 110-117 Available from: http://www.scielo.br/scielo.php?script=sci_abstract&pid=S1677-54492013000200110

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

PGE1 and other prostaglandins in the treatment of intermittent claudication: a meta-analysis

In intermittent claudication, pharmacologic drugs and invasive measures are indicated in patients who do not benefit from exercise training. To evaluate the therapeutic role of prostaglandins (PGs), especially of prostaglandin E1 (PGE1), for this indication, the author performed a meta-analysis of all published prospective, randomized, controlled clinical studies in which descriptive sample statistics of the pain-free walking distance (PFWD) and the maximum walking distance (MWD) were available. In total, 9 studies with PGE1 and 4 studies with other PGs (beraprost, iloprost, AS-013) that met these selection criteria could be analyzed. In patients treated with PGE1 (n = 344), PFWD increased significantly (p < 0.001) more (+107%) than in patients treated with other PGs (n = 402; +42%) or placebo (n = 470; +24%). Similar results were also found for the MWD. Side effects were significantly (p < 0.001) fewer with PGE1 therapy than with other PGs (14.0% vs 30.8% of patients). In conclusion, PGE1 proved to be the most effective and best tolerated of the PGs evaluated.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Treating intermittent claudication with Tibetan medicine Padma 28: does it work?

The authors concluded that Padma 28 provides significant relief from peripheral arterial occlusive disease-related symptoms (e.g. walking distance). However, given the methodological limitations of this review, the reliability of the authors' conclusions is questionable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Exercise-based interventions and health-related quality of life in intermittent claudication: a 20-year (1989-2008) review

Peripheral arterial disease (PAD) is a chronic, progressive disease with significant cardiovascular risk. Symptoms include pain in leg muscles on walking, relieved by rest (intermittent claudication). Treatment aims to maintain or improve quality of life (QoL) by minimising ischaemic symptoms and preventing progression to vascular occlusion. Management strategies include exercise-based interventions. Research from 1989 to 2008 was systematically reviewed to identify the QoL impact of exercise-based interventions in patients with intermittent claudication. Twenty-three studies were identified. Five were randomized controlled trials. Studies were summarized in terms of exercise interventions, QoL measures used and QoL findings. The majority used a generic QoL instrument; most commonly the Short Form Health Survey (SF-36). Eleven studies reported beneficial effects on the SF-36 Physical Functioning scale. Some also reported positive effects on the scales of Bodily Pain, Role-Physical, Vitality, General Health and the Physical Component Score. In seven studies, a disease-specific measure was used. In six of these, both generic and disease-specific questionnaires were used. Disease-specific measures demonstrated greater improvements across a range of QoL domains. Greater use of disease-specific measures and an extended follow-up period may enable a more definitive picture to emerge regarding effects of exercise on QoL in intermittent claudication.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Drug therapy for improving walking distance in intermittent claudication: a systematic review and meta-analysis of robust randomised controlled studies

This review concluded that several drugs were shown to improve walking distance in people with intermittent claudication, but with limited benefits. Overall the authors' conclusions were supported by the results, but they should be interpreted with some caution due to the possibility of publication bias, a lack of information on study quality and differences between studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Studies on the effectiveness and safety of cilostazol, beraprost sodium, prostaglandin E1 for the treatment of intermittent claudication

This review assessed cilostazol, beraprost sodium and prostaglandin E1 (PGE1) for treating intermittent claudication to improve walking distance. The authors concluded that cilostazol and PGE1 are effective, but further studies ofberaprost sodium are needed. A narrow literature search limits the reliability of these conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

A meta-analysis of the outcome of endovascular and noninvasive therapies in the treatment of intermittent claudication

PURPOSE: Intermittent claudication is a common symptom of peripheral arterial disease. Currently, there is a lack of consensus on the most effective therapies for this problem. We conducted a meta-analysis of randomized trials assessing the efficacy of endovascular therapy (EVT) compared with noninvasive therapies for the treatment of intermittent claudication.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

The effect of peripheral percutaneous transluminal angioplasty on quality of life in patients with intermittent claudication

This review assessed the effects of percutaneous transluminal angioplasty (PTA) on quality of life (QOL) in patients with intermittent claudication. The authors concluded that PTA may improve QOL in this patient group, but that good-quality evidence is lacking. The authors' conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

Beta-adrenergic blocking agents and intermittent claudication: systematic review

This review assessed the use of beta-blockers in patients with intermittent claudication (IC). The authors concluded there was no evidence to suggest that clinicians should be cautious in prescribing beta-blockers to patients with IC. Limitations in the conduct of the review and methods of analysis mean that the results of the meta-analyses are unreliable. However, the authors' overall conclusions are suitably cautious.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Intermittent claudication: functional capacity and quality of life after exercise training or percutaneous transluminal angioplasty. Systematic review

The authors assessed exercise training and percutaneous transluminal angioplasty (PTA) for intermittent claudication. They concluded that functional capacity improves significantly after PTA, but found no difference after exercise training. Both PTA and exercise training improve quality of life. The evidence to support the conclusions is weak. Better research is needed to determine the relative effectiveness of the two treatments.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Endovascular treatment for intermittent claudication in patients with peripheral arterial disease: a systematic review

BACKGROUND: We performed a systematic review and meta-analysis to examine whether patients with intermittent claudication can benefit from endovascular treatment (EVT).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Exercise therapy and the additional effect of supervision on exercise therapy in patients with intermittent claudication: systematic review of randomised controlled trials

OBJECTIVE: To review the evidence for the effectiveness of exercise therapy and to estimate the additional effect of supervision on exercise therapy in patients with intermittent claudication.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Systematic review of home-based exercise programmes for individuals with intermittent claudication

We aimed to conduct a systematic review of the evidence for structured, home-based exercise programmes (HEPs) in patients with intermittent claudication. The Medline, PsycINFO, EMBASE, and Cochrane databases were searched up to April 2013 for terms related to walking, self-management, and intermittent claudication. Descriptive, methodological and outcome data were extracted from eligible articles. Trial quality was assessed using the GRADE system. Seventeen studies were included with 1,457 participants. Six studies compared HEPs with supervised exercise training, five compared HEPs with usual care/observation control, and seven evaluated HEPs in a single-group design. Trial heterogeneity prevented meta-analysis. Nevertheless, there was "low-level" evidence that HEPs can improve walking capacity and quality of life in patients with intermittent claudication when compared with baseline or in comparison to usual care/observation control. In addition, improvements with HEPs may be inferior to those evoked by supervised exercise training. Considerable uncertainty exists regarding the long-term clinical and cost effectiveness of HEPs in patients with intermittent claudication. Thus, more robust trials are needed to build evidence about these interventions. Nevertheless, clinicians should consider using structured interventions to promote self-managed walking in patients with intermittent claudication, as opposed to simple "go home and walk" advice, when supervised exercise training is unavailable or impractical.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Meta-analysis of angiotensin converting enzyme inhibitors effect on walking ability and ankle brachial pressure index in patients with intermittent claudication

OBJECTIVE: The aim of this meta-analysis was to investigate the effect of angiotensin converting enzyme (ACE) inhibitors on maximum walking distance (MWD), pain-free walking distance (PFWD) and ankle brachial pressure index (ABPI) in patients with intermittent claudication (IC).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

A systematic review and meta-analysis of propionyl-L-carnitine effects on exercise performance in patients with claudication

Propionyl-L-carnitine (PLC) may improve exercise performance in patients with peripheral artery disease, but results from clinical trials have been inconsistent. The safety and efficacy of PLC for treatment of claudication was evaluated by a systematic review and meta-analysis of clinical trials for which data were available through September 2010. Eighty-five studies were identified, of which 13 were randomized controlled trials. Owing to database availability for the six phase III studies carried out with PLC (1 g orally, twice daily), a patient-level meta-analysis was conducted as the primary analysis. Treadmill performance data from these six studies were harmonized to peak walking distance (PWD) on a 7% grade at a speed of 3 km/hour. PLC (n = 440) was associated with a net 16 meter improvement (95% CI, 8-20 meters) in PWD as compared with placebo (n = 427) in the primary analysis (p = 0.002). The effect of PLC was similar in subpopulations defined using clinical and demographic variables, with possible enhanced benefit in patients engaged in an exercise program or enrolled at study sites in Russia. The systematic review of the effect of PLCs on claudication identified seven additional randomized controlled trials for a total of 13 trials, which included 681 patients on placebo and 672 on PLC. This meta-analysis confirmed a 45 meter net improvement on PLC using a random-effects model. In conclusion, oral PLC is associated with a statistically significant increase in PWD in patients with claudication, which may be clinically relevant.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Systematic review of exercise training or percutaneous transluminal angioplasty for intermittent claudication

BACKGROUND: The aim was to summarize the results of all randomized clinical trials (RCTs) comparing percutaneous transluminal angioplasty (PTA) with (supervised) exercise therapy ((S)ET) in patients with intermittent claudication (IC) to obtain the best estimates of their relative effectiveness.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Systematic review of the efficacy of cilostazol, naftidrofuryl oxalate and pentoxifylline for the treatment of intermittent claudication

BACKGROUND: A systematic review and network meta-analysis was undertaken to consider the evidence for the efficacy and tolerability of placebo, cilostazol, naftidrofuryl oxalate and pentoxifylline in patients with intermittent claudication due to peripheral arterial disease (PAD).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Effectiveness of interspinous implant surgery in patients with intermittent neurogenic claudication: a systematic review and meta-analysis

INTRODUCTION: Despite an increasing implantation rate of interspinous process distraction (IPD) devices in the treatment of intermittent neurogenic claudication (INC), definitive evidence on the clinical effectiveness of implants is lacking. The main objective of this review was to perform a meta-analysis of all systematic reviews, randomized clinical trials and prospective cohort series to quantify the effectiveness of IPDs and to evaluate the potential side-effects.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Do behaviour-change techniques contribute to the effectiveness of exercise therapy in patients with intermittent claudication? A systematic review

This systematic narrative review of randomised controlled trials (RCTs) identifies and evaluates the efficacy of behaviour-change techniques explicitly aimed at walking in individuals with intermittent claudication. An electronic database search was conducted up to December 2012. RCTs were included comparing interventions incorporating behaviour-change techniques with usual care, walking advice or exercise therapy for increasing walking in people with intermittent claudication. Studies were evaluated using the Cochrane Collaboration risk of bias tool. The primary outcome variable was maximal walking ability at least 3 months after the start of an intervention. Secondary outcome variables included pain-free walking ability, self-report walking ability and daily walking activity. A total of 3,575 records were retrieved. Of these, six RCTs met the inclusion criteria. As a result of substantial heterogeneity between studies, no meta-analysis was conducted. Overall, 11 behaviour-change techniques were identified; barrier identification with problem solving, self-monitoring and feedback on performance were most frequently reported. There was limited high-quality evidence and findings were inconclusive regarding the utility of behaviour-change techniques for improving walking in people with intermittent claudication. Rigorous, fully powered trials are required that control for exercise dosage and supervision in order to isolate the effect of behaviour-change techniques alongside exercise therapy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

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