Characterizing patient-reported claudication treatment goals to support patient-centered treatment selection and measurement strategies.
Characterizing patient-reported claudication treatment goals to support patient-centered treatment selection and measurement strategies.
复制标题
描述患者报告的跛行治疗目标，以支持以患者为中心的治疗选择和测量策略。
DOI：
10.1016/j.jvs.2022.09.002
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发表时间：
2022
影响因子：
4.3
通讯作者：
Corriere,MatthewA
中科院分区：
文献类型：
--
作者：
Powell,ChloéA;Kim,GloriaY;Edwards,SydneyN;Aalami,Oliver;Treat-Jacobson,Diane;Byrnes,MaryE;Osborne,NicholasH;Corriere,MatthewA
外周动脉疾病（PAD）的患者报告结局（PRO）越来越受到重视。然而，患者定义的治疗目标和期望知之甚少，可能无法实现或与指南或临床结局不一致。我们评估了患者报告的治疗目标与跛行患者和患者的特征，目标，和PAD特异性PRO scores.MethodsPatients诊断跛行之间的关联进行了前瞻性招募。使用多项选择调查项目量化患者定义的治疗目标和与步行距离、持续时间和速度相关的结局。自由文本项目用于识别与症状和治疗目标相关的活动，而不是步行距离、持续时间或速度。以外周动脉疾病生活质量量表和步行障碍问卷作为PRO。使用95%置信区间（CI）、分类检验和逻辑回归模型将治疗目标类别与PRO百分位数评分进行比较。患者特征和PRO之间的关联进行了评估，使用线性和有序logistic回归models.ResultsA共150例患者符合纳入标准被列入本研究。在这150名患者中，144名（96%）观看了整个调查。他们的平均年龄为70.0 ± 11.3岁，32.9%为女性。大多数受访者自我报告其种族为白色（n = 135），其次是黑人（n = 3）、亚洲人（n = 2）、美洲原住民（n = 2）和其他/未知（n = 2）。两名参与者自我报告了西班牙裔。主要治疗目标是增加步行距离或持续时间（62.0%）、能够进行特定活动或任务（23.0%）、增加步行速度（8.0%）或其他/无上述目标（7.0%）。与症状或目标相关的特定活动包括户外娱乐（38.5%）、劳动相关任务（30.7%）、运动（26.9%）、爬楼梯（23.1%）、上坡行走（19.2%）和购物（6%）。在选择增加步行距离和持续时间作为主要目标的患者中，64%的患者表示≥0.5英里（2640英尺）的距离和59%的患者表示≥30分钟的持续时间将是与有意义的改善一致的最小增加。年龄增加与距离改善目标≥0.5英里（比值比[OR]，0.68/5年; 95% CI，0.51-0.92;P= 0.012）或持续时间改善目标≥30分钟（OR，0.76/5年; 95% CI，0.58-0.99;P= 0.047）的比值较低相关。与PAD生活质量百分位数评分相关的患者特征包括年龄、踝臂指数和性别。踝肱指数是唯一的患者特征与步行障碍问卷百分位scores.ConclusionsPatients定义治疗目标，根据他们所期望的活动和期望，这可能会影响他们的目标和感知结果。对于许多患者，患者对步行距离和持续时间的最小增加的预期与有意义的改善一致，超过了报告的最小重要差异标准，并且无法使用常见的基于临床的步行测试进行捕获。患者年龄与治疗目标和PRO评分相关，相关的下限和上限效应可能分别影响年轻患者和老年患者对PRO变化的敏感性。治疗目标中的异质性支持考虑根据患者特征和观点进行定制的决策和结果。
ObjectivePatient-reported outcomes (PRO) have been increasingly emphasized for peripheral artery disease (PAD). Patient-defined treatment goals and expectations, however, are poorly understood and might not be achievable or aligned with guidelines or clinical outcomes. We evaluated the patient-reported treatment goals among patients with claudication and the associations between patient characteristics, goals, and PAD-specific PRO scores.MethodsPatients with a diagnosis of claudication were prospectively recruited. Patient-defined treatment goals and outcomes related to walking distance, duration, and speed were quantified using multiple-choice survey items. Free-text items were used to identify activities other than walking distance, duration, or speed associated with symptoms and treatment goals. The peripheral artery disease quality of life and walking impairment questionnaire instruments were included as PRO. The treatment goal categories were compared with the PRO percentile scores using 95% confidence intervals (CIs), categorical tests, and logistic regression models. Associations between the patient characteristics and PRO were evaluated using linear and ordinal logistic regression models.ResultsA total of 150 patients meeting the inclusion criteria were included in the present study. Of these 150 patients, 144 (96%) viewed the entire survey. Their mean age was 70.0 ± 11.3 years, and 32.9% were women. Most of the respondents had self-reported their race as White (n = 135), followed by Black (n = 3), Asian (n = 2), Native American (n = 2), and other/unknown (n = 2). Two participants self-reported Hispanic ethnicity. The primary treatment goals were an increased walking distance or duration without stopping (62.0%), the ability to perform a specific activity or task (23.0%), an increased walking speed (8.0%), or other/none of the above (7.0%). The specific activities associated with symptoms or goals included outdoor recreation (38.5%), labor-related tasks (30.7%), sports (26.9%), climbing stairs (23.1%), uphill walking (19.2%), and shopping (6%). Among the patients choosing an increased walking distance and duration as the primary goals, 64% had indicated that a distance of ≥0.5 mile (2640 ft) and 59% had indicated a duration of ≥30 minutes would be a minimum increase consistent with meaningful improvement. Increasing age was associated with lower odds of a distance improvement goal of ≥0.5 mile (odds ratio [OR], 0.68 per 5 years; 95% CI, 0.51-0.92;P= .012) or duration improvement goal of ≥30 minutes (OR, 0.76 per 5 years; 95% CI, 0.58-0.99;P= .047). Patient characteristics associated with PAD Quality of Life percentile scores included age, ankle brachial index, and gender. Ankle brachial index was the only patient characteristic associated with the walking impairment questionnaire percentile scores.ConclusionsPatients define treatment goals according to their desired activities and expectations, which may influence their goals and perceived outcomes. Patients’ expectations of minimum increases in walking distance and duration consistent with meaningful improvement exceeded reported minimum important difference criteria for many patients and would not be captured using common clinic-based walking tests. Patient age was associated with both treatment goals and PRO scores, and the related floor and ceiling effects could influence sensitivity to PRO changes for younger and older patients, respectively. Heterogeneity in treatment goals supports consideration of tailored decision-making and outcomes informed by patient characteristics and perspectives.
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DOI：
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发表时间：
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期刊：
影响因子：
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作者：
通讯作者：
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影响因子：
4.3
作者：
McDermott, MM;Liu, KA;Greenland, P
通讯作者：
Greenland, P
有症状、无肢体威胁的外周动脉疾病患者报告的结果测量：最先进的综述
DOI：
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发表时间：
2021
期刊：
Circulation. Cardiovascular Interventions
影响因子：
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作者：
Jennifer A. Rymer;Dennis I. Narcisse;Michael Cosiano;John Tanaka;Mary M. McDermott;Diane Treat;Michael S. Conte;Brandi Tuttle;Manesh R. Patel;K. Smolderen
通讯作者：
K. Smolderen
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DOI：
10.1024/0301-1526.28.1.25
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1999
期刊：
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影响因子：
--
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影响因子：
4.5
作者：
Harris PA;Taylor R;Thielke R;Payne J;Gonzalez N;Conde JG
通讯作者：
Conde JG