Perceived Versus Objective Change in Walking Ability in Peripheral Artery Disease: Results from 3 Randomized Clinical Trials of Exercise Therapy.
Perceived Versus Objective Change in Walking Ability in Peripheral Artery Disease: Results from 3 Randomized Clinical Trials of Exercise Therapy.
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DOI：
10.1161/jaha.120.017609
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发表时间：
2021-06-15
影响因子：
5.4
通讯作者：
Polonsky TS
中科院分区：
文献类型：
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作者：
McDermott MM;Tian L;Criqui MH;Ferrucci L;Greenland P;Guralnik JM;Kibbe MR;Li L;Sufit R;Zhao L;Polonsky TS
在下肢外周动脉疾病患者中，运动对患者报告结局的影响尚不清楚。在3项临床试验中，404名患有外周动脉疾病的患者被随机分配到运动组（N=205）或对照组（N=199），并在基线和6个月随访时完成6分钟步行和步行障碍问卷距离评分（评分0-100，100=最佳）。与对照组相比，运动使6分钟步行距离增加了+39.8 m（95% CI，26.8-52.8，P<0.001），步行障碍问卷距离评分增加了+7.3（95% CI，2.4-12.1，P=0.003）。在基线和随访时，共完成了2828个步行障碍问卷距离评分问题。在基线和随访之间步行1或更多距离的能力没有变化的参与者中，运动组的6分钟步行改善，对照组下降（+26.8 vs-6.5 m，P<0.001）。在那些认为他们的步行能力在基线和随访之间恶化了1个或更多距离的参与者中，运动组的6分钟步行改善了，而对照组则下降了（+18.4 vs-27.3 m，P<0.001）。在随访时报告小腿症状恶化的参与者中，运动组改善，对照组下降（+28.9 vs-12.5 m，P<0.01）。在3项随机试验中，运动显著改善了外周动脉疾病患者的6分钟步行距离，但许多随机接受运动的参与者报告步行能力没有变化或下降。这些发现表明，在外周动脉疾病患者中，客观测量的步行改善与感知的步行改善存在显著差异。clinicaltrials.gov.标识符：NCT 00106327、NCT 01408901。
In people with lower‐extremity peripheral artery disease, the effects of exercise on patient‐reported outcomes remain unclear. Four hundred four people with peripheral artery disease in 3 clinical trials were randomized to exercise (N=205) or a control group (N=199) and completed the 6‐minute walk and the Walking Impairment Questionnaire distance score (score 0–100, 100=best) at baseline and 6‐month follow‐up. Compared with the control group, exercise improved 6‐minute walk distance by +39.8 m (95% CI, 26.8–52.8, P<0.001) and the Walking Impairment Questionnaire distance score by +7.3 (95% CI, 2.4–12.1, P=0.003). In all, 2828 individual Walking Impairment Questionnaire distance score questions were completed at baseline and follow‐up. Among participants who perceived no change in ability to walk 1 or more distances between baseline and follow‐up, 6‐minute walk improved in the exercise group and declined in the control group (+26.8 versus −6.5 m, P<0.001). Among participants who perceived that their walking ability worsened for 1 or more distances between baseline and follow‐up, the 6‐minute walk improved in the exercise group and declined in the control group (+18.4 versus –27.3 m, P<0.001). Among participants who reported worsening calf symptoms at follow‐up, the exercise group improved and the control group declined (+28.9 versus −12.5 m, P<0.01). In 3 randomized trials, exercise significantly improved the 6‐minute walk distance in people with peripheral artery disease, but many participants randomized to exercise reported no change or decline in walking ability. These findings suggest a significant discrepancy in objectively measured walking improvement relative to perceived walking improvement in people with peripheral artery disease. clinicaltrials.gov. Identifiers: NCT 00106327, NCT 01408901.