| 1. |
- Bäck, Maria, 1978, et al.
(författare)
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Home-based versus hospital-based supervised exercise or walk advice as treatment for intermittent claudication : Hembaserad jämfört med sjukhusbaserad handledd fysisk träning eller träningsråd som behandling vid claudicatio intermittens
- 2014
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Method and patient group Intermittent claudication, the most common symptomatic presentation of peripheral arterial disease, is present in 7% of Swedish people aged 60 years or older. The progressive atherosclerotic process involves the development of stenoses and/or occlusions in the arteries propagating blood to the lower limbs. This causes effort-induced pain in the affected limb(s). Treatment is usually conservative and includes exercise therapy. Today, current practice in Sweden for patients with IC usually does not include hospital-based supervised exercise programs. A home-based supervised exercise program in a self-chosen environment might bridge the gap between the highly structured and costly hospital-based supervised exercise programs and ’go home and walk advice’. Question at issue Is home-based supervised exercise more effective than either unsupervised ‘go home and walk advice’, or hospital-based supervised exercise, for patients with intermittent claudication, in terms of walking distance, health related quality of life, symptoms, and risks associated with exercise? Studied risks and benefits for patients Ten articles were identified: two systematic reviews, six randomized controlled trials (RCT) and two cohort studies. The systematic reviews were only commented on. The quality of evidence (GRADE ⊕⊕) was low for all conclusions. Concluding remark Home-based supervised exercise for patients with intermittent claudication was compared with hospitalbased supervised exercise, or ‘go home and walk advice’. Six RCTs and two cohort studies were identified. There is low quality of evidence (GRADE ⊕⊕) that home-based supervised exercise, as compared with ‘go home and walk advice’, may slightly improve maximum and pain-free walking distance and result in little or no difference in health-related quality of life, and functional walking ability. There is low quality of evidence (GRADE ⊕⊕) that home-based supervised exercise may lead to less improvement in both maximum and pain-free walking distance than supervised hospital-based exercise, and result in little or no difference in health-related quality of life, and functional walking ability. There are no major ethical issues, and a reliable estimate of the total cost change is not possible, due to a total lack of reliable long-term data.
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| 4. |
- Linne, A., et al.
(författare)
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Low Post-operative Mortality after Surgery on Patients with Screening-detected Abdominal Aortic Aneurysms : A Swedvasc Registry Study
- 2014
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 48:6, s. 649-656
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Screening for abdominal aortic aneurysms (AAAs) substantially reduces aneurysm-related mortality in men and is increasing worldwide. This cohort study compares post-operative mortality and complications in men with screening-detected vs. non-screening-detected AAAs. Methods: Data were extracted from the Swedish National Registry for Vascular Surgery (Swedvasc) for all screening-detected men treated for AAA (n = 350) and age-matched controls treated for non-screening-detected AAA (n = 350). Results: There were no differences in baseline characteristics besides age, which was lower in the screening-detected group than in the non-screening-detected group (median 66 vs. 68, p < .001). Open repair was used more frequently than endovascular aortic repair (EVAR) in patients with screening-detected AAAs than in nonscreening-detected controls (56% vs. 45% p = .005). No differences in major post-operative complications at 30 days were observed between the groups. In patients treated with open repair there were no differences in 30-day, 90-day or 1-year mortality in screening-detected patients compared to non-screening-detected controls (1.0% vs. 3.2% p = .25, 2.1% vs. 4.5% p = .23, 4.1% vs. 5.8% p = .61). None of the patients treated with EVAR in either group died within 30 days. The 90-day mortality after EVAR was lower in patients with screening-detected AAA than in those with non-screening-detected AAAs (0.0% vs. 3.1%, p = .04). No difference in the 1-year mortality was detected in the EVAR-patients between the two groups (1.4% vs. 4.7%, p = .12). Conclusions: The contemporary post-operative mortality after AAA surgery was low in this national audit of patients with screening-detected AAAs and age-matched controls. Patients with screening-detected AAAs have the same frequency of complications at 30 days as patients with non-screening-detected AAA. This study gives further support to national screening programs for the detection of AAA in men.
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| 5. |
- Nordanstig, Joakim, et al.
(författare)
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Improved Quality of Life After 1 Year With an Invasive Versus a Noninvasive Treatment Strategy in Claudicants One-Year Results of the Invasive Revascularization or Not in Intermittent Claudication (IRONIC) Trial
- 2014
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Ingår i: Circulation. - : Ovid Technologies (Wolters Kluwer Health). - 0009-7322 .- 1524-4539. ; 130:12, s. 939-947
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Tidskriftsartikel (refereegranskat)abstract
- Background-The quality of evidence for invasive revascularization in intermittent claudication is low or very low. This prospective, randomized, controlled study tested the hypothesis that an invasive treatment strategy versus continued noninvasive treatment improves health-related quality of life after 1 year in unselected patients with intermittent claudication. Methods and Results-After clinical and duplex ultrasound assessment, unselected patients with intermittent claudication requesting treatment for claudication were randomly assigned to invasive (n=79) or noninvasive (n=79) treatment groups. Primary end point was health-related quality of life after 1 year, assessed with Medical Outcomes Study Short Form 36 version 1 and Vascular Quality of Life Questionnaire, and secondary end points included walking distances on a graded treadmill. The Medical Outcomes Study Short Form 36 version 1 physical component summary (P<0.001) and 2 Medical Outcomes Study Short Form 36 version 1 physical subscales improved significantly more in the invasive versus the noninvasive treatment group. Overall, Vascular Quality of Life Questionnaire score (P<0.01) and 3 of 5 domain scores improved significantly more in the invasive versus the noninvasive treatment group. Intermittent claudication distance improved significantly in the invasive (+124 m) versus the noninvasive (+50 m) group (P=0.003), whereas the change in maximum walking distance was not significantly different between groups. Conclusions-An invasive treatment strategy improves health-related quality of life and intermittent claudication distance after 1 year in patients with stable lifestyle-limiting claudication receiving current medical management. Long-term follow-up data and health-economic assessments are warranted to further establish the role for revascularization in intermittent claudication.
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| 6. |
- Nordanstig, Joakim, et al.
(författare)
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National experience with extracranial carotid artery aneurysms: epidemiology, surgical treatment strategy, and treatment outcome.
- 2014
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Ingår i: Annals of vascular surgery. - : Elsevier BV. - 1615-5947 .- 0890-5096. ; 28:4, s. 882-6
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Tidskriftsartikel (refereegranskat)abstract
- Extracranial carotid artery aneurysms (CAAs) are rare but confer risk of stroke, rupture, and local symptoms. Few cases have been reported, even from large centers, and therefore knowledge of the disease is limited. The purpose of this study was to review epidemiology, surgical treatment, and outcomes of CAAs in a nationwide setting using the Swedish National Registry for Vascular Surgery (Swedvasc).
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| 8. |
- Nordanstig, Joakim, et al.
(författare)
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Psychometric properties of the disease-specific health-related quality of life instrument VascuQoL in a Swedish setting
- 2012
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Ingår i: Health and Quality of Life Outcomes. - : Springer Science and Business Media LLC. - 1477-7525. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Traditional outcome measures in peripheral arterial disease (PAD) provide insufficient information regarding patient benefit. It has therefore been suggested to add patient-reported outcome measures. The main aim of this study was to validate the Swedish Vascular Quality of Life questionnaire (VascuQoL) version, a patient-reported PAD-specific health-related quality of life (HRQoL) instrument. Methods: Two-hundred PAD patients were consecutively recruited from two university hospitals. Out of the 200 subjects, 129 had intermittent claudication and 71 had critical limb ischemia. Mean age was 70 +/- 9 y and 57% of the participants were male. All patients completed SF-36 and VascuQoL at the vascular outpatient clinic, when evaluated for invasive treatment. Risk factors and physiological parameters were registered. Construct validity was tested by correlation analysis versus SF-36 and was also assessed with multitrait/multi-item scaling analysis (MTMI). Sensitivity analysis regarding disease severity identification was performed. Reliability was assessed with Cronbach's alpha and responsiveness by standardized response mean (SRM) calculations. Results: Significant correlations were demonstrated between relevant subscales of VascuQoL and SF-36. MTMI showed acceptable construct validity, but some scaling-errors. VascuQoL significantly (p < 0.001) discriminated claudicants from critical limb ischemia patients. Cronbach's alpha was 0.94 and SRM 1.02 (sum score). Conclusions: The Swedish version of VascuQoL is valid and quantifies central aspects of HRQoL in PAD patients. Sensitivity analysis showed high ability to differentiate between disease severity and SRM illustrated excellent responsiveness. The relative abundance of items however makes use in the everyday clinical setting somewhat difficult.
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| 9. |
- Nordanstig, Joakim, et al.
(författare)
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Six-minute walk test closely correlates to "real-life" outdoor walking capacity and quality of life in patients with intermittent claudication
- 2014
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 60, s. 404-409
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Tidskriftsartikel (refereegranskat)abstract
- Objective We used outdoor walking distance measured during 40 minutes as "real-life" outdoor walking capacity in 49 patients with intermittent claudication (IC). The outdoor walking distance was measured by a global positioning system application for a smartphone. The relationships of self-reported maximum walking distance (SR-MWD), the MWD on a graded treadmill test, and the 6-minute maximum walk distance (6MWD) vs outdoors walking capacity were investigated. Also studied were the associations of SR-MWD, MWD, and 6MWD with health-related quality of life assessed with the disease-specific instrument the Vascular Quality of Life Questionnaire (VascuQoL). Methods In this prospective observational cohort study, 49 IC patients underwent an outdoor walking capacity test for 40 minutes, and MWD and 6MWD were measured. SR-MWD was recorded, and all subjects completed the VascuQoL questionnaire. Associations between the different walk estimates and outdoor walking capacity and health-related quality of life were investigated by correlation analysis (Spearman ρ). Results Outdoor walking distance during 40 minutes was a median 2495 m (range, 1110-3300 m). SR-MWD correlated moderately and MWD correlated strongly to outdoor walking capacity (r = 0.56 and r = 0.65; P <.001, respectively). The 6MWD test showed the largest correlation to the outdoor walking capacity (r = 0.78; P <.001). The 6MWD was the only test that showed correlations with the VascuQoL sum score (r = 0.53; P <.01) and all of the domain scores, whereas SR-MWD and MWD showed weak correlations to the VascuQoL. Conclusions The distance walked during the 6-minute walk test is closely correlated to outdoor walking capacity and health-related quality of life in IC patients. Our data support the use of 6MWD for routine clinical evaluation of walking capacity in IC patients. Copyright © 2014 by the Society for Vascular Surgery.
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| 10. |
- Nordanstig, Joakim, et al.
(författare)
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Vascular Quality of Life Questionnaire-6 facilitates health-related quality of life assessment in peripheral arterial disease
- 2014
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 59:3, s. 700-U492
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Tidskriftsartikel (refereegranskat)abstract
- Background: Most commonly used outcome measures in peripheral arterial disease (PAD) provide scarce information about achieved patient benefit. Therefore, patient-reported outcome measures have become increasingly important as complementary outcome measures. The abundance of items in most health-related quality of life instruments makes everyday clinical use difficult. This study aimed to develop a short version of the 25-item Vascular Quality of Life Questionnaire (VascuQoL-25), a PAD-specific health-related quality of life instrument. Methods: The study recruited 129 individuals with intermittent claudication and 71 with critical limb ischemia from two university hospitals. Participants were a mean age of 70 +/- 9 years, and 57% were men. All patients completed the original VascuQoL when evaluated for treatment, and 127 also completed the questionnaire 6 months after a vascular procedure. The VascuQoL-25 was reduced based on cognitive interviews and psychometric testing. The short instrument, the VascuQoL-6, was tested using item-response theory, exploring structure, precision, item fit, and targeting. A subgroup of 21 individuals with intermittent claudication was also tested correlating the results of VascuQoL-6 to the actual walking capacity, as measured using global positioning system technology. Results: On the basis of structured psychometric testing, the six most informative items were selected (VascuQoL-6) and tested vs the original VascuQoL-25. The correlation between VascuQoL-25 and VascuQoL-6 was r = 0.88 before intervention, r = 0.96 after intervention, and the difference was r = 0.91 (P < .001). The Cronbach alpha for the VascuQoL-6 was .85 before and .94 after intervention. Cognitive interviews indicated that the responders considered all six items to be relevant and comprehensible. Rasch analysis was used to reduce response options from seven (VascuQoL-25) to four (VascuQoL-6). VascuQol-6 was shown to have high precision and discriminative properties. Item fit was excellent, with both "infit" and "outfit" between 0.7 and 1.3 for all six items. The standardized response mean after intervention was 1.15, indicating good responsiveness to clinical change. VascuQoL-6 results correlated strongly (r = 0.72; P < .001) with the actual measured walking ability (n = 21). Conclusions: VascuQoL-6 is a valid and responsive instrument for the assessment of health-related quality of life in PAD. The main advantage is the compact format that offers a possibility for routine use in busy clinical settings.
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| 11. |
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| 12. |
- Nordanstig, Joakim, et al.
(författare)
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Walking Performance and Health-related Quality of Life after Surgical or Endovascular Invasive versus Non-invasive Treatment for Intermittent Claudication - A Prospective Randomised Trial
- 2011
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884. ; 42, s. 220-227
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Despite limited scientific evidence for the effectiveness of invasive treatment for intermittent claudication (IC), revascularisation procedures for IC are increasingly often performed in Sweden. This randomised controlled trial compares the outcome after 2 years of primary invasive (INV) versus primary non-invasive (NON) treatment strategies in unselected IC patients. Materials/Methods: Based on arterial duplex and clinical examination, IC patients were randomised to INV (endovascular and/or surgical, n=100) or NON (n=101). NON patients could request invasive treatment if they deteriorated during follow-up. Primary outcome was maximal walking performance (MWP) on graded treadmill test at 2 years and secondary outcomes included health-related quality of life (HRQL), assessed with Short Form (36) Health Survey (SF-36). Results: MWP was not significantly (p=0.104) improved in the INV versus the NON group. Two SF-36 physical subscales, Bodily Pain (p<0.01) and Role Physical (p<0.05) improved significantly more in the INV versus the NON group. There were 7% crossovers against the study protocol in the INV group. Conclusions: Although invasive treatment did not show any significant advantage regarding MWP, the HRQL improvements associated with invasive treatment tentatively suggest secondary benefits of this regimen. On the other hand, a primary non-invasive treatment strategy seems to be accepted by most IC patients.
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