Determinants for non-attendance to supervised exercise therapy in Dutch patients with intermittent claudication

Abstract

Aim: For intermittent claudication conservative treatment is recommended over invasive treatment. The preferred conservative treatment is supervised exercise therapy (SET). However, attendance is low. Barriers for attendance to exercise treatment can be either intrinsic or extrinsic. In patients with intermittent claudication extrinsic barriers for attendance to SET have been studied. However, intrinsic barriers such as demographic data, health status, and disease status have yet to be identified.

Methods: This multicenter observational study had a longitudinal design. The vascular surgeon included patients with intermittent claudication when SET was indicated according to guideline recommendations. Patients needed a good understanding of the Dutch language. The vascular surgeon obtained basic data. Following, the researcher retrieved demographic data, disease status and overall health status from patient records. Three months after inclusion, patients received a survey to determine attendance to SET and asking about personal characteristics (such as age, gender, body height, body weight, smoking habits). Following patients were classified as non-attendant or attendant. For data analysis, descriptive analysis was followed by univariate logistic regression. P-values ≤0.15 were considered relevant. Results: Data of 40 patients has been analyzed. Relevant determinants for non-attendance to SET were body mass index, affected leg, ankle-brachial index in rest, and history with cardiovascular disease. Conclusion: The odds for non-attendance to SET are higher in patients that have a higher body mass index, are affected in the right leg, have lower ankle-brachial index in rest, and have history with cardiovascular disease. Future research should contain a larger sample size to enable multiple logistic regression. Additionally, other intrinsic barriers should be investigated as well. Clinical Relevance: Identification of intrinsic barriers may enable healthcare professionals to determine which patients are more likely to be non-attendant to SET. In the future, healthcare professionals may be enabled to apply strategies to avoid non-attendance.