Walk It Out: Implementing Home-Based Exercise for Patients with Peripheral Arterial Disease

Abstract

Problem and Purpose: Peripheral artery disease (PAD) is a serious chronic condition with the potential to cause significant pain and suffering for patients along with tremendous financial strain on the patient and the healthcare system. Clinical trials have demonstrated that walking therapy is a first-line intervention that can greatly improve PAD symptoms in patients, however, it is underutilized in the outpatient setting due to lack of resources. The purpose of this evidence-based practice change project is to help patients increase the amount they walk with a home-based exercise therapy (HBET) program.

Methods: Patients of the PENN Heart and Vascular Center in Philadelphia, Pennsylvania with known diagnoses of PAD and intermittent claudication (IC) were recruited by phone to participate in 12 weeks of HBET. Education was provided by phone and education materials mailed to each participant’s home making the entire project contactless during the COVID-19 pandemic. Participant’s progress was tracked weekly by phone and their ability to walk monitored with the Walking Impairment Questionnaire (WIQ) that was completed before and after the intervention. Participants also completed a free-response questionnaire.

Results: Eight participants successfully completed HBET with 100% completion rate. The mean difference in the WIQ score was 0.41 (p = .89), not a statistically significant improvement. The mean difference in pain with walking (a sub-category on the WIQ) was 1.46 (p = .01) which was a significant improvement. Participants had a majority of positive responses to HBET on the free-response questionnaire, and all participants planned to keep walking in the future.

Conclusion: HBET provides a cost-effective way to increase walking in patients with PAD and permanent adoption into the PENN Limb Salvage Program is recommended.