Article“Intermittent claudication a real pain in the calf”—Patient experience of diagnosis and treatment with a supervised exercise program
Section snippets
Methods
This was a qualitative study, using semistructured interviews, conducted in a single vascular surgery unit of a tertiary teaching hospital. Ethical approval was granted by the Research Ethics Committee, and the study was conducted in accordance with the ethical standards of the Declaration of Helsinki, 1975. All participants provided informed written consent.
Participants and SEP
All patients had been reviewed by a consultant vascular surgeon and were documented to have stable yet persisting IC. Inclusion criteria included adults over the age of 45 years, and an ankle-brachial pressure index < 0.9. Exclusion criteria included severe cardiovascular or musculoskeletal illness precluding participation in SEP, critical limb ischemia, or active cancer treatments. All patients suitable for inclusion were offered the SEP provided in secondary care. The SEP was performed three
Interviews
Interviews were conducted using a topic guide to ensure consistency across participants; however, a flexible format was used to allow participants to generate naturalistic data. All interviews were conducted on a face-to-face basis at a place convenient for the patient, either in the home or a comfortable, accessible hospital setting. All interviews were audio recorded and transcribed verbatim.
Interviews were split into three groups:
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Group A–exercise decliners
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Group B–exercise completers
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Group
Data analysis
Data were analyzed using thematic analysis. This approach is inductive (themes emerge from the data and are not imposed upon it by the researcher) and iterative (data collection and analysis occur simultaneously).9 Participants were also compared for commonality and differences.
Atypical cases were actively sought throughout the analysis and emerging ideas and themes modified in response. Data analysis involved a process of organizing the data, descriptive coding, thematic coding, writing, and
Results
In the recruitment between May 2015 and January 2017, a total of 547 patients were screened for the SEP. One hundred twenty-five patients were excluded based on the exclusion criteria, leaving a total of 422 eligible patients invited to participate. Ninety-two patients (22%) agreed to take part in the exercise program. Of the 92 patients who commenced on exercise only 38 fully completed (41%), 38 patients actively withdrew from the exercise program, and 2 patients died.
Understanding of the disease and risk factors
Many patients did not have a clear understanding of the disease process with only seven patients giving a clear description of a “blockage” or “furring” up of the arteries in their legs. Patients often used the terms “veins” and “arteries” interchangeably during the discussion. More men than woman responded with pathophysiological descriptions of the disease. In addition, a minority of patients discussed the potentially progressive nature of IC. “It is getting worse and I needed to do something
Previous exercise experience and current activity levels
Twenty-two patients had some level of exercise experience with most of them ending participation in sport at a school level. “I played netball at school but I didn't do anything after I left.” A minority of patients (14) continued with exercise in their adult life, mainly with activities such as walking. Only 9 patients out of the 25 interviewees were currently engaging in some form of physical activity which was mainly walking. “I try to walk every day; it's the only little bit of exercise I
Experience of the exercise program
Of the 14 patients who attended the class and were interviewed (four dropouts), 13 described it as “social” with the “instructors and other people who went making the class.” Only one patient (who had additional problems) said she “felt embarrassed because of her stomach.” Many patients described the class as “friendly,” “relaxing,” and a “feeling of all being in it together.” Although the 10 who completed the program did discuss the “commitment to coming three times a week,” they all said that
Discussion
This study aimed to examine the barriers and facilitators to exercise programs in patients with IC. Throughout the interviews, patients living with IC described significant symptoms with major functional reduction and impairment of daily activity levels. There were no discernible differences in symptoms or experiences between men and women and no difference between patients during the winter and summer months.
There were three major themes that emerged from the data including IC, perception to
Conclusion
This is the first study to assess the opinions of exercise programs in patients with IC using in-depth semistructured interviews. The first-line treatment for patients with IC is a SEP; however, a majority of patients either fail to engage or complete this treatment. The findings of this study identified four major themes including IC, perception to exercise, experience of exercise programs, and barriers to SEP participation. Although data suggest that SEP is still the most clinical and
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2021, Journal of Vascular NursingCitation Excerpt :see supplementary Table S1, interview guide). The research questions in the semi-structured interview guide drew on the conclusions from 26 out of 43 post-intervention evaluating surveys and systematic reviews on the conceptualization of a patient-centered program, as well as three qualitative studies that explore patient experiences of living with IC3,4,8,10,11. The model by Malterud et al. was used to suggest an adequate number of participants for the focus group interviews to demonstrate new knowledge referring to the aim of the study and to achieve “Information power”25[20, 25](p-70–75).
Illness perceptions in patients with peripheral arterial disease: A systematic review of qualitative studies
2021, International Journal of Nursing StudiesCitation Excerpt :However, other participants had no ideas about what caused their symptoms (Collins et al., 2006, Cunningham et al. 2014, Egberg et al., 2012, Gibson and Kendrick 1998, Gorely et al., 2015, Lokin et al., 2015), while others described beliefs that the symptoms could be explained by cramp or a sign of ageing (Egberg et al., 2012; Gorely et al., 2015; Harwood et al., 2017). These beliefs could result in delayed seeking of medical care (Gibson and Kendrick 1998; Gorely et al., 2015; Harwood et al., 2017). This component refers to individuals’ perceptions of the cause of the illness.
Conflicts of interest: The authors do not have any conflict of interest.
Funding: Harwood is funded by a University of Hull PhD Scholarship.