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A Review of Lumbar Spinal Stenosis with Intermittent Neurogenic Claudication: Disease and Diagnosis.Pain Medicine (Malden, Mass.) Dec 2019Lumbar spinal stenosis (LSS) is a degenerative spinal condition affecting nearly 50% of patients presenting with lower back pain. The goal of this review is to present... (Review)
Review
OBJECTIVE
Lumbar spinal stenosis (LSS) is a degenerative spinal condition affecting nearly 50% of patients presenting with lower back pain. The goal of this review is to present and summarize the current data on how LSS presents in various populations, how it is diagnosed, and current therapeutic strategies. Properly understanding the prevalence, presentation, and treatment options for individuals suffering from LSS is critical to providing patients the best possible care.
RESULTS
The occurrence of LSS is associated with advanced age. In elderly patients, LSS can be challenging to identify due to the wide variety of presentation subtleties and common comorbidities such as degenerative disc disease. Recent developments in imaging techniques can be useful in accurately identifying the precise location of the spinal compression. Treatment options can range from conservative to surgical, with the latter being reserved for when patients have neurological compromise or conservative measures have failed. Once warranted, there are several surgical techniques at the physician's disposal to best treat each individual case.
Topics: Back Pain; Decompression, Surgical; Humans; Intermittent Claudication; Low Back Pain; Lumbar Vertebrae; Spinal Stenosis
PubMed: 31808530
DOI: 10.1093/pm/pnz161 -
Circulation Research Jun 2021The prevalence of peripheral arterial disease (PAD) in the United States exceeds 10 million people, and PAD is a significant cause of morbidity and mortality across the... (Review)
Review
The prevalence of peripheral arterial disease (PAD) in the United States exceeds 10 million people, and PAD is a significant cause of morbidity and mortality across the globe. PAD is typically caused by atherosclerotic obstructions in the large arteries to the leg(s). The most common clinical consequences of PAD include pain on walking (claudication), impaired functional capacity, pain at rest, and loss of tissue integrity in the distal limbs that may lead to lower extremity amputation. Patients with PAD also have higher than expected rates of myocardial infarction, stroke, and cardiovascular death. Despite advances in surgical and endovascular procedures, revascularization procedures may be suboptimal in relieving symptoms, and some patients with PAD cannot be treated because of comorbid conditions. In some cases, relieving obstructive disease in the large conduit arteries does not assure complete limb salvage because of severe microvascular disease. Despite several decades of investigational efforts, medical therapies to improve perfusion to the distal limb are of limited benefit. Whereas recent studies of anticoagulant (eg, rivaroxaban) and intensive lipid lowering (such as PCSK9 [proprotein convertase subtilisin/kexin type 9] inhibitors) have reduced major cardiovascular and limb events in PAD populations, chronic ischemia of the limb remains largely resistant to medical therapy. Experimental approaches to improve limb outcomes have included the administration of angiogenic cytokines (either as recombinant protein or as gene therapy) as well as cell therapy. Although early angiogenesis and cell therapy studies were promising, these studies lacked sufficient control groups and larger randomized clinical trials have yet to achieve significant benefit. This review will focus on what has been learned to advance medical revascularization for PAD and how that information might lead to novel approaches for therapeutic angiogenesis and arteriogenesis for PAD.
Topics: Adult Stem Cells; Amputation, Surgical; Angiogenesis Inducing Agents; Angiogenesis Modulating Agents; Animals; Anticoagulants; Atherosclerosis; Endothelium, Vascular; Endovascular Procedures; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Intermittent Claudication; Limb Salvage; Lower Extremity; Mice; Microcirculation; Myocardial Infarction; Neovascularization, Physiologic; Peripheral Arterial Disease; Prevalence; Proprotein Convertase 9; RNA, Untranslated; Stroke
PubMed: 34110899
DOI: 10.1161/CIRCRESAHA.121.318266 -
Ugeskrift For Laeger May 2021Intermittent claudication is a manifestation of peripheral arterial occlusive disease. Multiple large international guidelines state that besides cardiovascular risk... (Review)
Review
Intermittent claudication is a manifestation of peripheral arterial occlusive disease. Multiple large international guidelines state that besides cardiovascular risk management, supervised exercise therapy (SET) should be offered to all patients with intermittent claudication. As described in this review, The Netherlands have already established a systemic rehabilitation program, ClaudicatioNet, where SET has been included and have shown positive outcomes. Despite all large national guidelines and the successful experience from the Netherlands, Denmark still fails to include SET to patients with intermittent claudication.
Topics: Exercise Therapy; Humans; Intermittent Claudication; Netherlands; Peripheral Arterial Disease; Treatment Outcome; Walking
PubMed: 33998446
DOI: No ID Found -
JAMA Apr 2022Home-based walking exercise interventions are recommended for people with peripheral artery disease (PAD), but evidence of their efficacy has been mixed. (Randomized Controlled Trial)
Randomized Controlled Trial
Effect of a Home-Based, Walking Exercise Behavior Change Intervention vs Usual Care on Walking in Adults With Peripheral Artery Disease: The MOSAIC Randomized Clinical Trial.
IMPORTANCE
Home-based walking exercise interventions are recommended for people with peripheral artery disease (PAD), but evidence of their efficacy has been mixed.
OBJECTIVE
To investigate the effect of a home-based, walking exercise behavior change intervention delivered by physical therapists in adults with PAD and intermittent claudication compared with usual care.
DESIGN, SETTING, AND PARTICIPANTS
Multicenter randomized clinical trial including 190 adults with PAD and intermittent claudication in 6 hospitals in the United Kingdom between January 2018 and March 2020; final follow-up was September 8, 2020.
INTERVENTIONS
Participants were randomized to receive a walking exercise behavior change intervention delivered by physical therapists trained to use a motivational approach (n = 95) or usual care (n = 95).
MAIN OUTCOMES AND MEASURES
The primary outcome was 6-minute walking distance at 3-month follow-up (minimal clinically important difference, 8-20 m). There were 8 secondary outcomes, 3 of which were the Walking Estimated Limitation Calculated by History (WELCH) questionnaire (score range, 0 [best performance] to 100), the Brief Illness Perceptions Questionnaire (score range, 0 to 80 [80 indicates negative perception of illness]), and the Theory of Planned Behavior Questionnaire (score range, 3 to 21 [21 indicates best attitude, subjective norms, perceived behavioral control, or intentions]); a minimal clinically important difference was not defined for these instruments.
RESULTS
Among 190 randomized participants (mean age 68 years, 30% women, 79% White race, mean baseline 6-minute walking distance, 361.0 m), 148 (78%) completed 3-month follow-up. The 6-minute walking distance changed from 352.9 m at baseline to 380.6 m at 3 months in the intervention group and from 369.8 m to 372.1 m in the usual care group (adjusted mean between-group difference, 16.7 m [95% CI, 4.2 m to 29.2 m]; P = .009). Of the 8 secondary outcomes, 5 were not statistically significant. At 6-month follow-up, baseline WELCH scores changed from 18.0 to 27.8 in the intervention group and from 20.7 to 20.7 in the usual care group (adjusted mean between-group difference, 7.4 [95% CI, 2.5 to 12.3]; P = .003), scores on the Brief Illness Perceptions Questionnaire changed from 45.7 to 38.9 in the intervention group and from 44.0 to 45.8 in the usual care group (adjusted mean between-group difference, -6.6 [95% CI, -9.9 to -3.4]; P < .001), and scores on the attitude component of the Theory of Planned Behavior Questionnaire changed from 14.7 to 15.4 in the intervention group and from 14.6 to 13.9 in the usual care group (adjusted mean between-group difference, 1.4 [95% CI, 0.3 to 2.5]; P = .02). Thirteen serious adverse events occurred in the intervention group, compared with 3 in the usual care group. All were determined to be unrelated or unlikely to be related to the study.
CONCLUSIONS AND RELEVANCE
Among adults with PAD and intermittent claudication, a home-based, walking exercise behavior change intervention, compared with usual care, resulted in improved walking distance at 3 months. Further research is needed to determine the durability of these findings.
TRIAL REGISTRATIONS
ISRCTN Identifier: 14501418; ClinicalTrials.gov Identifier: NCT03238222.
Topics: Aged; Exercise Test; Exercise Therapy; Female; Humans; Intermittent Claudication; Male; Peripheral Arterial Disease; Self Care; Surveys and Questionnaires; Walking
PubMed: 35412564
DOI: 10.1001/jama.2022.3391 -
Journal of Vascular Surgery Jan 2021
Topics: Humans; Intermittent Claudication; Negative-Pressure Wound Therapy
PubMed: 33349388
DOI: 10.1016/j.jvs.2020.08.021