title: Patient Characteristics and Comorbidities Influence Walking Distances in Symptomatic Peripheral Arterial Disease: A Large One-Year Physiotherapy Cohort Study.
abstract: OBJECTIVE
  The aim of this study is to investigate the association between age, gender, body-mass index, smoking behavior, orthopedic comorbidity, neurologic comorbidity, cardiac comorbidity, vascular comorbidity, pulmonic comorbidity, internal comorbidity and Initial Claudication Distance during and after Supervised Exercise Therapy at 1, 3, 6 and 12 months in a large sample of patients with Intermittent Claudication.
  
  
  METHODS
  Data was prospectively collected in standard physiotherapy care. Patients received Supervised Exercise Therapy according to the guideline Intermittent Claudication of the Royal Dutch Society for Physiotherapy. Three-level mixed linear regression analysis was carried out to analyze the association between patient characteristics, comorbidities and Initial Claudication Distance at 1, 3, 6 and 12 months.
  
  
  RESULTS
  Data from 2995 patients was analyzed. Results showed that being female, advanced age and a high body-mass index were associated with lower Initial Claudication Distance at all-time points (p = 0.000). Besides, a negative association between cardiac comorbidity and Initial Claudication Distance was revealed (p = 0.011). The interaction time by age, time by body-mass index and time by vascular comorbidity were significantly associated with Initial Claudication Distance (p≤ 0.05). Per year increase in age (range: 33-93 years), the reduction in Initial Claudication Distance was 8m after 12 months of Supervised Exercise Therapy. One unit increase in body-mass index (range: 16-44 kg/m2) led to 10 m less improvement in Initial Claudication Distance after 12 months and for vascular comorbidity the reduction in improvement was 85 m after 12 months.
  
  
  CONCLUSIONS
  This study reveals that females, patients at advanced age, patients with a high body-mass index and cardiac comorbidity are more likely to show less improvement in Initial Claudication Distances (ICD) after 1, 3, 6 and 12 months of Supervised Exercise Therapy. Further research should elucidate treatment adaptations that optimize treatment outcomes for these subgroups.
authors.affiliation: Department of Epidemiology, Functioning and Rehabilitation Programme, CAPRHI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dörenkamp
authors.affiliation: Department of Epidemiology, Functioning and Rehabilitation Programme, CAPRHI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Ilse
authors.initials: I
authors.lastname: Mesters
authors.affiliation: Department of Epidemiology, Functioning and Rehabilitation Programme, CAPRHI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: de Bie
authors.affiliation: Department of Epidemiology, Functioning and Rehabilitation Programme, CAPRHI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.|Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Joep
authors.initials: J
authors.lastname: Teijink
authors.affiliation: Department of Methodology and Statistics, CAPRHI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: van Breukelen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015897:Comorbidity; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications / Q000534:rehabilitation; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009985:Orthopedics; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D016138:Walking