Introduction
Evidence-based guidelines primarily recommend supervised exercise therapy (SET) to improve physical functioning and quality of life in patients who suffer from intermittent claudication, the most common symptom of peripheral arterial disease (PAD).1–5 Although evidence for the short-term benefits of SET is strong,6 7 there are also patient-level limitations and barriers that hinder engagement.8 9 Frequently reported barriers by patients are, for example, comorbid health concerns and the lack of tailored information, guidance and support to achieve walking recommendations.10–14 These barriers highlight the importance of a personalised approach for exercise therapy in patients with intermittent claudication.
Pursuing a personalised approach shifts the focus away from a traditional paternalistic approach towards one where the healthcare professional includes patient needs, circumstances and personal preferences.15 16 This approach, also called personalised care or person-centred care, is widely recognised as an essential component of high-quality healthcare due to its positive associations with patient satisfaction, patient behaviour and health status.15 17 18 One of the commonly proposed strategies to improve personalisation of care is to monitor a patient’s progress and compare this progress with outcomes of similar patients.19–23 In patients with intermittent claudication, healthcare professionals, such as physical and exercise therapists, could use this approach to inform patient expectations, provide tailored and realistic insight into the expected course of therapy and thereby tackle barriers for independent walking such as a lack of belief or certainty that treatment will be effective.11 14 21
To support physical and exercise therapists in monitoring walking distance and quality of life in patients with intermittent claudication, we developed personalised outcomes forecasts (POFs) of SET.24 Similarly to reference charts, POFs provide insight into an individual’s personal prognosis by visualising the estimated walking distance and quality of life over the treatment trajectory. The estimates are created using historical outcomes data of patients similar to the patient of interest.24 By informing patients of the expected course and outcome of therapy, POFs may help therapists to tailor care to the needs of the individual and thereby potentially improve patient outcomes.25 Moreover, we expect that POFs could enable therapists to improve patient engagement and shared decision-making (SDM).21 26 The latter is noteworthy since the use of SDM is limited among physical therapists while it is considered a cornerstone of personalised care.27–31
The primary research objective (RO1) of our study was to assess differences in patient outcomes (ie, functional walking distance (FWD), maximal walking distance (MWD) and health-related quality of life (HRQoL)) before and after the implementation of POFs in the conservative treatment of patients with intermittent claudication. The secondary RO (RO2) was to assess differences in the level of SDM before and after the implementation of POFs at the start of the conservative treatment of patients with intermittent claudication.