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Background: Little is known about the extent to which routine care management of peripheral arterial disease (PAD) and intermittent claudication (IC) align with best practice recommendations on exercise therapy. We conducted a scoping review to examine the published literature on the availability and workings of exercise therapy in the routine management of patients with PAD and IC, and the attitude and practice of health professionals and patients. Methods: A systematic search was conducted in February 2018. The Cumulative Index of Nursing and Allied Health Literature, Ovid MEDLINE, Allied and Complementary Medicine Database, ScienceDirect, Web of Science and the Directory of Open Access Repositories were searched. Hand searching of reference lists of identified studies was also performed. Inclusion criteria were based on study aim, and included studies that reported on the perceptions, practices, and workings of routine exercise programs for patients with IC, their availability, access, and perceived barriers. Results: Eight studies met the eligibility criteria and were included in the review. Studies conducted within Europe were included. Findings indicated that vascular surgeons in parts of Europe generally recognize supervised exercise therapy as a best practice treatment for IC, but do not often refer their patients for supervised exercise therapy due to the unavailability of, or lack of access to supervised exercise therapy programs. Available supervised exercise therapy programs do not implement best practice recommendations, and in the majority, patients only undergo one session per week. Some challenges were cited as the cause of the suboptimal program implementation. These included issues related to patients’ engagement and adherence as well as resource constraints. Conclusion: There is a dearth of published research on exercise therapy in the routine management of PAD and IC. Available data from a few countries within Europe indicated that supervised exercise is underutilized despite health professionals recognizing the benefits. Research is needed to understand how to improve the availability, access, uptake, and adherence to the best exercise recommendations in the routine management of people with PAD and IC.
Background: Little is known about the extent to which routine care management of peripheral arterial disease (PAD) and intermittent claudication (IC) align with best practice recommendations on exercise therapy. We conducted a scoping review to examine the published literature on the availability and workings of exercise therapy in the routine management of patients with PAD and IC, and the attitude and practice of health professionals and patients. Methods: A systematic search was conducted in February 2018. The Cumulative Index of Nursing and Allied Health Literature, Ovid MEDLINE, Allied and Complementary Medicine Database, ScienceDirect, Web of Science and the Directory of Open Access Repositories were searched. Hand searching of reference lists of identified studies was also performed. Inclusion criteria were based on study aim, and included studies that reported on the perceptions, practices, and workings of routine exercise programs for patients with IC, their availability, access, and perceived barriers. Results: Eight studies met the eligibility criteria and were included in the review. Studies conducted within Europe were included. Findings indicated that vascular surgeons in parts of Europe generally recognize supervised exercise therapy as a best practice treatment for IC, but do not often refer their patients for supervised exercise therapy due to the unavailability of, or lack of access to supervised exercise therapy programs. Available supervised exercise therapy programs do not implement best practice recommendations, and in the majority, patients only undergo one session per week. Some challenges were cited as the cause of the suboptimal program implementation. These included issues related to patients’ engagement and adherence as well as resource constraints. Conclusion: There is a dearth of published research on exercise therapy in the routine management of PAD and IC. Available data from a few countries within Europe indicated that supervised exercise is underutilized despite health professionals recognizing the benefits. Research is needed to understand how to improve the availability, access, uptake, and adherence to the best exercise recommendations in the routine management of people with PAD and IC.
Introduction: Orthopedic patients require prolonged immobilization and undergo major surgical procedures which make them susceptible to venous thromboembolism (VTE). The role of chemoprophylaxis to prevent VTE is still debated, with many surgeons using it routinely, while certain centers use it sporadically. The present review assesses the evidence in literature regarding the VTE chemoprophylaxis in different subsets of orthopedic patients with specific focus on arthroplasty, pelvic trauma, and long-bone fractures. Materials and methods: A PubMed search to look for current usage of routine chemoprophylaxis in hip/knee arthroplasties and postoperative cases of pelvic-acetabular, hip, and tibia fractures yielded 2,216 hits. Based on the relevant articles, the evidence in literature was studied to determine the role of chemoprophylaxis. Results: The incidence of VTE in orthopedics patients is well documented with several studies, both Indian and Western quoting rates of up to 72%. There are no guidelines from any Indian orthopedics body or society, and most of the surgeons rely on the recommendations from the American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP). These guidelines are based on the review of the literature and recommend routine chemoprophylaxis to prevent VTE in hip/knee arthroplasties and hip fractures. Low molecular weight heparin, apixaban, rivaroxaban, and fondaparinux are potential agents. Oral low-dose aspirin is also effective in arthroplasty patients, while its efficacy may not be at par with the other agents in trauma cases; the evidence is however still not clear. There is no similar role of routine chemoprophylaxis in fractures distal to the knee; as the thrombi formed are distal, they do not often embolize to the lungs and are rarely clinically significant. Conclusion:Patients undergoing hip and knee arthroplasties or surgeries for pelvic-acetabular and hip fractures require routine VTE chemoprophylaxis. LMWH or newer agents like apixaban or fondaparinux are effective in decreasing the incidence of clinical VTE and could be prescribed for a period as long as 6-8 weeks postoperatively.
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