Factors Associated With Adherence to Claudication Therapy Among Veterans - The FAACT Study
Symptomatic leg pain or claudication due to peripheral artery disease can range from mild to severely limiting pain that significantly reduces walking distance. Treatments for claudication are twofold: (1) conservative management and (2) surgical intervention by way of stenting and/or balloon angioplasty. Studies have shown that both strategies are equally effective in improving walking abilities as well as quality of life over the long-term. With surgical intervention, there is the lure of immediate relief from symptoms, if successful. However, compared to exercise, there is a surgery-associated 4% risk of major lower extremity amputation in the long term. Despite the low-amputation risk and benefits of exercise, initiating exercise and ensuring compliance with recommendations remain challenging. Low adherence rates raise pertinent questions with respect to the reasons for adherence failure, and differences between those who walk and those who do not walk. Objectives of this cross-sectional study included: identifying predictive factors that are associated with walking, examining whether successful smoking cessation translated to walking behavior, and qualitatively describing perceptions of claudication among a cohort of Veterans. Between August and October 2017, 500 surveys were mailed to potential participants across the United States. Responses were received from 140 participants (28%). The median age among this cohort of Veterans was 69 years (66-73). Of 137 individuals, 47 (34%) indicated that they reserved a dedicated time to walk for exercise compared to 90 (61%) who did not walk for exercise. From this analysis, we report that the intertemporal choices of regular saving habits (OR: 8.79, [2.23-34.78]), complex-problem solving (OR: 0.12, [0.03, 0.45]), puzzle-solving, (OR: 5.34, [1.41, 20.17]) were predictors associated with walking behavior (current and previous). With respect to smoking cessation, 44% (61/140) of respondents indicated that they had successfully quit smoking. In examining whether previous smoking and current smoking, among a cohort of Veterans, could describe exercise behavioral and psychological profiles, we found that participants who reported current smoking were less likely to also report walking behavior (OR: 0.33, [0.12, 0.90]). Participants with a history of smoking were also future-oriented, and regular savers. Finally, from the results of a phone-based interview of 10 respondents, we propose strategies, although seemingly minor, that may increase the likelihood of community-based walking.^
Sharath, Sherene Esther, "Factors Associated With Adherence to Claudication Therapy Among Veterans - The FAACT Study" (2017). Texas Medical Center Dissertations (via ProQuest). AAI10682848.