Global positioning system use in the community to evaluate improvements in walking after revascularization: a prospective multicenter study with 6-month follow-up in patients with peripheral arterial disease

Marie Gernigon, Alexis Le Faucheur, Dominique Fradin, Bénédicte Noury-Desvaux, Cédric Landron, Guillaume Mahe, Pierre Abraham, Marie Gernigon, Alexis Le Faucheur, Dominique Fradin, Bénédicte Noury-Desvaux, Cédric Landron, Guillaume Mahe, Pierre Abraham

Abstract

Revascularization aims at improving walking ability in patients with arterial claudication. The highest measured distance between 2 stops (highest-MDCW), the average walking speed (average-WSCW), and the average stop duration (average-DSCW) can be measured by global positioning system, but their evolution after revascularization is unknown.We included 251 peripheral artery diseased patients with self-reported limiting claudication. The patients performed a 1-hour stroll, recorded by a global positioning system receiver. Patients (n = 172) with confirmed limitation (highest-MDCW <2000m) at inclusion were reevaluated after 6 months. Patients revascularized during the follow-up period were compared with reference patients (ie, with unchanged lifestyle medical or surgical status). Other patients (lost to follow-up or treatment change) were excluded (n = 89).We studied 44 revascularized and 39 reference patients. Changes in highest-MDCW (+442 vs. +13 m) and average-WSCW (+0.3 vs. -0.2 km h) were greater in revascularized than in reference patients (both P < 0.01). In contrast, no significant difference in average-DSCW changes was found between the groups. Among the revascularized patients, 13 (29.5%) had a change in average-WSCW, but not in highest-MDCW, greater than the mean + 1 standard deviation of the change observed for reference patients.Revascularization may improve highest-MDCW and/or average-WSCW. This first report of changes in community walking ability in revascularized patients suggests that, beyond measuring walking distances, average-WSCW measurement is essential to monitor these changes. Applicability to other surgical populations remains to be evaluated.

Registration: http://www.clinicaltrials.gov/ct2/show/NCT01141361.

Figures

FIGURE 1
FIGURE 1
English translation of the recto-verso recommendation sheet provided to each patient for the stroll.
FIGURE 2
FIGURE 2
Flow diagram of the patients, with the corresponding numbers of technically satisfactory GPS recordings and the causes of technically unsuccessful GPS recordings.
FIGURE 3
FIGURE 3
Typical recordings of the distance covered during each walking bout at T0 (upper panels) and T1 (lower panels) for 1 revascularized patient (A) and 1 reference patient (B).
FIGURE 4
FIGURE 4
Changes in walking speed (average-WSCW) and the highest measured distance (highest-MDCW) during a community walk among reference (red dots) and revascularized patients (blue squares). The dashed lines represent the mean + 1 SD of changes needed to detect MCII compared with reference patients. Yellow square: average-WSCW or WIQ-speed improved only; Orange square: highest-MDCW or WIQ-distance improved only; Purple square: Both average-WSCW and highest-MDCW or both WIQ-speed and WIQ-distance improved; White square: No MCII.

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Source: PubMed

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