Da un protocollo sperimentale a un modello assistenziale per l’arteriopatia periferica: compliance, outcome riabilitativo e costo-efficacia di un programma originale di sport-terapia

Background Exercise training is an effective, low-cost yet underutilized therapy to improve the functional ability of patients with intermittent claudication. Its diffusion could be favoured by models of intervention that would help ensure functional and cardiovascular improvements, patient compliance and lower costs for the healthcare system. Recently an original model of sport therapy for peripheral arterial disease (PAD) prescribed at hospital and performed at home (Test in-Train out, Ti-To) showed to be more effective than a traditional home based training. Aim of the study The study aims to evaluate compliance, effect on rehabilitative outcomes and cost-effectiveness of the Ti-To model in its application as a health care model during a two- years period. Subjects and Methods 250 (age 70.5±9.2, M=191) out of 289 patients included in the Rehabilitation Program were recruited into the study . Compliance was evaluated by means of a score ranging from 0 to 4 (higher score indicates higher compliance). Rehabilitative outcomes, evaluated upon entry and at discharge, were: Ankle Brachial Index (ABI), Pain Threshold Speed (PTS) and Maximal Speed (Smax) measured by means of an incremental treadmill test, Initial Claudication Distance (ICD) and Absolute Claudication Distance (ACD) measured by means of a constant load treadmill test. Quality of life (QoL) was also evaluated in a sample composed of 90 patients by means of SF 36 questionnaire. Besides a cost effectiveness analysis was performed in order to determine the cost to walk an additional meter for ICD and ACD, the cost to gain 10% of ICD and ACD and to increase of 1 m/min the parameter PTS. The intervention was based on two 10 min-sessions/day of intermittent walking performed at home at an intensity 20%-30% lower than PTS and on serial check-ups at hospital to update the exercise program. The rehabilitative team included one doctor, a nurse and one expert of sport sciences. Results Average compliance score was 3.1±0.9. Functional parameters significantly improved (ABI: 0.60±0.16 a 0.64±0.18, p<0.0001; PTS (Km/h): 2.9±1.2 a 4.0±1.2 p<0.0001; Vmax (Km/h) 3.6±1.2 a 4.3±1.1; ICD (m) 79.2±47.8 a 115.8±53.4, p<0.0001; ACD (m): 125.3±69.6 a 179.9±71.9, p<0.0001). Baseline characteristics of patients who underwent QoL evaluation were not different from the whole population under study. All SF 36 subscales significantly improved (p<0.0001). Most of parameters showed a moderate to large Cohen’s d Effect Size. 1839 visits were performed (7.4±2.0/patient). The average cost of a visit and of a therapy cycle were € 68.93 and €507.20 respectively, with an average cost of €8,14 E to walk one additional meter before stopping and a cost to gain 10% of ICD and ACD and 1m/min of PTS respectively of 65.8 e € 72,2 e €23.56. Conclusion An original rehabilitative model for PAD based on exercise prescribed at hospital and performed at home showed a high compliance, effectiveness on improving functional capacity and QoL and a lower cost-effectiveness ratio compared to the available models of intervention in AOP.