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Podiatry-led PAD programme endorsed by NICE

Podiatry-led PAD programme endorsed by NICE

NICE endorsed programme of exercise in patients with peripheral vascular disease    

The Salford Lower Limb Vascular Assessment Service was commissioned in 2012 and is a community based podiatry led service which provides assessment and diagnosis of peripheral arterial disease (PAD). Following a diagnosis of PAD the clinicians work with patients to develop an individual clinical management plan to manage their increased cardiovascular and limb risks. This includes optimising best medical therapy, making lifestyle changes such as stopping smoking, increasing cardiovascular exercise and weight management. In the case of severe PAD with deteriorating symptoms or critical limb ischaemia onward referral for a surgical opinion is appropriate but the vast majority of PAD patients can be managed with conservative treatment in the community.

The National Institute for Health and Care Excellence (NICE) provides recommendations regarding the management of PAD (NICE CG147) (1), this includes as a first line treatment offering 2 hour of supervised exercise a week for a three month period. There is evidence that supervised exercise improves walking capacity and quality of life to a greater extent than independent exercise (2), (3), and longer term benefits and sustained improvements (4).

The Podiatrists from the service approached the local cardiac rehabilitation team and agreed a programme to incorporate PAD patients into the exercise programme offered to patients after a cardiac event. As well as support to increase their walking distance this offered support to make lifestyle changes. This was supported by the local vascular surgery teams and commissioners and has been included in the NICE shared learning database as an example of good practice. This programme could easily be replicated utilising existing cardiac rehabilitation teams.

Read the case study:
Community Triage for Lower Limb Vascular Concerns: Reducing the burden on hospitals

Download document:
NICE accredited Cardiac Rehabilitation Access: for people with peripheral arterial disease and intermittent claudication

    

Susan Matthews and Pam Smith
Vascular Specialist Podiatrists


References.

        
  1. NICE CG 147 https://www.nice.org.uk/guidance/cg147
  2. Al-Jundi  W, Madbak K, Beard JD et al. 2013. Systematic review of home based exercise programmes for individuals with intermittent claudication. European Journal of Vascular and Endovascular Surgery. December 2013. Vol 46, issue 6 pages 690 – 706.
  3. Fokkenrood HJ, Bendermarcher BL, Jan Lavret G et al 2013. Supervised exercise therapy versus non supervised exercise therapy for intermittent claudication. Cochrane database of systematic reviews issue 8 : CD005263.
  4. Ratliff DA et al. Supervised exercise training for intermittent claudication : lasting benefit at 3 years. European Journal of vascular and endovascular surgery 2007. 34(3) p 322-326.
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