Does evidence exist on whether specific interventions can improve adherence to a home exercise program in a patient with intermittent claudication?

Abstract

The purpose of “Evidence in Practice” is to illustrate the literature search process to obtain evidence that can guide clinical decision making. This article is not a case report. The examination, evaluation, and intervention sections are purposely abbreviated. A 71-year-old man was referred by his physician to our clinic for examination and treatment with reports of bilateral lower-extremity pain, which was worse on the right side than on the left. The patient reported that his symptoms were most noticeable while walking distances greater than 2 city blocks. He did not report any pain while at rest, and his leg pain was relieved by sitting for 5 to 10 minutes. He also had a history of type 2 diabetes mellitus, hypertension, and hyperlipidemia. His current medications included glipizide (Glucotrol XL*) for control of diabetes mellitus, clopidogrel bisulfate (Plavix†) to reduce platelet-induced thrombosis, simvastatin (Zocor‡) to improve his plasma lipid profile, and amlodipine besylate (Norvasc*) for treatment of hypertension. He reported that he has smoked cigarettes for 46 years. Although he tried to quit unsuccessfully several times, he reduced his consumption to ½ pack per day for the past 5 years. He reported that his leg symptoms began approximately 2 years ago, but he initially attributed his pain with walking to his age and arthritis. He felt that the intensity of his symptoms were becoming progressively worse and that the symptoms seemed to come on sooner, causing his walking distances to become shorter. For example, he recently started walking several mornings each week with his wife and several acquaintances at a local shopping mall; however, he was unable to keep up with his wife and fellow “mall-walkers” because of his leg pain. Before referral to our clinic, the patient underwent radiographic studies of the lumbar spine and both …