Abstract
Background:
Peripheral Arterial Disease (PAD) significantly impairs functional capacity and quality of life (QoL) due to reduced lower limb perfusion. This study evaluates the effectiveness of a nurse-led intervention program incorporating dietary counseling, exercise, and education on functional capacity and QoL in PAD patients.
Methods:
A pretest/posttest-controlled design was employed with 30 participants (15 experimental, 15 control) recruited from KG Hospital, Coimbatore, India. The intervention included nutritional supplementation, home-based walking, Buerger Allen exercises, and educational sessions over six months. Outcomes were assessed using the Ankle–Brachial Index (ABI), 6-Minute Walk Test (6MWT), Walking Impairment Questionnaire (WIQ), and VascuQoL-25 at baseline, three months, and six months.
Results:
The experimental group showed significant improvements in ABI (0.84 vs. 0.65, P < 0.0001), 6MWT distance (278.87 vs. 186.93 meters, P < 0.0001), and WIQ scores (all P < 0.01) at six months compared to controls. Biochemical markers, including fasting blood sugar (FBS) and Hemoglobin A1c (HbA1c), also improved significantly. No adverse events were reported, indicating the intervention‘s safety.
Conclusion:
These findings suggest that nurse-led interventions are effective in enhancing functional capacity and metabolic health in PAD patients, supporting their integration into clinical practice.
Keywords: 6-Minute walk test, ankle–brachial index, functional capacity, intermittent claudication, peripheral arterial disease, quality of life
INTRODUCTION
Peripheral Arterial Disease (PAD) is a chronic atherosclerotic condition characterized by narrowed arteries, leading to reduced blood flow to the lower extremities.[1] This results in intermittent claudication, reduced mobility, and diminished quality of life (QoL), particularly in patients with comorbidities like diabetes mellitus (DM) and hyperlipidemia.[2] PAD affects approximately 200 million people globally, with prevalence increasing with age and cardiovascular risk factors.[3] Despite its burden, non-pharmacological interventions, such as structured exercise and lifestyle modifications, remain underutilized in clinical settings.[4]
Nurse-led interventions offer a promising, cost-effective approach to managing chronic conditions through patient education, exercise programs, and dietary counselling.[5] Previous studies have shown that supervised exercise improves walking distance and QoL in PAD,[6] but the efficacy of nurse-led, home-based programs remains underexplored. This study aims to evaluate the impact of a comprehensive nurse-led intervention on functional capacity and QoL in PAD patients with Fontaine Stage IIa, focusing on those with DM or hyperlipidemia.
METHODOLOGY
Study design
A study involving two groups, one receiving a nurse-led intervention and the other routine medical care, assessed at baseline, three months, and six months posttest.
Setting and population
The study was conducted at KG Hospital's Diabetology and Cardiology Outpatient Departments in Coimbatore, India, focusing on patients diagnosed with PAD.
Selection criteria
The study requires participants over 40 with Fontaine Stage IIa or IIb PAD, intermittent claudication, ABI score, diabetes, hyperlipidemia, and walking ability without hemodynamic instability.
Sample and sampling
A total of 30 participants (15 experimental, 15 control) were selected using non-probability purposive sampling, with equal representation of PAD + DM and PAD+hyperlipidemia subgroups.
Intervention
The experimental group underwent a six-month nurse-led program, including nutrient supplementation, dietary counseling, home-based walking, Buerger Allen exercise, and education on PAD management. They received 25 g nutrient balls, 1500–1800 kcal/day menu plans, and home visits for exercise logbooks and video demonstrations.
The control group received routine medical care with biweekly telephonic follow-ups (10–15 minutes) to monitor general health parameters.
Data collection tools
The data collection tools include demographic and clinical profiles, foot tests, physical foot assessments, ABI measurements, walking tests, VascuQoL-25, and laboratory tests like FBS, Hemoglobin A1c (HbA1c), and lipid profile.
RESULTS
Baseline comparability
Baseline demographic, clinical, and functional characteristics were comparable between groups. Mean age was 54.33 ± 5.51 years (experimental) vs. 51.80 ± 5.75 years (control) (P = 0.2282). Comorbidities (DM: 53.3%, hyperlipidemia: 46.7%) and functional measures (ABI: 0.64 vs. 0.65, P = 0.7919; 6MWT: 197.73 vs. 188.47 meters, P = 0.3643) showed no significant differences.
Functional outcomes
Values are presented as mean ± standard deviation. Independent sample t-tests were used to compare group differences. A P value < 0.05 was considered statistically significant.
Table 1 shows that at three months, the experimental group showed significant improvements in ABI (0.75 ± 0.06 vs. 0.64 ± 0.07, P = 0.0001) and 6MWT distance (241.53 ± 30.09 vs. 187.87 ± 23.84 meters, P < 0.0001). WIQ scores were similar (P > 0.05). At six months, the experimental group showed significant improvements in ABI (0.84 vs. 0.65), 6MWT distance (278.87 m vs. 186.93 m), and WIQ scores for distance (81.73 vs. 67.33), speed (66.27 vs. 55.00), and stair climbing (67.13 vs. 53.93), all with statistically significant P values.
Table 1.
Posttest 1 Scores at Three Months (n=30)
| Parameter | Experimental (n=15) | Control (n=15) | P |
|---|---|---|---|
| ABI | 0.75±0.06 | 0.64±0.07 | 0.0001 |
| 6MWT Distance (m) | 241.53±30.09 | 187.87±23.84 | 0.0000 |
| WIQ Distance (%) | 66.00±8.87 | 67.07±9.20 | 0.7489 |
| WIQ Speed (%) | 53.27±7.72 | 55.47±9.74 | 0.4989 |
| WIQ Stair (%) | 51.53±9.05 | 53.00±8.77 | 0.6557 |
6MWT=6-minute walk test, WIQ=Walking impairment questionnaire, ABI=Ankle brachial index
Biochemical outcomes
At six months, the experimental group showed significant improvements in metabolic parameters. Fasting blood sugar (FBS) was reduced to 117.93 ± 15.56 mg/dL compared to 139.73 ± 24.56 mg/dL in the control group (P = 0.0034). HbA1c levels were also lower in the experimental group at 6.50 ± 0.48% versus 6.91 ± 0.56% (P = 0.0115). Additionally, high-density lipoprotein (HDL) levels improved significantly to 45.07 ± 5.17 mg/dL compared to 40.80 ± 5.52 mg/dL (P = 0.0316).
Change analysis
Table 2 represents from baseline to six months, the experimental group showed significantly greater improvements in ABI (+0.21 vs. –0.01), 6MWT distance (+95.27 m vs. +8.27 m), FBS (–18.27 vs. –0.53 mg/dL), and HDL (+5.20 vs. –0.07 mg/dL), all with statistically significant P values.
Table 2.
Change in functional and biochemical parameters (pre- vs posttest 2) (n=30)
| Parameter | Mean change (experimental) | Mean change (control) | P |
|---|---|---|---|
| ABI | 0.21±0.10 | –0.01±0.04 | <0.0001 |
| 6MWT Distance (m) | 95.27±46.50 | 8.27±22.90 | <0.0001 |
| WIQ Distance (%) | 22.87±8.98 | 20.33±13.00 | 0.5401 |
| WIQ Speed (%) | 32.60±16.84 | 28.53±9.52 | 0.4242 |
| WIQ Stair (%) | 37.53±13.71 | 37.13±13.82 | 0.9371 |
| FBS (mg/dL) | –18.27±15.14 | –0.53±15.62 | 0.0035 |
| HbA1c (%) | –0.38±0.44 | –0.08±0.31 | 0.0347 |
| LDL (mg/dL) | –10.80±13.87 | –0.07±10.85 | 0.0213 |
| HDL (mg/dL) | +5.20±4.44 | –0.07±3.36 | 0.0003 |
| Triglycerides (mg/dL) | –13.87±34.30 | +1.67±21.48 | 0.1462 |
| Total cholesterol (mg/dL) | –11.80±25.60 | +2.73±18.21 | 0.0523 |
ABI=Ankle brachial index, 6MWT=6-minute walk test, WIQ=Walking impairment questionnaire, FBS=Fasting blood sugar, HbA1c=Hemoglobin A1c, LDL=Low-density lipoprotein, HDL=High-density lipoprotein
In PAD+DM vs. PAD+HL, PAD+HL patients had lower HbA1c (6.37 ± 0.40 vs. 6.91 ± 0.52%, P = 0.0075) and higher HDL (44.36 ± 5.34 vs. 40.19 ± 5.18 mg/dL, P = 0.0349).
DISCUSSION
The nurse-led intervention significantly improved functional capacity (ABI, 6MWT, WIQ) and metabolic parameters (FBS, HbA1c, HDL) in PAD patients, supporting the alternative hypothesis (H1). These findings align with prior research demonstrating the efficacy of structured exercise and lifestyle interventions in PAD.[6] The substantial increase in 6MWT distance (+95.27 meters) exceeds the minimal clinically important difference (50 meters),[7] indicating meaningful functional gains.
Home-based walking and Buerger Allen exercises likely enhanced peripheral perfusion (evidenced by ABI improvements), while dietary counseling contributed to metabolic improvements, particularly in FBS and HbA1c, critical for PAD patients with DM.[4] The lack of significant VascuQoL differences may reflect the instrument’s sensitivity or the need for longer follow-up to capture QoL changes.[8]
Subgroup analysis suggests that PAD+HL patients may achieve better metabolic outcomes than PAD+DM patients, likely due to the complex glycemic burden in diabetes.[5]
CONCLUSION
Nurse-led intervention improves functional capacity and metabolic health in PAD patients, demonstrating safety and efficacy. Integration into management, especially early-stage patients, requires larger, randomized trials.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
The author(s) received no financial support for the research, authorship, and/or publication of this article.
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