27 February 2020

The Radboudumc, with the University of Colorado, ClaudicatioNet and Harteraad, has developed a method to better treat people with intermittent claudication (a vascular disease in which the arteries in the leg are constricted). This method, by Thomas Hoogeboom among others, enables physiotherapists to coordinate the care process with the patient better. The patient benefits greatly from this method, called the People-like-me approach.
 
Intermittent claudication
Intermittent claudication (in Latin: Claudicatio Intermittens) is a vascular disease in which the arteries in the leg are constricted (peripheral arterial vascular disease). This disease causes pain, cramping, and a numb/tired feeling in the legs. The complaints mainly arise while walking because of an oxygen deficiency in the legs. The pain disappears when people stand still, often within ten minutes. This is why, in some languages, the disease is also called ‘window-shopping legs’: people walking from shop window to shop window, having to stop frequently to recover. The pain means that patients eventually start walking less and less. Intermittent claudication also increases the risk of other cardiovascular diseases, such as a heart attack or stroke. Every year, approximately 20,000 people in the Netherlands start treatment for these symptoms.
 
People-like-me approach
In the past, surgery was often performed; nowadays, physiotherapists often prescribe intensive walking therapy. In many cases, this is combined with a lifestyle change, such as quitting smoking and eating healthier. Now, an extra move has been made, which comes from the method used at the maternity consultation office. Every new child is weighed and measured there. This baby is then compared to the progress of all children who have been measured before. But what if you do not look at the whole group, but only at the 10 to 20 babies that are most similar to the new baby? Would that not provide a much better estimate?
 
Thomas Hoogeboom, a researcher at IQ Healthcare, among others, translated this idea into physiotherapy practice: patients are not compared to all people with intermittent claudication, but only to those who resemble the patient. This method includes considering age, gender, motivation, lifestyle factors (such as weight and smoking) and the presence of other conditions. The wishes and possibilities of the patient are taken into account, which makes it a very person-oriented approach. This creates a much more focused prognosis and treatment plan based on a personal profile. We call these individual prognostic profiles (People-like-me approach) KomPas. This video explains: https://www.youtube.com/watch?v=fylZYGbdu2M.
 
A joint decision
Patients experience real benefit from this method. They are more motivated and often adjust their lifestyle. This intensive collaboration between care provider and patient is the future: it is no longer the care provider who tells the patient what needs to be done, but the patient and care provider together determine how the best result can be achieved. In time, this method could also be applied to people recovering from surgery and people with chronic conditions. Moreover, it could lead to a reduction in healthcare costs: fewer procedures would be needed and treatment could be organized more efficiently. This is currently being researched.
 
Publication in Physical Therapy, Person-Centered Care and Physical Therapy: A “People-Like-Me” Approach – Andrew J Kittelson, Thomas J Hoogeboom, Margaret Schenkman, Jennifer E Stevens-Lapsley, Nico L U van Meeteren.
 

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