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Intermittent Claudication with Flo motivates patients and increases clinic capacity

posted 10 May 2017, 03:12 by Philip O'Connell   [ updated 16 Oct 2017, 02:34 by Hollie Stirman ]
Mairi Ross 
Vascular Physiotherapist 

10 May 2017 

(SCO NHS NHI) Patients feel less isolated and more motivated to improve Intermittent Claudication with Flo's help

Intermittent Claudication (IC) is a symptom of peripheral arterial disease (PAD) where pain is experienced in the main muscle groups of the leg when exercising and walking.  Patients with IC need to push further into their leg pain when exercising and walking to gain any benefit from physiotherapy – this develops the collateral circulation allowing the blood to follow a natural bypass to the affected muscles and therefore reducing the pain felt thus increasing the pain free walking distance. 

NHS Highland (NHSH) is the largest Health Board in Scotland covering 32 500km2 serving a population of 320,000. 2.3% of adults over the age of 16 will be affected by IC – this equates approximately to 4,420 adults in NHSH.  The geography of this area is one of the biggest challenges to delivering patient care.  A large number of patients are very remote and rural, making the journey to Inverness long and tiring.  If we can treat and assess these patients in their homes then the geography challenge will no longer be an issue. 

With an ever-increasing population there should be no need to review clinically stable claudicants especially if telehealth can be used for remote monitoring. 

“If we can treat and assess this cohort of patients in their homes, then the geography challenge will no longer be an issue bringing great benefit to patients and clinicians alike whilst deriving greater value from NHS resources and creating clinic capacity for patients who do require face-to-face review.”

Welcoming Flo

The opportunity for us to use Flo to enable us to remotely gather information regarding their condition and ability, and also to encourage and motivate these patients to continue with their exercise regime and daily walking went live with IC patients in Jan 2016. 

At the patient’s initial assessment, they undergo a treadmill test measuring the pain onset distance (POD), maximum walking distance (MWD) and the reason for having to stop walking. Patients are then given a home exercise programme and advised to push into their pain level a little more than they normally would. Some of these patients will attend a weekly exercise class at Raigmore Hospital (Inverness).

Patients who consent are enrolled with Flo at the end of the initial physiotherapy assessment, The session is extended by 15 minutes to allow for the actions below:
  • To explain what Flo is and how she can benefit the patient whilst they are at home
  • To provide a patient information leaflet with time to read this 
  • To explain consent and for the patient to sign the consent form 
  • To loan the patient a pedometer and show them how it works 
  • To register the patient with Flo and send consent form to TEC

Flo’s Interactions with our IC Patients

Patients receive regular interaction with Flo’s friendly persona around key elements involved in their treatment plan. This helps to educate and motivate patients to become more confident and engaged with their self care, examples include:
  • Understanding the number of steps the patient can take before having to stop and the reasons for stopping walking 
  • Interaction around physiotherapy exercise 
  • Patient reported impact of symptoms on daily activities 
  • Medicine compliance for aspirin or clopidogrel 
  • Smoking status 
  • Compliance with diabetes management 
  • Patients report their daily step count registered on their pedometer 

Patients are then re-assessed after 3 months when they repeat the initial treadmill test.