The PodPAD project: a podiatry-led integrated pathway for people with peripheral arterial disease in the UK – a pilot study 

Background: Peripheral arterial disease affects the lower limb and is associated with diabetes, high cholesterol, smoking and obesity. It increases the risk of cardiovascular morbidity and mortality. It can be symptomatic causing intermittent claudication, but often there are few clinical signs. Podiatrists are able to detect the presence of peripheral arterial disease as part of their lower limb assessment and are well placed to give advice on lifestyle changes to help reduce disease progression. This is important to improve health outcomes and is offered as a prevention/public health intervention.

Method: The study was located at a UK National Centre for Sports and Exercise Medicine, in which health care clinics are situated in existing leisure/sports facilities. This allowed easy access to gym facilities for participants, if they agreed to this as part of their activity programme. Outcomes considered to be favourable were: improvement in symptoms of PAD (reduction in intermittent claudication pain if present), improved ABPI readings, increase in number of pedal pulses palpated or a change in Doppler sounds from monophasic to bi or tri-phasic, decrease in cholesterol and HbA1c levels (if applicable) and the success of any smoking cessation and activity programmes. Quality of life and patient satisfaction with the programme was also assessed. Patients were excluded if they were unable to give informed consent due to lack of mental capacity and if they were unable to participate in increased activity due to other co-morbidities.

Conclusion: As this was a pilot study the sample size was low, but some statistically significant improvements with some measures were observed over the 6-month study. Podiatrists are able to provide a comprehensive vascular assessment of the lower limb and accompanying tailored advice on lifestyle changes including smoking cessation and exercise. Locating clinics in National Centres for Sports and Exercise Medicine enables easy access to exercise facilities to encourage the adoption of increased activity levels, though the long term sustainability of exercise programmes still requires evaluation.

This study was reviewed and approved by London Brent Ethics Committee IRAS ID 204611 and received research governance approval from the sponsor, Sheffield Teaching Hospitals NHS Foundation Trust Research and Innovation Office STH19410.