Extracorporeal shockwave therapy as a novel treatment for Intermittent Claudication

Background – Intermittent claudication is a prevalent manifestation of peripheral arterial disease and affects about 3% of the UK population. Its conservative management includes best medical therapy, smoking cessation and supervised exercise, however exercise uptake among patients is poor. Pilot data has demonstrated that extracorporeal shockwave therapy is effective for improving walking distance in patients with intermittent claudication. The work of this thesis aims to consider its effectiveness for improving quality of life. Methods – In a double-blind, sham-controlled, randomised trial, patients with intermittent claudication were randomised in a 1:1 ratio to extracorporeal shockwave therapy or sham treatment. The primary endpoint was change in physical functioning at 12-week follow-up, as measured by the SF-36. Secondary endpoints included changes in walking distances, and changes in ankle brachial pressure index pre and post exercise, amongst others. Results – 138 patients were recruited and randomised. The intervention group had a significantly higher physical functioning score at 12 weeks (Mdn 41 vs 34, p=0.033), though not significant at secondary analysis. They also had significantly longer claudication distance (Mdn 125 vs 88, p=0.004) and maximum walking distances (Mdn 179 vs 129, p=0.013). No significant difference in ABPI between the two groups was evident. Conclusion – This study demonstrates that extracorporeal shockwave Therapy is clinically effective for improving walking distances and may have a positive effect in quality of life in patients with intermittent claudication. It should be considered as an adjunct to conservative management, especially in patients not willing or unable to participate in supervised exercise programs.