Episode 28 – Peripheral Vascular Disease

Watch the video version of this Q&A episode on YouTube - https://youtu.be/WSvUOk80it8 

A patient diagnosed with peripheral vascular disease begins a supervised treadmill exercise regimen. After two minutes of ambulation, the patient reports the onset of claudication symptoms rated as 3/10 on a pain scale. What is the physical therapist’s MOST appropriate initial response? 

1. Encourage the patient to continue until symptoms become more painful
2. Reduce the speed and grade of the treadmill until symptoms resolve
3. Allow the patient to rest, resuming ambulation once symptoms have subsided
4. Discontinue use of the treadmill and select an alternative mode of exercise

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A patient diagnosed with peripheral vascular disease begins a supervised treadmill exercise regimen. After two minutes of ambulation, the patient reports the onset of claudication symptoms rated as 3/10 on a pain scale. What is the physical therapist’s MOST appropriate initial response? 

1. Encourage the patient to continue until symptoms become more painful
2. Reduce the speed and grade of the treadmill until symptoms resolve
3. Allow the patient to rest, resuming ambulation once symptoms have subsided
4. Discontinue use of the treadmill and select an alternative mode of exercise

A student’s ability to answer this question is going to be heavily influenced by their knowledge related to peripheral vascular disease. Let’s take a quick academic dive into this common pathology! 

Peripheral Vascular Disease (PVD)
PVD is a condition where there is narrowing of the lumen of blood vessels causing a reduction in circulation usually secondary to atherosclerosis.

Signs and Symptoms: Individuals with peripheral vascular disease may have mild or no symptoms, while others experience significant claudication, most often in the legs, which serves to limit physical activity. Other symptoms include leg numbness or weakness, shiny and cool skin in the extremities, weak or absent peripheral pulses, skin color changes, and hair loss on the legs. 

Risk Factors: Phlebitis, injury or surgery, autoimmune disease, diabetes mellitus, smoking, hyperlipidemia, inactivity, hypertension, positive family history, increased age, and obesity 

Intervention: Patient education is paramount regarding the disease process and includes limb protection, foot and skin care, and risk factor reduction (e.g., smoking cessation, avoiding cold exposure). Physical therapy management typically includes a progressive walking program and exercise to improve functional and vascular prognosis. Symptom provoking ambulation programs have been shown to effectively increase the intensity and duration of ambulation in patients with PVD.

Armed with this information, let’s explore each of the options:

Option 1 - Encourage the patient to continue until symptoms become more painful
Patients engaging in exercise training to decrease claudication symptoms should be encouraged to continue ambulating until symptoms increase to a moderate level of severity.

Rest breaks should be initiated before symptoms approach an intolerable intensity or at the patient’s request. A rating of 3/10 on a pain scale is relatively mild, and in the absence of other symptoms provides ample evidence to continue ambulation.

Option 2 - Reduce the speed and grade of the treadmill until symptoms resolve

During initial training, speed and grade settings are typically selected with the intent of eliciting the patient’s claudication symptoms within three to five minutes. An exercise-rest-exercise pattern of activity is recommended with exercise intensity remaining high enough to exacerbate symptoms.

A rating of 3/10 on a pain scale would not typically provide enough justification to reduce the intensity of the treadmill parameters.

Option 3 - Allow the patient to rest, resuming ambulation once symptoms have subsided
Once symptoms become limiting with each exercise effort, the patient should rest in either sitting or standing until symptoms subside. The exercise-rest-exercise pattern should continue with exercise intensity sufficient to elicit symptoms and require intermittent rest breaks.

This option is fairly tempting. However, the patient’s subjective pain report of 3/10 would not typically be sufficient to warrant the initiation of a rest period.

Option 4 - Discontinue use of the treadmill and select an alternative mode of exercise
Walking exercise regimens intended to elicit claudication symptoms have been shown to be an extremely effective mode of exercise for the treatment of PVD and claudication.

A treadmill offers a consistent means of altering exercise parameters (e.g., speed and grade). As a result, the presented information does not warrant termination of the described intervention.

The correct answer is Option 1

Let’s explore the all student data:
33% of students selected Option 1, Encourage the patient to continue until symptoms become more painful, the correct response
32% of students selected Option 2, Reduce the speed and grade of the treadmill until symptoms resolve
29% of students selected Option 3, Allow the patient to rest, resuming ambulation once symptoms have subsided
6% of students selected Option 4, Discontinue use of the treadmill and select an alternative mode of exercise

System Classification
This question is a Cardiovascular and Pulmonary Systems question which represents approximately 14% of all exam items.

Content Outline Classification
This question is an Interventions question which represents approximately 29% of all exam items.

Level Classification
This question is a Level 3 question since the question requires candidates to systematically analyze and often interpret information to determine an appropriate course of action. The questions tend to have some degree of subjectivity and candidates are required to assign varying degrees of importance to different variables.

Remediation of Level 3 questions occurs by continuing to refine decision making processes when answering examination questions and differentiating between good, better, and best options.

Academic Focus Area
Looking to review related academic content? Check out pages 474 and 475 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!