{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T14:39:15Z","timestamp":1790433555633,"version":"4.1.0"},"reference-count":72,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,5,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">No network meta\u2010analysis has considered the relative efficacy of cilostazol, home exercise therapy, supervised exercise therapy (SET), endovascular revascularization (ER), and ER plus SET (ER+SET) in improving maximum walking distance (MWD) over short\u2010 (&lt;1\u00a0year), moderate\u2010 (1 to &lt;2\u00a0years), and long\u2010term (\u22652\u00a0years) follow\u2010up in people with intermittent claudication.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">A systematic literature search was performed to identify randomized controlled trials testing 1 or more of these 5 treatments according to Preferred Reporting Items for Systematic Review and Meta\u2010Analysis guidelines. The primary outcome was improvement in MWD assessed by a standardized treadmill test. Secondary outcomes were adverse events and health\u2010related quality of life. Network meta\u2010analysis was performed using the gemtc R statistical package. The Cochrane collaborative tool was used to assess risk of bias. Forty\u2010six trials involving 4256 patients were included. At short\u2010term follow\u2010up, home exercise therapy (mean difference [MD], 89.4\u00a0m; 95% credible interval [CrI], 20.9\u2013157.7), SET (MD, 186.8\u00a0m; 95% CrI, 136.4\u2013237.6), and ER+SET (MD, 326.3\u00a0m; 95% CrI, 222.6\u2013430.6), but not ER (MD, 82.5\u00a0m; 95% CrI, \u22122.4 to 168.2) and cilostazol (MD, 71.1\u00a0m; 95% CrI, \u221224.6 to 167.9), significantly improved MWD (in meters) compared with controls. At moderate\u2010term follow\u2010up, SET (MD, 201.1; 95% CrI, 89.8\u2013318.3) and ER+SET (MD, 368.5; 95% CrI, 195.3\u2013546.9), but not home exercise therapy (MD, 99.4; 95% CrI, \u2212174.0 to 374.9) or ER (MD, 84.2; 95% CrI, \u221235.3 to 206.4), significantly improved MWD (in meters) compared to controls. At long\u2010term follow\u2010up, none of the tested treatments significantly improved MWD compared to controls. Adverse events and quality of life were reported inconsistently and could not be meta\u2010analyzed. Risk of bias was low, moderate, and high in 4, 24, and 18 trials respectively.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">This network meta\u2010analysis suggested that SET and ER+SET are effective at improving MWD over the moderate term (&lt;2\u00a0year) but not beyond this. Durable treatments for intermittent claudication are needed.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.019672","type":"journal-article","created":{"date-parts":[[2021,6,21]],"date-time":"2021-06-21T20:01:29Z","timestamp":1624305689000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["Network Meta\u2010Analysis Comparing the Outcomes of Treatments for Intermittent Claudication Tested in Randomized Controlled Trials"],"prefix":"10.1161","volume":"10","author":[{"given":"Shivshankar","family":"Thanigaimani","sequence":"first","affiliation":[{"name":"The Queensland Research Centre for Peripheral Vascular Disease (QRC\u2010PVD) College of Medicine and Dentistry James Cook University Townsville Queensland Australia"},{"name":"The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Phie","sequence":"additional","affiliation":[{"name":"The Queensland Research Centre for Peripheral Vascular Disease (QRC\u2010PVD) College of Medicine and Dentistry James Cook University Townsville Queensland Australia"},{"name":"The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinmay","family":"Sharma","sequence":"additional","affiliation":[{"name":"The Queensland Research Centre for Peripheral Vascular Disease (QRC\u2010PVD) College of Medicine and Dentistry James Cook University Townsville Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Wong","sequence":"additional","affiliation":[{"name":"The Queensland Research Centre for Peripheral Vascular Disease (QRC\u2010PVD) College of Medicine and Dentistry James Cook University Townsville Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"The Queensland Research Centre for Peripheral Vascular Disease (QRC\u2010PVD) College of Medicine and Dentistry James Cook University Townsville Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6729-2296","authenticated-orcid":false,"given":"Pacific","family":"Huynh","sequence":"additional","affiliation":[{"name":"The Queensland Research Centre for Peripheral Vascular Disease (QRC\u2010PVD) College of Medicine and Dentistry James Cook University Townsville Queensland Australia"},{"name":"The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Moxon","sequence":"additional","affiliation":[{"name":"The Queensland Research Centre for Peripheral Vascular Disease (QRC\u2010PVD) College of Medicine and Dentistry James Cook University Townsville Queensland Australia"},{"name":"The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhondda","family":"Jones","sequence":"additional","affiliation":[{"name":"The Queensland Research Centre for Peripheral Vascular Disease (QRC\u2010PVD) College of Medicine and Dentistry James Cook University Townsville Queensland Australia"},{"name":"The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5779-8848","authenticated-orcid":false,"given":"Jonathan","family":"Golledge","sequence":"additional","affiliation":[{"name":"The Queensland Research Centre for Peripheral Vascular Disease (QRC\u2010PVD) College of Medicine and Dentistry James Cook University Townsville Queensland Australia"},{"name":"The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia"},{"name":"The Department of Vascular and Endovascular Surgery Townsville University Hospital Townsville Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","first-page":"826","article-title":"The health\u2010related quality of life of people with peripheral arterial disease in the community: the Edinburgh Artery Study","volume":"54","author":"Dumville JC","year":"2004","unstructured":"Dumville JC, Lee AJ, Smith FB, Fowkes FG. 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