Intermittent claudication (IC) is a manifestation of peripheral arterial disease (PAD). Current evidence-based international treatment guidelines recommend supervised exercise therapy (SET) as the preferred initial treatment for IC patients.1,2 Furthermore, treatment should be aimed at cardiovascular risk reduction through lifestyle modification and pharmacotherapy (anti-platelet and statin therapy). However, in daily practice, many patients receive an invasive intervention by means of an angioplasty (‘dotter’) or bypass surgery instead of SET as first-choice treatment. A “stepped care” model (SCM) strives to initially refer all IC patients to SET, preserving invasive interventions for patients not sufficiently responding SET.3
ClaudicatioNet was founded in 2010. It is a so-called open network, which means that membership is attainable for every physical therapist (PT) who fulfills a set of participation criteria.4 ClaudicatioNet delivers patient value through optimizing treatment outcomes by ensuring that PTs are well trained and thus ‘specialized’ in SET and cardiovascular risk factor modification. Furthermore, ClaudicatioNet strives to achieve implementation of the SCM and ensures 100% availability of SET in the Netherlands. Previously, patients either received walking advice, which is inferior to SET,5-7 or an invasive intervention, which is accompanied by high risks (morbidity/mortality). Therefore, by making SET available to all, patients are ‘spared’ either ineffective therapy or unnecessary risks. The current situation in the Netherlands is unique, as worldwide availability of SET remains poor.8 Implementation of the SCM can lead to significant yearly savings of over 32M euros on health care expenditure.3 ClaudicatioNet contributed to turning the hypothetical savings found in medical research into actual daily practice, and continues to do so.
In 2015, ClaudicatioNet introduced a so-called ‘Kwaliteitssysteem’ (translation: Quality System). This is an innovative eHealth solution designed to assess the quality of each individual PT and the network as a whole. Relevant and validated outcome measures of patients with IC receiving SET will be automatically aggregated in this Quality System. This will provide data on treatment effect and referral patterns. Consequently, ClaudicatioNet researchers can formulate benchmarks for quality of care and isolate underperformers, subsequently providing them with targeted advice or additional training to improve the competence of individuals and groups of PTs. The Quality System will increase the quality and transparency of care for patients, physicians and health insurance companies.
Beyond IC, ClaudicatioNet aims at upscaling of its established framework to include other chronic diseases where similar rehabilitation principles apply. Examples of such disease are coronary artery disease and chronic heart failure (cardiac rehabilitation), and chronic obstructive pulmonary disease (pulmonary rehabilitation). Over the years, ClaudicatioNet has gathered experience on the implementation strategy and management of such a network, which makes realization of a ‘Chronic Care Physical Therapy Network’ feasible.
Furthermore, we strongly believe that such a network guarantees improved quality control (with the help of the Quality System) and evidence-based physical therapy in these areas.