A Usability Study of a Tele-health Service for Patients With Peripheral Arterial Disease.

Disease management programs (DMPs) are one of the methods used to optimize the care of patients with chronic diseases. DMPs are coordinated health care measures for patient populations with diseases in which active patient participation in treatment can lead to substantial effects. Specific treatment regimens, based on evidence-based treatment guidelines and structured patient information, are predominantly aimed at preventing disease exacerbations and complications. The World Health Organization (WHO) also recommends, among other things, forcing patient adherence through structured information and patient empowerment strategies to establish participatory treatment.

Peripheral arterial disease (PAD) causes oxygen and nutrient deprivation of tissues through narrowing of arterial vessels in the extremities. The cause of PAD is arteriosclerosis. The course of the disease begins asymptomatically and manifests itself over time with pain and cramps predominantly in the muscles of the lower extremity. The pain symptoms usually occur initially during physical exertion, and later at rest. As PAD progresses, chronic ulceration and necrosis occur.

Professional societies such as the European Society of Cardiology (ESC) and the European Society of Vascular Medicine (ESVM) regularly publish guidelines for the diagnosis and treatment of PAD. Therapy of PAD consists of drug therapy for the purpose of cardiovascular risk reduction (lipid and blood pressure lowering drugs and anticoagulant drugs as well as therapy of diabetes mellitus). Another aspect in the event of disease progression is interventional angioplasty, in which the affected constriction in the leg arteries is dilated and, if necessary, treated with stents. Another important pillar is also structured and supervised gait training and, in general, an improvement in lifestyle with cessation of nicotine abuse and a healthy diet.

In particular, structured gait training, which should be performed at least three times a week for 30 to 60 minutes, is strongly recommended in the current ESVM and ESV guidelines. Studies showed that structured gait training can increase walking distance by 200% in 12 weeks in patients with claudication. Daily individual interval training of 60 minutes with 5- to 15-minute intervals also proved effective in increasing walking distance. This is to overcome the pain threshold of claudication while walking. Furthermore, evidence showed that gait training may be equivalent to endovascular interventions in terms of long-term outcomes.

The aim of this study is to analyze the applicability (usability) of a telehealth service as part of a potential disease management program for patients with peripheral arterial disease.

A prospective monocentric pilot study will be conducted at the clinical department of angiology.

The study duration per participant is 90 (±14) days and is divided into 2 observation phases. In phase 1, there will be supervision by a certified nurse and the telehealth service app, and in phase 2, there will be only singular use of the app without contact by the certified nurse.

The Declaration of Helsinki (as amended from time to time) and the guidelines of "Good Clinical Practice" were taken into account in the conduct and also the planning of the study.

Furthermore, the framework guideline for the "IT infrastructure in the application of telemonitoring" was used for the planning of the study.

According to the manufacturer's manuals, the pedometers AS80/AS97/AS99 from the company Beurer are not medical devices. The app serves as a diary for patients and is not a Clinical Decision Support System. The "User's Manual PAD Stepping" is included with the study material.

Reference Projects:

The DMS app system is also already being used in routine care in the "Herzmobil" project in Styria and Tyrol. Here, patients with chronic heart failure are cared for.

The use of the DMS app is currently also being used in two other studies. These are observational studies that are not subject to the Medical Devices Act. Both projects have a positive ethics vote and are listed under the following titles:

• Telemedical follow-up of hospitalized patients with coronavirus disease-2019 (COVID-19) DRKS ID of the study: DRKS00022244.
• Building a training database of voice data recordings and body weight trajectories in hemodialysis patients for algorithm development.