Inequity in exercise-based interventions for adults with intermittent claudication due to peripheral arterial disease: a systematic review

To determine the equity in access to trials of exercise interventions for adults with intermittent claudication due to peripheral arterial disease.
Systematic electronic database searches of MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Clinical Trials, PEDRO, Opengrey, ISRCTN and ClinincalTrials.gov for randomised controlled trials of exercise interventions for adults with intermittent claudication were conducted. Data extraction was informed by Cochrane’s PROGRESS-Plus framework.
Searches identified 6412 records. Following the screening of 262 full texts, 49 trials including 3695 participants were included. All trials excluded potential participants on at least one equity factor. This comprised place of residence, language, sex, personal characteristics (e.g., age and disability), features of relationships (e.g., familial risk factors) and time-dependent factors, (e.g., time since revascularisation). Overall, 1839 of 7567 potential participants (24.3%) were excluded based on equity factors. Disability was the most frequently reported factor for exclusions.
Trialists endeavour to enrol a representative sample in exercise trials whilst preserving the safety profile of the intervention. This review highlights that these efforts can inadvertently lead to inequities in access as all trials excluded potential participants on at least one equity factor. Future exercise trials should optimise participation to maximise generalisability of findings. PROSPERO registration no. CRD42020189965.Implications for rehabilitation
Equity factors influence health opportunities and outcomes.
All trials of exercise for people with intermittent claudication excluded adults on at least one equity factor.
Disability was the predominant factor for exclusions from trials.
Trials should optimise participation to maximise generalisability of results as these findings are used to inform treatment and service design.

Equity factors influence health opportunities and outcomes.
All trials of exercise for people with intermittent claudication excluded adults on at least one equity factor.
Disability was the predominant factor for exclusions from trials.
Trials should optimise participation to maximise generalisability of results as these findings are used to inform treatment and service design.

本研究旨在明确外周动脉疾病所致间歇性跛行成人运动干预临床试验的获取公平性。
系统检索MEDLINE、Embase、护理与联合卫生文献累积索引（CINAHL）、考克兰对照临床试验中心注册库（Cochrane Central Register of Controlled Clinical Trials）、物理治疗证据数据库（PEDRO）、开放灰色文献数据库（Opengrey）、国际随机对照试验注册号数据库（ISRCTN）以及美国临床试验注册平台（ClinicalTrials.gov）等电子数据库，筛选针对间歇性跛行成人的运动干预随机对照试验。数据提取遵循PROGRESS-Plus框架。
本次检索共识别出6412条记录，经对262篇全文文献进行筛查后，最终纳入49项试验，共涉及3695名受试者。所有试验均基于至少一项公平性因素排除了潜在受试者，排除因素包括居住地、语言、性别、个人特征（如年龄与残疾状况）、人际关系特征（如家族危险因素）以及时间相关因素（如血管重建术后时长）。总计7567名潜在受试者中有1839人（24.3%）因公平性因素被排除，其中残疾是最常见的排除因素。
试验研究者通常会尝试招募具有代表性的样本以开展运动干预试验，同时保障干预的安全性。但本综述表明，这类尝试可能会意外造成获取公平性的缺失——所有纳入的试验均基于至少一项公平性因素排除了潜在受试者。未来的运动干预试验应优化受试者招募流程，以最大化研究结果的外推性。本研究已在国际前瞻性系统综述注册平台（PROSPERO）注册，注册号为CRD42020189965。
康复启示
公平性因素会影响健康机会与转归。
所有针对间歇性跛行患者的运动试验均至少基于一项公平性因素排除了成人受试者。
残疾是试验中最主要的排除因素。
鉴于本研究结果将用于指导治疗方案与服务设计，试验应优化受试者招募以最大化研究结果的外推性。

公平性因素会影响健康机会与转归。
所有针对间歇性跛行患者的运动试验均至少基于一项公平性因素排除了成人受试者。
残疾是试验中最主要的排除因素。
鉴于本研究结果将用于指导治疗方案与服务设计，试验应优化受试者招募以最大化研究结果的外推性。