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 rehabilitationEquity 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试验的获取公平性。
研究系统检索了MEDLINE、Embase、护理及联合健康文献累积索引（CINAHL）、Cochrane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）、灰色文献数据库（Opengrey）、国际标准随机对照试验注册库（ISRCTN）以及临床试验注册平台（ClinicalTrials.gov），查找针对间歇性跛行成人的运动干预随机对照试验。数据提取工作基于Cochrane PROGRESS-Plus框架（PROGRESS-Plus framework）开展。
本次检索共获取6412条记录，经对262篇全文进行筛查后，最终纳入49项试验，共计3695名参与者。所有试验均通过至少一项公平性因素排除潜在参与者，涉及居住地、语言、性别、个人特征（如年龄与残疾状况）、人际关系特征（如家族性危险因素）以及时间相关因素（如血管重建术后时长）。总计7567名潜在参与者中，1839人（24.3%）因公平性因素被排除。残疾是最常被报告的排除因素。
试验研究者在力求招募具有代表性的研究样本、保障干预措施安全性的同时，本综述发现此类努力可能无意间引发获取公平性缺失——所有试验均通过至少一项公平性因素排除了潜在参与者。未来的运动试验应优化参与者招募流程，以最大化研究结果的外推性。
本研究已完成PROSPERO注册，注册编号为CRD42020189965。

康复领域启示：
公平性因素会影响健康机会与转归。所有针对间歇性跛行人群的运动试验均至少通过一项公平性因素排除了成人参与者。残疾是试验排除参与者的主要因素。由于此类研究结果将用于指导治疗与服务设计，试验应优化参与者招募以最大化结果的外推性。公平性因素会影响健康机会与转归。所有针对间歇性跛行人群的运动试验均至少通过一项公平性因素排除了成人参与者。残疾是试验排除参与者的主要因素。由于此类研究结果将用于指导治疗与服务设计，试验应优化参与者招募以最大化结果的外推性。