Thesis (Ph.D)-Cairo Univsersity - Faculty of Physical Therapy - Department of Cardiovascular / Respiratory Disorder and Geriatrics

Bibliography: p. 129-147.

Background: Peripheral arterial disorder (PAD) is a common vascular disordercausedprimarilyby atherosclerosis , it leads to a decrease in blood flow in the legs. It features intermittent claudication (IC) with costly complications and a significant decrease in functional ability. The theory of High tone external muscle stimulation ( HTEMS) first in transmitting a certain, and possibly the highest dose of energy into tissues by high frequency ,and second by the resonance effect inducing oscillation of cellular and tissue structures improves cell metabolism , leading to analgesic , circulatory and other beneficial effects. However, their use was recently introduced in PAD management. The aim of the study was to investigate the effect of HTEMS on endothelial dysfunction and walking parameters in PAD . Methods: 60 diabetic patients with moderate stage PAD based on their ankle brachial pressure index which ranged from 0.4 to 0.7 with intermittent claudication (IC ) and their age ranged from 40 to 70 years, selected from an outpatient clinic of vascular Medicine department Cairo university hospitals, were assigned randomly into two groups A&B. group (A) ( HTEMS group) included 30 patients who received high tone external muscle stimulation performed using a (HiTop 191-H; gbo Medizintechnik, Rimbach, Germany), 60 minutes per session, 3 times per week, for 12 weeks, in addition to their medical treatment . group (B) ( Exercise group ) included 30 patients who participated in supervised regular aerobic exercise training program on treadmill with moderate intensity, (score 12-14 on Borg scale for rate of perceived exertion) 40 minutes per session, 3 times per week, for 12 weeks in addition to their medical treatment , the period of the study was from March 2021 to August 2021. The endpoints of this study were ankle-brachial index (ABI), claudication Pain Distance (CPD), Claudication pain time (CPT), Maximal walking distance (MWD), Maximal walking time (MWT), nitric oxide (NO) , and walking impairment questionnaire (WIQ). Results: there was significant improvement in all parameters in both groups with no significant differences between them asthe percent increase in ABPI value in groups A and B was 4.69% and 3.08%, respectively.The percent increase in CPD value in groups A and B was 108.46% and 112.78%, respectively, while it was 95.30% and 102.18%, in CPT in group A and B respectively. The percent increase in PWD value in groups A and B was 90.36% and 91.31%, respectively, while it was 96.29% and 99.03%, in PDT in group A and B respectively. The percent increase in the NO mean value in groups A and B was 17.94% and 17.36%, respectively. In group A the percentage of improvement in WIQ after 12 weeks of the study was 52.13% and 53.72% in group B respectively in walking impairment score, while it was 33.35 % and 35.50% in group A and B respectively in walking distance score, and was 58.18% and 61.49% in group A and B respectively in walking speed score. Conclusion: The outcome of the study proved the positive influence of HTEMS in the improvement of Walking capacity and endothelial function in patients with PAD. It might also be employed as an alternative modality to exercise training, especially for patients with PAD who cannot adhere to exercise training or where the exercise is contraindicated

الهدف من البحث : صُممت هذه الدراسة لمعرفة تأثير تحفيز العضلات الخارجي عالي الشدة HTEMS على متوسط قيمة مؤشر الضغط العضدي في الكاحل ABPI ، ومعلمات المشي [مسافة ألم العرج (CPD) ، ووقت ألم العرج (CPT) ، اقصى مسافة للمشي (PWD، و اطول وقت للمشي (PWT) ، واكسيد النيتريك (NO )، و استبيان اعتلال المشي ( (WIQ في مرضى الشرايين الطرفية. العينة وطرق البحث : تم اختيار ستون مريضا بالسكري من كلا الجنسين (25 أنثى ، 35 ذكر) مصابين باعتلال الشرايين الطرفية . تراوح متوسط قيمة مؤشر الضغط العضدي في الكاحل ABPI للعينة المختارة بين 0.4 إلى 0.7. تراوحت أعمارهم بين 40-70 سنة. تم اختيار المرضى من العيادة الخارجية بقسم طب الأوعية الدموية بمستشفيات جامعة القاهرة

Issues also as CD.

Text in English and abstract in Arabic & English.