The quality of evidence is downgraded by study limitations (unclear blinding and relatively high withdrawal rates that were linked to outcome), and by imprecise results (few patients).
A Cochrane review [Abstract] 1 included 5 studies with a total of 365 subjects comparing Padma 28 (a Tibetan herbal preparation) with placebo for at least 16 weeks of follow-up. Pain-free and maximum walking distances both increased significantly in the groups treated with Padma 28, with no significant change in the placebo group. In general, the studies presented results comparing the treatment arms before and after treatment but made no comparisons between the Padma 28 and placebo groups. Pooled data of maximum walking distance after treatment with Padma 28 and placebo indicated a statistically significant difference (MD 95.97 m, 95% CI 79.07 to 112.88 m; 2 studies, n=193). There was no effect on ankle brachial index. Mild side effects, especially gastrointestinal discomfort, tiredness and skin eruption, were reported but this outcome was not statistically significantly different between the groups (OR 1.09, 95% CI 0.42 to 2.83; 4 studies, n=231).
Longer term effects are unknown and the clinical importance of the improvements in walking distance are unclear as no quality of life data were reported.
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