The perspectives of adults with venous leg ulcers on exercise: an exploratory study.

OBJECTIVE: Exercise has the potential to offer a range of health benefits in addition to improving healing outcomes for people with venous leg ulcers (VLUs). However, despite evidence-based recommendations, most of these individuals do not engage in regular exercise. The aim of this study was to gain an understanding of the perspectives of adults with VLUs, in relation to exercise. METHOD: This was a qualitative design using semi-structured interviews and discussions. Ten participants with venous leg ulceration volunteered to participate. Recruitment was through a specialist wound clinic. Verbatim data were collected by an experienced moderator using a semi-structured guide. Data saturation was reached after three group discussions and two interviews. A random selection of transcripts was sent back to the participants for verification. Thematic content analysis was used to determine major themes and categories. Two transcripts were independently analysed, categories and themes independently developed, cross checked and found comparable. Remaining transcripts were analysed using the developed categories and codes. RESULTS: Regardless of their current exercise routine, participants reported exercising before venous leg ulceration and expressed an interest in either becoming active or maintaining an active lifestyle. Overall, four themes emerged from the findings: i) participant understanding of the relationship between chronic venous insufficiency and exercise patterns; ii) fear of harm impacts upon positive beliefs and attitudes to exercise; iii) perceived factors limit exercise; and iv) structured management facilitates exercise. CONCLUSION: The value of exercise in improving outcomes in VLUs lies in its capacity to promote venous return and reduce the risk of secondary conditions in this population. Despite motivation and interest in being exercise active, people with VLUs report many obstacles. Further exploration of mechanisms that assist this patient population and promote understanding about management of barriers, coupled with promotion of enabling factors, is vital for improving their exercise participation.

Education project to improve venous stasis self-management knowledge.

PURPOSE: The purpose of this study was to evaluate patients' knowledge of chronic venous disease, venous ulcer occurrence and recurrence, and self-care at baseline, immediately following, 2, and 9 weeks after an educational intervention. SUBJECTS AND SETTING: The study sample comprised 30 patients diagnosed with venous ulcers. The research setting was an outpatient facility specializing in wound care located in South Florida; the educational intervention occurred in subjects' homes. DESIGN: Single group before and after intervention research design. METHODS: Patients diagnosed with a first-time venous ulcer were assessed regarding their disease and self-care knowledge. Assessments were completed at baseline, immediately following an educational intervention, and during 2- and 9-week follow-up home visits. In addition to evaluating patient knowledge, wound healing (evaluated by the treating nurse or reported by the patient) was assessed at 2- and 9-week follow-up and wound recurrence was assessed at 9-week follow-up. RESULTS: The educational intervention resulted in a statistically significant increase in knowledge scores (P = .002). This change persisted when patients were evaluated during 2- and 9-week follow-up visits (P = .003). In addition, half of patients who completed the educational intervention remained free of recurrence when evaluated at 9 weeks. CONCLUSION: Results suggest that patient education related to venous ulcers improves knowledge regarding the disease process and self-care and reduces recurrence when measured at 9 weeks postintervention.

[The daily life of men who lives with chronic venous ulcer: phenomenological study]. / O cotidiano do homem que convive com a úlcera venosa crônica: estudo fenomenológico.

The chronic venous leg ulcer is the major therapeutic problem of lower limb injuries, which can trigger changes in the daily life of the person affected by it. This study aimed to understand the daily life of men who lives with chronic venous ulcers. A phenomenological study was conducted with eight men, who were interviewed during June and July of 2001. The study asked questions related to: "Restrictions in social life" and "Recovering the skin integrity and restart the activities affected by the wound". The answers revealed that men with these ulcers have social implications in the areas of productivity and sexuality. This leads to restrictions in everyday life with loss in performance of socially established roles for men, leading to anxiety for his return at full performance of his social role. The findings suggest significant experiential aspects that may guide professionals in the planning and implementation of health actions aimed to treat these patients.

A randomized, controlled, double-blind prospective trial with a Lipido-Colloid Technology-Nano-OligoSaccharide Factor wound dressing in the local management of venous leg ulcers.

Venous leg ulcers (VLUs) are the most prevalent chronic wounds in western countries with a heavy socioeconomic impact. Compression therapy is the etiologic treatment of VLU but until now no wound dressing has been shown to be more effective than another. The aim of this study was to assess the efficacy of a new dressing in the management of VLU. Adult patients presenting a noninfected VLU and receiving effective compression therapy were enrolled in this randomized, controlled, double-blind trial. The VLUs were assessed every 2 weeks for 8 weeks. The primary study outcome was the relative Wound Area Reduction (WAR, in %), and the secondary objectives were absolute WAR, healing rate, and percentage of wounds with >40% surface area reduction. One hundred eighty-seven patients were randomly allocated to treatment groups. Median WAR was 58.3% in the Lipido-Colloid Technology-Nano-OligoSaccharide Factor (TLC-NOSF) dressing group (test group) and 31.6% in the TLC dressing group (control group) (difference: -26.7%; 95% confidence interval: -38.3 to -15.1%; p = 0.002). All other efficacy outcomes were also significant in favor of the TLC-NOSF dressing group. Clinical outcomes for patients treated with the new dressing are superior to those patients treated with the TLC dressing (without NOSF compound), suggesting a strong promotion of the VLU healing process.

Life-style advice and self-care strategies for venous leg ulcer patients: what is the evidence?

OBJECTIVE: To ascertain the evidence for lifestyle changes and self-care activities encouraged by health professionals to prevent venous leg ulcer recurrence. METHOD: A literature search was undertaken using online databases: Medline, CINAHL, Psychinfo and Cochrane for relevant literature between 1990 and 2012. RESULTS: A total of 16 papers were identified, with recurrent themes of physical activity, exercise, mobility and leg elevation emerging. The evidence for the efficacy of compression therapy in preventing recurrence is substantial and is not discussed here. CONCLUSION: There is some evidence that increasing physical activity, improving mobility and foot exercises may be beneficial in preventing ulcer recurrence. The evidence on the benefits of leg elevation on recurrence prevention is unclear and further research is needed.

Wound care in short-term rehabilitation facilities and long-term care: special needs for a special population.

Chronic wounds can pose a challenging diagnostic and treatment dilemma in the older frail adult population. The benefits of short-term rehabilitation and long-term care settings are the access to interdisciplinary resources. Rehabilitative specialists, dieticians, and skilled nurses are readily available to meet the patients' needs as they transition to home or remain in a long-term care setting for their higher level of care needs. This article follows 3 cases: a skin tear complicated by venous ulceration, a pressure ulcer with fever, and arterial ulcers in a patient who opts for comfort care. The cases illustrate the higher needs of this population and emphasize the attention that must be paid to respect nursing-time intensiveness, incorporate realistic goals of care for wound healing, and ensure excellent communication with the team members, patients, and family.

Physical activity in patients with venous leg ulcer--between engagement and avoidance. A patient perspective.

OBJECTIVE: To identify and describe the qualitative variations in how physical activity is perceived and understood by individuals with current or previous venous leg ulcer. DESIGN: A qualitative study using semi-structured interviews. METHOD: Twenty-two individuals aged 60-85 years were interviewed. The interviews were recorded, transcribed verbatim and analysed by three researchers using a phenomenographic research approach. A set of categories of descriptions and their internal relationships were constructed based on the essential features of the variation in patients' perceptions of physical activity. RESULTS: Four categories of descriptions were identified: (i) 'self-management', (ii) 'instructions and support', (iii) 'fear of injury' and (iv) 'a wish to stay normal'. The categories could be interpreted by a two-dimensional construct: (1) perception of venous leg ulcer as a chronic or acute condition and (2) engagement or avoidance behaviour toward physical activity. Chronicity and behaviour combined together formed a 2 × 2 square housing the four qualitatively different categories. Irrespective of category, the participants reported that information given by caregivers regarding leg ulcer and physical activity was insufficient or contradictory. Written information or exercise programmes were not obtained regularly and not at all in primary care. CONCLUSION: A dichotomous view emerged from participants' experiences of physical activity based on (1) perception of venous leg ulcer as a chronic or acute condition and (2) engagement or avoidance behaviour toward physical activity.

Predicting the Likelihood of Delayed Venous Leg Ulcer Healing and Recurrence: Development and Reliability Testing of Risk Assessment Tools.

Venous leg ulcers are characterized by a long healing process and repeated cycles of ulceration. A secondary analysis of data from multisite longitudinal studies was conducted to identify risk factors for delayed healing and recurrence of venous leg ulcers for development of risk assessment tools, and a single-site prospective study was performed to as- sess the new tools' interrater reliability (IRR). The development of the risk assessment tools was based on results from previous multivariate analyses combined with further risk factors documented in the literature from systematic reviews, randomized controlled trials, and cohort studies with regard to delayed healing and recurrence. The delayed healing tool contained 10 items, including patient demographics, living status, use of high-compression therapy, ulcer area, wound bed tissue type, and percent reduction in ulcer area after 2 weeks. The recurrence tool included 8 items, including his- tory of deep vein thrombosis, duration of previous ulcer, history of previous ulcers, body mass index, living alone, leg elevation, walking, and compression. Using consensus procedures, content validity was established by an advisory group of 21 expert multidisciplinary clinicians and researchers. To determine intraclass correlation (ICC) and IRR, 3 rat- ers assessed 26 patients with an open ulcer and 22 with a healed ulcer. IRR analysis indicated statistically signi cant agreement for the delayed healing tool (ICC 0.84; 95% con dence interval [CI], 0.70-0.92; P <.001) and the recurrence tool (ICC 0.88; 95% CI, 0.75-0.94; P <.001). The development and reliability results of these risk assessment tools meet the recommendations for evidence-based, reliable tools and may bene t clinicians and patients in the management of venous leg ulcers. Studies to examine the items with low ICC scores and to determine the predictive validity of these tools are warranted.

[Physical exercise in thte treatment of ulcus cruris venosum]. / Bringen Sie lhre Venenkranken auf Trab!

As an adjuvant measure, physical exercise should be recommended for all patients with an ulcus cruris venosum, and should be a permanent part of the patient's lifestyle on completion of wound healing. Although clinical studies have shown that physical exercise has a positive effect on numerous factors of relevance for the development of an ulcer, sports activities undertaken for therapeutic and prophylactic purposes are still made little use of by patients.

Physical Therapy in Wound Care: A Cost-Effectiveness Analysis.

Management of chronic wounds remains unsatisfactory in terms of treatment cost and time required for complete wound closure (CWC).This study aimed to calculate the healing rates, estimated cost, and time required for CWC in wounds; compare estimated wound care costs between healing and nonhealing wounds; and compare cost effectiveness between venous leg ulcer (VLU) and non-VLU.This was a retrospective cohort study performed at a physical therapy (PT) wound care clinic. Deidentified patient data in the electronic medical database from September 10, 2012 to January 23, 2015 were extracted.Among 159 included patients with wounds, 119 (74.84%) patients were healed with CWC. The included patients were treated for 109.70 ±â€Š95.70 days, 29.71 ±â€Š25.66 visits, and at the costs per treatment episode of $1629.65 ±â€Š1378.82 per reimbursement rate and $2711.42 ±â€Š2356.81 per breakeven rate. For patients with CWC (healing group), the treatment duration was 98.01 ±â€Š76.12 days with the time for CWC as 72.45 ±â€Š64.21 days; the cost per treatment episode was $1327.24 ±â€Š1143.53 for reimbursement rate and $2492.58 ±â€Š2106.88 for breakeven cost. For patients with nonhealing wounds, treatment duration was found to be longer with costs significantly higher (P < 0.01 for all). In the healing group, no differences were found between VLU and non-VLU in treatment duration (95.46 days vs. 100.88 days, P = 0.698), time for CWC (68.06 days vs. 77.38 days, P = 0.431), and cost ($2756.78 vs. 2397.84 for breakeven rate, P = 0.640) with the exception of wound dressing costs ($329.19 vs. 146.47, P = 0.001).Healing rates may be affected with patient exclusions. Costs at physicians' offices were not included.Incorporation of PT in wound care appeared to be cost effective. PT may thus be a good referral option for patients with wounds. However, the results should be interpreted cautiously and further studies are warranted.

Wound healing and lymphedema: a new look at an old problem.

As the science of wound healing has evolved in the past two decades, so has awareness of the "hidden epidemic" of lymphedema. Substantial information has been accumulated regarding the pathophysiology and therapy of lymphedema. However, until now, the relationship between wound care and lymphedema has received little attention. This review outlines this relationship and asserts that proper wound care demands attention to the related lymphedema. The differences between edema and lymphedema, as well as current evidence-based support defining the negative effect of lymphedema on wound healing, are discussed. The principles of compression therapy in wound related lymphedema also are addressed.

[Electromagnetic therapy after phlebectomy]. / Elektromagnitnaia terapiia posle flebektomii.

Comparative analysis of outpatient treatment by means of pulsed complexly-modulated electromagnetic field (PCMEMF) applied after phlebectomy in 30 patients with varicosity of the lower limbs showed the expediency of this type of treatment in the postoperative period. Exposure of the operated on limb to PCMEMF raises the efficacy of the rehabilitation measures and reduces the terms of the patients' temporary incapacity.

[The rehabilitation of patients with trophic ulcers of the legs in a polyclinic]. / Reabilitatsiia bol'nykh s troficheskimi iazvami nizhnikh konechnostei v usloviiakh polikliniki.

The author's experience with observation of 200 patients shows that complex treatment of trophic ulcers of lower extremities under conditions of polyclinic including zinc-gelatin bandage and phlebectomy, facilitates better use of hospital beds, increases their effectiveness and is of economic and social significance because of the total dispensary examination of population.

[3rd degree chronic venous insufficiency: physiotherapy treatment]. / Insuffisance veineuse chronique stade III: Prise en charge physio- thérapeutique.

A venous ulcer is the end result of a long pathological process where venous hypertension represents the principal cause of a number of complications. The physiotherapist by adapting various different therapeutic approaches improves the vascular, joint and respiratory problems of these patients.

O cotidiano do homem que convive com a úlcera venosa crônica: estudo fenomenológico / La vida cotidiana de hombre que vive con la úlcera venosa crónica: un estudio fenomenológico / The daily life of men who lives with chronic venous ulcer: phenomenological study

A úlcera venosa crônica constitui o maior problema terapêutico das lesões de membros inferiores, podendo desencadear mudanças na vida diária da pessoa por ela acometida. Objetivou-se compreender o cotidiano do homem que convive com a úlcera venosa crônica. Estudo fenomenológico realizado com oito homens, entrevistados em junho e julho de 2012. As categorias identificadas, "Restrições na vida social" e "Recuperar a integridade da pele e retomar as atividades afetadas pela ferida", revelam que a convivência do homem com a ferida produz repercussões no âmbito produtivo e na sexualidade. Isso o leva a restrições na vida cotidiana, com prejuízo no desempenho de papéis socialmente estabelecidos para o gênero masculino, o que desperta no homem a ansiedade pela retomada das atividades prejudicadas. Os achados sinalizam aspectos vivenciais relevantes que podem orientar os profissionais no planejamento e execução de ações de saúde voltadas para essa clientela.

La úlcera venosa crónica de la pierna es el principal problema terapéutico de lesiones de las extremidades inferiores, lo que puede provocar cambios en la vida cotidiana de la persona afectada por ella. Este estudio tuvo como objetivo comprender la vida cotidiana del hombre que vive con úlceras venosas crónicas. Un estudio fenomenológico se llevó a cabo con ocho hombres, que fueron entrevistados durante junio y julio de 2012. Las categorías de "Restricciones en la vida social" y "Reanudar las actividades afectadas por la herida" revelan que la coexistencia del hombre con la herida produce consecuencias sociales en el contexto de las actividades laborales y la sexualidad. Esto da lugar a restricciones en la vida cotidiana, una pérdida en el rendimiento de los roles socialmente establecidas para los hombres, lo que lleva a diseñar el pleno cumplimiento de su función social. Estos hallazgos sugieren importantes aspectos experienciales que pueden orientar a los profesionales en la planificación y ejecución de acciones de salud dirigidos a tratar a estos pacientes.

The chronic venous leg ulcer is the major therapeutic problem of lower limb injuries, which can trigger changes in the daily life of the person affected by it. This study aimed to understand the daily life of men who lives with chronic venous ulcers. A phenomenological study was conducted with eight men, who were interviewed during June and July of 2012. The study asked questions related to: "Restrictions in social life" and "Recovering the skin integrity and restart the activities affected by the wound". The answers revealed that men with these ulcers have social implications in the areas of productivity and sexuality. This leads to restrictions in everyday life with loss in performance of socially established roles for men, leading to anxiety for his return at full performance of his social role. The findings suggest significant experiential aspects that may guide professionals in the planning and implementation of health actions aimed to treat these patients.

[Significance of the ankle joint pump for returning venous blood. Report of experiences using a mechanical treatment method]. / Die Bedeutung der Sprunggelenkspumpe für den Rücktransport des venösen Blutes. Erfahrungsbericht mit einer mechanisch-apparativen Behandlungsmethode.

We report on new medicomechanic equipment designed for the improvement of the venous reflux in the lower extremity. It may be employed as postoperative prophylaxis against thrombosis and in the treatment of secondary manifestations based on venous insufficiency, as well as with pathological changes caused by ankylosis of the ankle.

Randomized clinical trial of four-layer and short-stretch compression bandages for venous leg ulcers (VenUS I).

BACKGROUND: A randomized clinical trial was undertaken to determine the relative effectiveness of four-layer and short-stretch bandaging for venous ulceration. METHODS: A total of 387 adults with a venous ulcer, who were receiving leg ulcer treatment either in primary care or as a hospital outpatient, were recruited to this parallel-group open study and randomized to either four-layer or short-stretch bandages. Follow-up continued until the patient's reference leg was ulcer free or for a minimum of 12 months. The primary endpoint was time to complete healing of all ulcers on the reference leg. Secondary outcomes included proportion of ulcers healed, health-related quality of life, withdrawals and adverse events. Analysis was by intention to treat. RESULTS: Unadjusted analysis identified no statistically significant difference in median time to healing: 92 days for four-layer and 126 days for short-stretch bandages. However, when prognostic factors were included in a Cox proportional hazards regression model, ulcers treated with the short-stretch bandage had a lower probability of healing than those treated with the four-layer bandage: hazard ratio 0.72 (95 per cent confidence interval 0.57 to 0.91). More adverse events and withdrawals were reported with the short-stretch bandage. CONCLUSION: Venous leg ulcers treated using a four-layer bandage healed more quickly than those treated with a short-stretch bandage.

[Biomechanical stimulation therapy as physical treatment of arthrogenic venous insufficiency]. / Biomechanische Stimulationstherapie (BMS) zur physikalischen Behandlung des arthrogenen Stauungssyndroms.

We report about a new type of physical therapy which can be used in patients with joint immobility secondary to by chronic venous insufficiency. Biomechanical stimulation therapy (BMS) uses mechanical vibration of standardised frequencies from 18-35 Hz spectrum to expose the feet and legs to longitudinal mechanical stimuli. Therapeutic benefit and clinical improvement can be achieved after a short period of treatment. We describe a 76 year old female patient suffering from both impaired motion and recurrent venous ulceration due to chronic venous insufficiency. After 10 days treatment with BMS, mobility of upper ankle joints improved by 16 degrees and 19 degrees and was accompanied by healing of venous ulcerations after skin flap transplantation. Biomechanical stimulation methods were developed in the former Soviet Union where they were used in sports medicine to improve relaxation of strained muscle structures and to increase the stretching ability of capsules and tendons. We have successfully treated 6 patients with impaired mobility and chronic venous insufficiency. We believe that BMS is likely to become a valuable therapeutic tool in patients with this problem in the near future.