Risk factors for the recurrence of venous leg ulcers in adults: A systematic review protocol.

BACKGROUND: Venous leg ulcers are slow to heal, and recurrence is frequent. Living with venous leg ulcers can affect physical and psychological health, and result in financial burden for individuals. Physiological and psychosocial factors are associated with venous leg ulcer recurrence. As over 50% of venous leg ulcers will recur within 12 months of healing, a comprehensive knowledge of holistic risk factors associated with recurrence is required by health professionals involved in the care of the person with venous leg ulcers. AIM: To develop a systematic review protocol to determine the risk factors for recurrence of venous leg ulcers in adults. METHOD AND ANALYSIS: This protocol was developed according to the Preferred Reporting Items Form Systematic Review and Meta-Analysis Protocols (PRISMA-P). The inclusion criteria will be based on the PICOS mnemonic-adults with a history of venous leg ulcer/s (participants), risk factor/s under physiological (general/medical), clinical, demographics, psychosocial categories (I (intervention) or E (exposure), venous leg ulcer non-recurrence (comparison group), venous leg ulcer recurrence (outcomes to be measured) and will include study designs of original qualitative, quantitative and mixed method studies (study designs to be included). Methodological quality will be assessed using the Mixed Methods Appraisal Tool. This Systematic Review Protocol was registered in PROSPERO [CRD42021279792]. RESULTS: If meta-analysis is not possible, a narrative review of results will be presented. CONCLUSIONS: This systematic review on recurrence of venous leg ulcers can provide evidence-based information for preventive strategies for recurrence of a healed venous leg ulcer. The standardised approach outlined in this systematic review protocol offers a rigorous and transparent method to conduct the review.

A pilot evaluation of a neuromuscular electrical stimulation (NMES) based methodology for the prevention of venous stasis during bed rest.

Bed rest poses an increased risk factor for a potentially fatal venous thromboembolism (VTE). Lack of activation of the calf muscle pump during this resting period gives rise to venous stasis which may lead to deep vein thrombosis (DVT) development. Our aim was to investigate the effects that 4h of bed rest have on the lower limb hemodynamics of healthy subjects and to what extent electrically elicited contractions of the calf muscles can alleviate these effects. Outcome variables included popliteal vein blood flow and heart rate. Primary results indicated that the resting group experienced a significant decline in popliteal venous blood flow of approximately 47% with approximately 13% decrease in heart rate. The stimulated groups maintained a significantly higher venous blood flow and heart rate. Volume flow in the contralateral limb remained constant throughout the study and was comparable to that of the stimulated limb's recovery flow. The results suggest that even short periods of bed rest can significantly reduce lower limb blood flow which could have implications for DVT development. Electrically elicited calf muscle contractions significantly improve lower limb blood flow and can alleviate some debilitating effects of bed rest.

Randomized trial of balneotherapy associated with patient education in patients with advanced chronic venous insufficiency.

OBJECTIVES: Except for compression therapy, physical therapy has scarcely been evaluated in the treatment of chronic venous disorders (CVD). Spa treatment is a popular way to administer physical therapy for CVD in France, but its efficacy has not been evaluated yet. This study aimed to assess the efficacy of balneotherapy associated with patient education, as performed in the spa resort of La Léchère, in patients with advanced chronic venous insufficiency (CEAP clinical classes C4/C5). METHODS: The study was a randomized controlled trial, spa therapy being administered on top of the usual medical care. Evaluation was by a blinded independent investigator. Subjects were patients with primary or post-thrombotic CVD with skin changes but no active ulcer (C4a, C4b, or C5), living in Grenoble area, and willing to undergo a spa treatment course in La Léchère. The treated group had the three week spa treatment course in La Léchère, soon after randomization; the control group also had a spa treatment, but starting at day 365. The treatment consisted of four balneology sessions per day, six days a week during three weeks, and three educational workshops. An independent follow-up was performed in Grenoble hospital every three months for 15 months. The main outcome criterion was the severity of the skin changes, as evaluated by means of malleolar chromametry. Quality of life, as measured by the Chronic Venous Insufficiency Questionnaire 2 scale, a visual analog scale (VAS) for leg symptoms, and the occurrence of leg ulcers were used as secondary criteria. The year after spa treatment in the treated group was compared with the year before spa treatment in the control group. RESULTS: Fifty-nine subjects were enrolled (29 in the treatment group and 30 in the control group). No statistically significant difference between groups was found at study onset regarding age, sex, etiology, CEAP "C" class, and the outcome variables. After treatment, chromametry showed significantly decreased pigmentation and erythema in the treatment group compared with the controls (P < .01). Quality of life (P < .01) and symptoms (P < .001) also improved significantly. These differences remained significant after one year follow-up. The control patients improved similarly after their own spa treatment (day 450). CONCLUSION: This study shows that spa therapy, associating balneotherapy and patient education, is able to improve significantly the skin trophic changes of the CVD patients and their CVD related quality of life and symptoms. This effect is of large magnitude and remains significant one year after the treatment course.

Does social support impact on venous ulcer healing or recurrence?

Much of the leg ulcer literature focuses on clinical assessment and management of chronic venous leg ulceration in order to achieve healing. Chronic venous leg ulceration, however, should be classed as a chronic or long-term condition, defined as a condition,'that is currently not curable and therefore can only be managed', although it is not generally acknowledged as such. There is an extensive body of literature which focuses on the psychosocial issues that impact negatively on the quality of life of patients with long-term conditions, such as diabetes or arthritis. These include the emotional impact of pain, social support, coping mechanisms and response to stress and treatment adherence. Health care professionals are becoming increasingly aware of the impact psychosocial issues may have on wound healing in general, but particularly, in chronic venous leg ulceration and prevention of recurrence. This article reviews the current literature on the role of social support and its impact on venous ulcer healing/recurrence and concludes that health professionals caring for patients with chronic venous ulceration need to consider alternative outcome intervention measures for patients for whom healing may not be a realistic option.

Two-layer compression hosiery for patients with venous leg ulceration.

Patients may experience a recurrence of leg ulceration if they do not wear prescribed compression hosiery when ulcers have healed. This article examines the use of compression hosiery kits, which can be used for the treatment of active ulceration as well as prevention of recurrence. For some patients, the stockings may be easier to apply than traditional compression hosiery, thereby enabling them to benefit from continued wear.

[High voltage stimulation for enhanced healing of venous ulcers]. / Elektrostymulacja wysokonapieciowa we wspomaganiu gojenia owrzodzen troficznych.

Venous ulcers are significant both surgical and dermatological problem. This article discusses research findings and the clinical use of high voltage stimulation (HVS) in ulceration repair. Practical treatment decisions involving types of electrical impulses, polarity, electrode placement and other parameters are discussed. The article also summarizes recent knowledge on characteristics and biological effects of HVS application.