Venous leg ulcer recurrences - The relationship to self-efficacy, social support and quality of life - A mixed method study.

AIM: The aim of this study was to explore the occurrence of venous leg ulcer recurrence and the relationship with self-efficacy, social support and quality of life. Furthermore, we investigated the lived experiences of those patients and their understanding of why they developed a recurrence. DESIGN: We used a convergent parallel mixed method design consisting of a cohort and an interpretative phenomenological study arm. METHODS: Consecutive patients (N = 145) were recruited into the study. Between 2014 and 2018, three primary care centres took part in the study. Data collection methods included chart review, administered questionnaires and semi-structured interviews. RESULTS: The incidence of the venous leg ulcer recurrence was 33.1% within the study period. The scores for self-efficacy, social support and venous leg ulcer health-related quality of life show little variation between all measurement points and within subgroups. The qualitative findings identified two main themes: accidentally damaging the skin and avoiding venous leg ulcer recurrences. Venous leg ulcer recurrences frequently arose from accidents. Therefore, participants developed strategies to avoid additional ulcers. CONCLUSION: To optimize recurrence prevention, improvements in knowledge of people with VLUs should be considered. IMPACT: A mixed method, convergent, parallel design was used to explore the occurrence of venous leg ulcer recurrence and the relation of a venous leg ulcer recurrence with self-efficacy, social support and health-related quality of life. As well as the lived experiences of venous leg ulcer patients and why they developed a recurrence. The incidence of venous leg ulcer recurrences within the study period was 33.1%. Damaging the skin and avoiding a recurrence were the main identified themes.

Development and feasibility of a multidisciplinary education program on adherence to treatment in persons with venous leg ulcers in the clinical setting: A pilot study.

AIMS: The aim of this study is to: (a) develop an evidence-based multidisciplinary educational intervention for patients with a venous leg ulcer; and (b) conduct a pilot study to assess the feasibility of the intervention in the clinical setting. DESIGN: A two-stage study design was used: (a) an multidisciplinary expert committee designed an educational intervention including support materials; and (b) a pilot randomized controlled trial was conducted to assess the feasibility of the intervention in one wound care outpatient clinic in Western Switzerland. METHODS: A multidisciplinary expert committee identified evidence for effective care interventions to improve venous leg ulcer patients' wound healing and recurrences rates. They subsequently designed the educational intervention and support materials. In this pilot study venous leg ulcer patients were then randomly assigned to receive multidisciplinary education or standard care from March-July 2018. The objective was to evaluate the feasibility of the intervention in the clinical setting. Allocation to groups was achieved to concealed, simple randomization. Participants and study nurses were not blinded, data analyst was blinded. RESULTS: The intervention, including support material was developed. Twelve of 16 invited venous leg ulcer patients were recruited and randomized (control group N = 6; intervention group N = 6). Participation rate was 75%. The implementation of the intervention was feasible in the clinical setting. The performance of the Venous Leg Ulcer Self Efficacy Tool for measuring adherence to therapy and the Mini Nutritional Assessment and Frequent Food Questionnaire for the assessment of the nutritional intake was satisfactory. However, Fitbit smartwatch for measuring activity was not a suitable device in this study population. CONCLUSION: The implementation of the designed multidisciplinary educational program was feasible. The pilot study identified weaknesses in the study protocol, which will be amended for the full-size clinical trial. IMPACT: Findings of the pilot study informed the improvement of the design of the main study.

Internal consistency and reliability of the Swiss-French translation of the venous leg ulcer self efficacy tool (VeLUSET).

OBJECTIVE: This study was conducted to assess the psychometric properties of the translated and adapted Venous Leg Ulcer Self Efficacy Tool (VeLUSET) in the new cultural context. DESIGN: Validation study SETTING: Three outpatient clinics in Western Switzerland. PARTICIPANTS: 32 consecutive persons with venous leg ulcers (VLU). MAIN OUTCOME MEASURES: To determine the internal consistency and reliability of the VeLUSET for use in a Swiss-French speaking venous leg ulcer population. RESULTS: Overall, the Cronbach alpha for the VeLUSET-FR was 0.96 (95% CI 0.93 to 0.98) on test and retest. Lin's concordance correlation coefficient of test and retest scores was 0.93 (95% CI 0.86 to 0.96). CONCLUSION: The results indicate that the VeLUSET-FR is a valid and reliable instrument for measuring self-efficacy among Swiss-French persons affected by a venous leg ulcer. Our findings show that the psychometric properties are similar to those of the original tool. Therefore, we suggest that the VeLUSET-FR can be effectively used for measuring self-efficacy in Swiss-French persons with VLU.

A targeted interprofessional educational intervention to address therapeutic adherence of venous leg ulcer persons (TIEIVLU): study protocol for a randomized controlled trial.

BACKGROUND: Venous leg ulcers are slow-healing wounds with a high recurrence rate of 70% and a 60% risk of becoming chronic. Signs and symptoms such as pain or exudate are not only a burden on those affected but also on the healthcare system and society in general. The estimated leg ulcer prevalence in the general population is 1%. Treatment costs for leg ulcers are estimated to be 3% of overall health expenditure. Current therapeutic approaches are multifaceted and include compression therapy, leg elevation, specific ankle-exercises and a protein diet. They require an interdisciplinary team of health care professionals. Approximately 70% of patients have a knowledge deficit with regards to therapeutic measures and have difficulties with adherence to treatment protocols. Therefore, it is of utmost importance that the treatment team provides effective patient education and support during the learning phase. However, there is little evidence and no published studies that describe and evaluate effective interdisciplinary educational interventions that target compliance/adherence to the treatment plan in patients with leg ulcers. We therefore propose to develop an evidence-based interprofessional educational intervention and evaluate its feasibility first in a pilot study and subsequently in a randomized controlled trial. METHOD/DESIGN: First, the development of an evidence-based educational intervention in collaboration with an expert panel is proposed and second, a randomized controlled feasibility study in a wound-care outpatient clinic. Eligible patients (n = 20) with leg ulcers will be randomized to receive either interdisciplinary education and usual care or only usual care, for 12 weeks. Data will be analyzed using SPSS version 25. Univariate and bivariate analysis will be conducted according to the data level and distribution of the data. DISCUSSION: We will first develop an evidenced-based educational intervention and second, we will examine the feasibility of implementing this educational intervention in a realistic care context in patients with leg ulcers. The results will inform the final design of a subsequent randomized controlled trial, which will examine the effectiveness of the educational intervention. An intervention that enhances patient adherence to therapy would be beneficial to individual patients and to society as a whole. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03454698 . Registered on 6 March 2018.