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Vieira Santos E Santos L, Netto Maia J, de Vasconcelos CR, Lima de Andrade D, Marques Lins E, Schmidt C, Andrade MDA. The relationship between the clinical severity of chronic venous insufficiency and the calf muscle pump: A cross-sectional study. J Bodyw Mov Ther 2023; 36:153-157. [PMID: 37949553 DOI: 10.1016/j.jbmt.2023.04.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 06/07/2022] [Accepted: 04/15/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To investigate the connection between the clinical severity of chronic venous insufficiency (CVI) and the biomechanics of the calf muscle pump (CMP). MATERIAL AND METHODS Through a cross-sectional observational study, we analyzed women on the age range between 30 and 80 years with chronic venous insufficiency, stratified according to the clinical classification. Ninety-nine women were assessed and classified into groups with different levels of severity: C1 (n = 22); C2 (n = 22); C3 (n = 22); C4 (n = 22); C5 (n = 8); C6 (n = 3). The main purpose was to investigate the strength of the calf muscle pump through total work (TW) and peak torque (PT), and the range of motion (ROM) of the ankle joint. For a secondary analysis, the fatigue index was assessed. All results were run through the Humac®/NORMT isokinetic dynamometer to obtain the data. RESULTS Our findings pointed out that as the clinical severity of CVI increases, there is a reduction on the PT, the TW, the maximum active ROM and the ROM at 120°/sec. As severity increased, there was a reduction of 24Nm in the TW at 30°/sec.and a reduction of 3Nm in the PT at 30°/sec. OUTCOMES When increased, clinical severity of CVI may trigger downgrading in the strength of the CMP and the ROM in the ankle. These findings are of relevance to the clinician, since through these findings, individuals with venous insufficiency may be treated more precisely for each classification.
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Affiliation(s)
- Luiza Vieira Santos E Santos
- Departamento de fisioterapia e Laboratório de Cinesiologia e Avaliação Funcional, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Juliana Netto Maia
- Departamento de fisioterapia e Laboratório de Cinesiologia e Avaliação Funcional, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Cinthia Rodrigues de Vasconcelos
- Departamento de fisioterapia e Laboratório de Cinesiologia e Avaliação Funcional, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Danielly Lima de Andrade
- Departamento de fisioterapia e Laboratório de Cinesiologia e Avaliação Funcional, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Esdras Marques Lins
- Departamento de cirurgia vascular, CSS, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Cristine Schmidt
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, CIAFEL, Faculdade de Desporto, Universidade do Porto, Portugal
| | - Maria do Amparo Andrade
- Departamento de fisioterapia e Laboratório de Cinesiologia e Avaliação Funcional, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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Siegling M, Renner R, Erfurt‐Berge C. Mobility range, level of pain and sleep quality of patients with venous leg ulcers. Int Wound J 2023; 20:3177-3184. [PMID: 37078373 PMCID: PMC10502286 DOI: 10.1111/iwj.14195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/21/2023] Open
Abstract
This study aimed to compare mobility range, level of pain and sleep quality in patients with venous leg ulcers to age- and gender-matched controls without ulcers. Twenty patients with venous leg ulceration and 20 matched controls each answered a questionnaire, completed the short-physical performance battery, filled in a subject diary and wore a smartwatch for 1 week. The median daily step counts of the ulcer group (3622 steps/day) and the control group (5133 steps/day) were significantly different (P = .017). Significant correlations between total step count and age, duration of physical outdoor activities and scores in the short-physical performance battery were observed in the ulcer group. The scores in the short-physical performance battery were significantly different in both groups (P = .005), indicating weaker physical performance in the ulcer group. The greatest difference in the self-reported level of pain between the two groups was stated during movement. On average, the ulcer group slept shorter by 1 h 38 min (P = .002) and had 0.7 wake phases per night (P = .019) more than the control group. Assessing mobility in patients with venous leg ulcers can be used to develop preventive and interventional concepts to improve and individualise physical therapies.
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Affiliation(s)
- Michael Siegling
- Department of DermatologyUniklinikum Erlangen, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | | | - Cornelia Erfurt‐Berge
- Department of DermatologyUniklinikum Erlangen, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
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3
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A shear-wave sonoelastography investigation of calf muscle pump biomechanics in patients with chronic venous disease and healthy controls. J Bodyw Mov Ther 2023; 33:53-59. [PMID: 36775526 DOI: 10.1016/j.jbmt.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/23/2022] [Accepted: 09/24/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND chronic venous disease (CVD) is a common progressive disorder with incompetence of calf muscle pump due to weakness and ankle mobility abnormality is an important etiological factor in CVD, but the biomechanical properties of calf muscle pump are remain unknown. OBJECTIVES The purpose of the present study was to evaluate group differences between the biomechanical properties changes of the medial gastrocnemius muscle (GM) and its fascias in participants with CVD and healthy controls. METHODS In this case-control study, thirty patients with CVD in three equal groups (mild: C1 - C2, moderate: C3 - C4, severe: C5 - C6) and 20 healthy subjects in a control group participated. The medial GM and its fascias shear modulus (stiffness) were measured using a shear-wave sonoelastography in rest and active dorsiflexion positions of ankle joint. RESULTS The results of variance (ANOVA) analysis showed a significant difference in shear wave elastography (SWE) value between the groups for medial GM and its fascias at rest and active dorsiflexion of the ankle joint (P < 0.05). There was a statistically significant increase in SWE value of the medial GM and its fascias in moderate (c3-c4) and severe CVD groups (C5-C6) compared to the control and mild (C1-C2) CVD groups. A positive correlation was discovered between disease grades and the medial GM and its fascias SWE in patients with CVD ranging between r = 0.846 to 0.891; P < 0.001. CONCLUSION An alteration stiffness in calf myofascial pump as compared to control group indicated an impaired myofascial biomechanics. Calf myofascial SWE may be valuable information in the diagnosis and follow-up processes of patients with CVD.
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Menegatti E, Mandini S, Pagani A, Mandini B, Zerbini V, Piva T, Raisi A, Fabbri M, Fogli M, Mazzoni G, Zamboni P, Gianesini S. The Effect of Active Stretching Training in Patients with Chronic Venous Insufficiency Monitored by Raster-Stereography. SENSORS (BASEL, SWITZERLAND) 2022; 22:8509. [PMID: 36366206 PMCID: PMC9657419 DOI: 10.3390/s22218509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Musculoskeletal disorders can be associated with advanced clinical stages of chronic venous insufficiency (CVI). The aim of the study is to investigate the effect of active stretching (AS) training on lower limb venous function and quality of life in patients affected by CVI. (2) Methods: A prospective two-armed pilot randomized controlled was conducted. Twenty (20) CVI patients were randomly assigned to an AS training or to a control group (C) who did not receive any exercise indication. At baseline and after three months all the participants were tested for leg volumetry (LV), air plethysmography (APG), and quality of life (QoL) measured by a disease specific validated questionnaire (VVSymQ), ankle range of motion (ROM), and postural deformities using an optoelectronic body posture machine. (3) Results: At the end of the training in the AS group a significant leg volume reduction was detected (from 2340 ± 239 mL to 2239 ± 237 mL (4.3%); p < 0.0001), whereas in the C group no significant volume changes were found. The ejection fraction rate (EF%) increased significantly from 49.3 ± 9.3 to 61.1 ± 14.5, p < 0.005. A moderate-strong linear correlation with EF% and ankle ROM variation was found (R2 = 0.6790; p < 0.0034). Several postural outcomes such as pelvic tilt, pelvic torsion, and lordotic angle significantly improved in the AS group (p < 0.01, p < 0.04, p < 0.01 respectively). (4) Conclusion: The AS training impacts on the APG parameters related to the musculoskeletal pump efficiency, opening a further possibility in the management of CVI patients by means of an appropriate adapted physical exercise program.
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Affiliation(s)
- Erica Menegatti
- Department of Environmental and Prevention Sciences, University of Ferrara, 44123 Ferrara, Italy
| | - Simona Mandini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Anselmo Pagani
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Beatrice Mandini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Valentina Zerbini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Tommaso Piva
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Andrea Raisi
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Marinella Fabbri
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Marco Fogli
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Gianni Mazzoni
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Paolo Zamboni
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Sergio Gianesini
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Nepomuceno de Souza I, Fernandes de Oliveira LF, Geraldo Izalino de Almeida IL, Ávila MR, Silva WT, Trede Filho RG, Pereira DAG, de Oliveira LFL, Lima VP, Scheidt Figueiredo PH, Costa HS. Impairments in ankle range of motion, dorsi and plantar flexors muscle strength and gait speed in patients with chronic venous disorders: A systematic review and meta-analysis. Phlebology 2022; 37:496-506. [DOI: 10.1177/02683555221094642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To verify the differences in ankle range of motion (ROM), muscle strength of dorsi and plantar flexors, and gait speed among healthy subjects, and patients with chronic venous disorders (CVD) with and without venous leg ulcer. Methods A systematic review and meta-analysis ( http://osf.io/b7n3k ) were conducted following a search of MEDLINE, Web of Science, CINAHL, LILACS, Scopus, and EMBASE databases. Results Eight papers were included. The ankle ROM was significantly lower both in dorsiflexion and plantar flexion in patients with venous leg ulcer when compared to healthy individuals and CVD patients without venous leg ulcer. The muscle strength of the plantar flexors and gait speed were reduced in CVD patients when compared to healthy ones. Conclusion Impaired muscle strength and gait speed can be detected in CVD patients compared to healthy individuals, and ankle ROM tends to be reduced in CVD patients even in the absence of venous leg ulcers.
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Affiliation(s)
- Iara Nepomuceno de Souza
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Lucas Fróis Fernandes de Oliveira
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | | | - Matheus Ribeiro Ávila
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Whesley Tanor Silva
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Renato Guilherme Trede Filho
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
- Postgraduate course in Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Danielle Aparecida Gomes Pereira
- Physiotherapy Department, School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Luciano Fonseca Lemos de Oliveira
- Physiotherapy Department, School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Vanessa Pereira Lima
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
- Postgraduate course in Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Pedro Henrique Scheidt Figueiredo
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
- Postgraduate course in Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Henrique Silveira Costa
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
- Postgraduate course in Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
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Li T, Yang S, Dou C, Geng Q, Lu Q, Hu F, Ding J. Effects of different exercise methods of calf muscles on the hemodynamics of lower extremity vein. Phlebology 2022; 37:432-438. [PMID: 35348406 DOI: 10.1177/02683555221085829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the effects of active and passive calf muscle contraction on the hemodynamics of the lower extremity vein. METHODS 30 females were selected by convenient sampling. The hemodynamic indexes of the common femoral vein were measured by Duplex ultrasound during the active ankle pump exercise, active circular exercise, passive ankle pump exercise, passive circular exercise, and massage the calf muscles. RESULTS There was no significant difference in the velocity of common femoral vein when the subjects do active ankle pump exercise, active circular exercise, and massage the calf muscles (p > .05), but the velocity of common femoral vein was faster than that of passive ankle pump exercise and passive circular exercise (p < .01). CONCLUSION The effects of active ankle exercise and massage on promoting venous blood return of lower extremity are better than that of passive ankle exercise.
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Affiliation(s)
- Tianhua Li
- Department of Nursing, 74725Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shuhong Yang
- The Second Operating Room,74725Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chenhao Dou
- Department of Spine, 74725the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Geng
- Department of Arthritis, 74725the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qing Lu
- Department of Orthopaedics, 74725the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fang Hu
- The Second Operating Room,74725Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Junqin Ding
- Department of Nursing, 74725Third Hospital of Hebei Medical University, Shijiazhuang, China
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Nantakool S, Chuatrakoon B, Veen MVD, Rerkasem A, Rerkasem K. Exercise Training as an Adjunctive Therapy for Chronic Venous Insufficiency Patients: Evidence from Research to Practice. INT J LOW EXTR WOUND 2021:15347346211060126. [PMID: 34792418 DOI: 10.1177/15347346211060126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chronic venous insufficiency, which is defined as a condition relevant to persistent ambulatory venous hypertension, is a common cause of venous leg ulcers. Compression therapy is commonly used to relieve ambulatory venous hypertension and heal leg ulcers. Exercise is considered as adjunctive therapy, targeting calf muscle pump function, to additionally favor the compression treatment for facilitating the healing process. Different exercise training regimens for promoting wound healing and its relevant outcomes are reviewed and discussed in this study.
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Affiliation(s)
- Sothida Nantakool
- Environmental-Occupational Health Sciences and Non-Communicable Diseases Center of Excellence, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Busaba Chuatrakoon
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Maurits van der Veen
- Environmental-Occupational Health Sciences and Non-Communicable Diseases Center of Excellence, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Amaraporn Rerkasem
- Environmental-Occupational Health Sciences and Non-Communicable Diseases Center of Excellence, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kittipan Rerkasem
- Environmental-Occupational Health Sciences and Non-Communicable Diseases Center of Excellence, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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8
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Randomized controlled trial on Dryland And Thermal Aquatic standardized exercise protocol for chronic venous disease (DATA study). J Vasc Surg Venous Lymphat Disord 2021; 9:1226-1234.e2. [DOI: 10.1016/j.jvsv.2020.12.078] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/23/2020] [Indexed: 11/20/2022]
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9
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Erdal ES, Demirgüç A, Kabalcı M, Demirtaş H. Evaluation of physical activity level and exercise capacity in patients with varicose veins and chronic venous insufficiency. Phlebology 2021; 36:636-643. [PMID: 33745365 DOI: 10.1177/02683555211002339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The clinical indication of chronic venous insufficiency (CVI) is related to functional performance and the benefits of physical activity in patients with CVI are known. Despite its importance, the literature is limited in this regard. This study aimed to determine exercise capacity and physical activity level in patients with varicose veins and CVI. METHODS Volunteers who came to the polyclinic with leg pain complaints were enrolled in the study. Individual sociodemographic and clinical information was recorded. Individuals' pain severity was assessed by the visual analog scale (VAS) and exercise capacity was assessed by 6-minute walk test (6MWT). International Physical Activity Questionnaire (IPAQ) was used to assess the level of physical activity. RESULTS The study group consisted of 51 individuals who were diagnosed with varicose veins and CVI. The control group consisted of 51 individuals without varicose veins and CVI diagnosis. In the study group, the VAS during activity was significantly higher compared to the control group. The 6MWT distance, distance %, IPAQ total score and IPAQ walking score of the control group were significantly higher in comparison with the study group (p<0.05). CONCLUSIONS We believe that our findings will lead the planning of interventions to increase the level of physical activity in CVI patients.
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Affiliation(s)
- Elif Sakızlı Erdal
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Arzu Demirgüç
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Sanko University, Gaziantep, Turkey
| | - Mehmet Kabalcı
- Department of Cardiovascular Surgery, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Hüseyin Demirtaş
- Department of Cardiovascular Surgery, Dr. Nafiz Körez Sincan Public Hospital, Ankara, Turkey
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Fujii T, Ohno N, Sawazaki T, Ogura K, Miyati T, Sugama J. Gravity magnetic resonance imaging measurement of muscle pump change accompanied by aging and posture. Jpn J Nurs Sci 2021; 18:e12407. [PMID: 33474807 PMCID: PMC8359411 DOI: 10.1111/jjns.12407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/16/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
AIM To date no age-comparative study has been reported about effect of exercise on muscle pump action change, while its effect is suggested to differ in ages. This study aims to clarify the changes in muscle pump action with aging by measuring the muscle and vein area, and blood flow in lower legs. METHODS Subjects were healthy volunteers and consisted of three groups: young age group (N = 20), middle age group (N = 20) and old age group (N = 16). The lower leg flexor muscle area and popliteal vein area were measured by using T1-weighed magnetic resonance imaging at the condition pre- and post-ankle exercise in three positions. Moreover, popliteal blood flow velocity was also measured using phase contrast magnetic resonance imaging. RESULTS The elderly had the highest number of individuals who had exercise habits (p < .001). In a multiple linear regression analysis, sitting posture, leg muscle volume, and rate of change in the soleus muscle were significantly related to blood flow velocity change. CONCLUSIONS No difference was found in the changes in muscle pump action with age. The study results suggested that elderly people with exercise habits might be able to maintain the muscle pump action.
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Affiliation(s)
- Taiga Fujii
- Graduate School of Frontier Science InitiativeKanazawa UniversityKanazawaJapan
| | - Naoki Ohno
- Faculty of Health SciencesInstitute of Medical, Pharmaceutical and Health Sciences, Kanazawa UniversityKanazawaJapan
| | - Takuto Sawazaki
- Department of NursingNagoya City University HospitalNagoyaJapan
| | - Kohei Ogura
- Advanced Health Care Science Research UnitInstitute for Frontier Science Initiative, Kanazawa UniversityKanazawaJapan
| | - Tosiaki Miyati
- Faculty of Health SciencesInstitute of Medical, Pharmaceutical and Health Sciences, Kanazawa UniversityKanazawaJapan
| | - Junko Sugama
- Advanced Health Care Science Research UnitInstitute for Frontier Science Initiative, Kanazawa UniversityKanazawaJapan
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11
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Tsuchiya S, Sawazaki T, Osawa S, Fujiu M, Okuwa M, Sugama J. Influences of lower limb edema on daily lives of elderly individuals in an elderly day care center. Jpn J Nurs Sci 2020; 18:e12383. [PMID: 33025717 DOI: 10.1111/jjns.12383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/18/2020] [Accepted: 08/29/2020] [Indexed: 11/26/2022]
Abstract
AIM The purpose of this study is to describe the influences of lower limb edema on the daily lives of elderly individuals in elderly day care to describe the necessity of care for lower limb edema. METHODS Semi-structured interviews based on a quality of life questionnaire for limb lymphedema were conducted. Two types of text mining analysis methods were used: a frequent word analysis and a content analysis. The edema severity was graded on a scale of 0 to 3, and the sum of the numerical values of the grades for each person was defined as the pitting score. RESULTS The seven participants had a mean age of 83.4 ± 4.6 years (mean ± SD). The pitting scores ranged from 1 to 25 in the participants. The words "think" (389 times), "walk" (136 times), and "put on" (135 times) were extracted frequently. The content analysis focused on the words "walk" and "put on." The participants complained of difficulty walking, pain, and numbness when walking, weakness of their lower limbs, difficulty putting on shoes, restrictions on shoe types, and difficulty finding shoes. CONCLUSIONS These results demonstrate that elderly individuals experienced troubles during their daily lives caused by lower limb edema, which highlights the necessity of symptom management. Active interventions for edema by nurses are necessary to improve quality of life in elderly individuals.
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Affiliation(s)
- Sayumi Tsuchiya
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Takuto Sawazaki
- Department of Nursing, Nagoya City University Hospital, Nagoya, Japan
| | - Shuji Osawa
- Faculty of Geosciences and Civil Engineering, Institute of Science and Engineering, Kanazawa University, Kanazawa, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Makoto Fujiu
- Faculty of Geosciences and Civil Engineering, Institute of Science and Engineering, Kanazawa University, Kanazawa, Japan
| | - Mayumi Okuwa
- Department of Clinical Nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Junko Sugama
- Department of Clinical Nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.,Innovative Integrated Bio-Research Core, Institute for Frontier Science Initiative, Kanazawa University, Kanazawa, Japan
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12
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Volpe EFT, Resqueti VR, da Silva AAM, Gualdi LP, Fregonezi GAF. Supervised exercise protocol for lower limbs in subjects with chronic venous disease: an evaluator-blinded, randomized clinical trial. Trials 2020; 21:414. [PMID: 32430078 PMCID: PMC7238730 DOI: 10.1186/s13063-020-04314-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/10/2020] [Indexed: 11/21/2022] Open
Abstract
Background Chronic venous insufficiency (CVI) causes pathophysiological changes in the lower-limb muscles, particularly the calf muscles, and limits ankle range of motion (ROM). These changes reduce functional activities and decrease quality of life (QOL). Although several studies have shown the benefits of exercise (strengthening the calf muscles to improve calf-muscle pumping and QOL) in patients with CVI, few studies are randomized controlled trials. This has led to a weak indication of exercise for the treatment of patients with CVI. The aim of this study is to analyze the effects of a supervised exercise program to improve calf-muscle endurance as well as QOL in patients with CVI. Methods/design This is an evaluator-blind, randomized clinical trial with an 8-week duration and a follow-up evaluation at week 16. A pilot study with subjects with a CVI diagnosis will be performed to calculate sample size. The participants will be randomly allocated (1:1) into a treatment or a control group (usual care/no intervention). The treatment intervention consists of a bi-weekly supervised exercise program of the lower limbs that will include aerobic training, strengthening and cardiovascular exercises. The participants from both groups will participate in a health education lecture. Primary outcomes are changes in calf-muscle endurance and QOL score. Secondary outcomes are changes in exercise capacity, ankle ROM, electrical muscle activity and cardiac output. The first statistical comparison will be performed after 8 weeks’ intervention. Discussion Patients with CVI may have an impaired calf-muscle pump and decreased exercise capacity. A randomized controlled trial evaluating a supervised exercise program should provide much needed information on the management of CVI to promote health and independence. Trial registration This study was registered on the Brazilian Clinical Trials Database (REBEC) (RBR-57xtk7). The results will be disseminated at scientific events, presentations, and publications in peer-reviewed journals.
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Affiliation(s)
- Esther Fernandes Tinoco Volpe
- PneumoCardioVascular Lab/HUOL Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERRH) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Campus Universitário Central, Caixa Postal 1524/ Campus Universitário Lagoa Nova, Natal, Rio Grande do Norte, CEP: 59078-900, Brazil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Vanessa R Resqueti
- PneumoCardioVascular Lab/HUOL Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERRH) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Campus Universitário Central, Caixa Postal 1524/ Campus Universitário Lagoa Nova, Natal, Rio Grande do Norte, CEP: 59078-900, Brazil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Ana Aline Marcelino da Silva
- PneumoCardioVascular Lab/HUOL Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERRH) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Campus Universitário Central, Caixa Postal 1524/ Campus Universitário Lagoa Nova, Natal, Rio Grande do Norte, CEP: 59078-900, Brazil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Lucien Peroni Gualdi
- PneumoCardioVascular Lab/HUOL Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERRH) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Campus Universitário Central, Caixa Postal 1524/ Campus Universitário Lagoa Nova, Natal, Rio Grande do Norte, CEP: 59078-900, Brazil.,Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte (UFRN), Santa Cruz, Rio Grande do Norte, Brazil
| | - Guilherme A F Fregonezi
- PneumoCardioVascular Lab/HUOL Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERRH) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Campus Universitário Central, Caixa Postal 1524/ Campus Universitário Lagoa Nova, Natal, Rio Grande do Norte, CEP: 59078-900, Brazil. .,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
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Jonker L, Todhunter J, Schutter J, Halliday C, Fisher S. A multi-centre, prospective, randomised controlled feasibility study of plantar resistance exercise therapy for venous leg ulcers – Results of the PREVUE study. Phlebology 2020; 35:237-246. [DOI: 10.1177/0268355519858889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To evaluate the feasibility of an interventional study involving a seated plantar resistance exercise programme, using a StepIt pedal, aimed at promotion of venous leg ulcer healing. Methods Thirty-two venous leg ulcer patients, recruited from community, GP and hospital settings, were randomised to either a standard care or adjuvant StepIt exercise programme arm for up to 12 weeks. The exercise involved a twice daily routine of 10 times 1 min of exercise, i.e. 2 s push and 2 s lift repetitions (equating to 300 daily ‘steps’). Results Complete healing of the venous leg ulcers was observed in 10 out of 15 (67%; StepIt cohort) and 7 out of 17 (41%; control cohort), respectively (p-value 0.18, Fisher’s exact test). Baseline differences between the two cohorts were longer wound chronicity, less venous leg ulcer-related pain and better venous leg ulcer-related quality of life in the StepIt cohort. One adverse event, involving increased wound exudate and slough production, was observed in a participant using StepIt, and no study withdrawals were recorded in either arm. StepIt users whose wound had completely healed by week 12 were more likely to be compliant with the exercise programme (self-reported) and more positive about the trial experience; however, all would recommend the device to others. Conclusions Seated plantar resistance exercise shows promise and may accelerate venous leg ulcer wound healing. The StepIt pedal is well-received by patients, and its efficacy may depend on the degree of patient compliance with the exercise programme. Further larger scale studies are indicated to allow more concrete inferences to be made on the clinical and potential health economics impact that this device may have.
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Affiliation(s)
- Leon Jonker
- Cumbria Partnership NHS Foundation Trust, Carlisle, UK
| | - Jane Todhunter
- North Cumbria University Hospitals NHS Trust, Carlisle, UK
| | - Jose Schutter
- Cumbria Partnership NHS Foundation Trust, Carlisle, UK
| | | | - Stacey Fisher
- Cumbria Partnership NHS Foundation Trust, Carlisle, UK
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Differences in pain, fatigue, and quality of life in patients with chronic venous insufficiency based on physical activity level. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:76-83. [PMID: 32175146 DOI: 10.5606/tgkdc.dergisi.2020.18068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/10/2019] [Indexed: 01/20/2023]
Abstract
Background This study aims to compare the effect of different physical activity levels on pain, fatigue, and quality of life in patients with chronic venous insufficiency. Methods Between October 2018 and February 2019, a total of 69 patients (4 males, 65 females; mean age 50 years; range, 19 to 73 years) who were diagnosed with chronic venous insufficiency and consulted for physiotherapy were included in the study. The physical activity level of the patients was determined using the International Physical Activity Questionnaire in three groups as light, moderate, or vigorous. Fatigue, pain, and QoL were assessed using the Fatigue Severity Scale, visual analog scale (during the night, activity, and rest), and Venous Insufficiency Epidemiological and Economic Study Quality/Symptom Scale, respectively. Results Of a total of 69 patients, 17 were in the light-intensity physical activity group, 32 in the moderate-intensity physical activity group, and 20 in the vigorous-intensity physical activity group. Perceived pain during activity and fatigue were significantly different between the light- and moderate-intensity physical activity groups (p<0.05). There was no significant difference in pain, fatigue, and quality of life scores between the vigorous-intensity physical activity group and the other two groups (p>0.05). Conclusion Our study results suggest that a moderate level of physical activity may be helpful to overcome symptoms such as pain and fatigue in patients with chronic venous insufficiency and to improve quality of life.
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Meulendijks AM, Welbie M, Tjin EPM, Schoonhoven L, Neumann HAM. A qualitative study on the patient's narrative in the progression of chronic venous disease into a first venous leg ulcer: a series of events. Br J Dermatol 2019; 183:332-339. [PMID: 31677155 DOI: 10.1111/bjd.18640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND A venous leg ulcer (VLU) has a significant negative impact on quality of life. Prevention of a VLU is not yet imbedded in clinical practice because risk factors for developing a first VLU are not well known. OBJECTIVES To explore further the progression of chronic venous disease (CVD) into a first VLU from the patient's perspective. METHODS A qualitative study using semistructured interviews was conducted among male and female patients with a VLU. Patients from primary and secondary care, under and over 50 years of age, and with first and recurrent VLUs were included. The interviews were transcribed and analysed using a narrative approach to a thematic analysis. Transcripts were organized in chronological order and an iterative process was used to code the transcripts. RESULTS Four key themes and the connections made between them emerged from the 11 narratives on the progression of CVD towards a first VLU: 'comorbidity', 'mobility', 'work and lifestyle' and 'acknowledgment of CVD'. Comorbidity was linked to reduced mobility and late acknowledgment of CVD. Comorbidity also affected work and lifestyle and vice versa. Work and lifestyle affected mobility and was linked to the acknowledgment of CVD. CONCLUSIONS A reduction in mobility as a result of comorbidity and work and lifestyle occurred before the VLU developed. Patients did not recognize symptoms of CVD and did not acknowledge the chronicity of CVD. Healthcare professionals should be aware of reductions in mobility and the knowledge deficit in patients with CVD. What's already known about this topic? Not all patients with chronic venous disease (CVD) develop a venous leg ulcer (VLU). A patient's quality of life decreases significantly when a VLU develops. Risk factors for the development of a first VLU in patients with CVD are not well known, unlike risk factors for other chronic wounds like diabetic foot ulcer and pressure ulcers. What does this study add? The patient's narrative towards the development of a first VLU, a series of events. Insight into the events (comorbidity, mobility, work and lifestyle) that patients themselves link to the development of a VLU. Insight into the patients' acknowledgment of CVD in the progression of CVD towards a first VLU. What are the clinical implications of this work? More awareness is needed of CVD symptoms among patients and healthcare providers, as well as more awareness for prevention of a VLU in clinical practice. New insights (for further studies) are needed into the concept of mobility and the development of a VLU. Improved patient education and follow-up are needed for patients with CVD.
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Affiliation(s)
- A M Meulendijks
- University of Applied Sciences Utrecht, Research Group Healthy and Sustainable Living, Utrecht, the Netherlands.,Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - M Welbie
- University of Applied Sciences Utrecht, Research Group Healthy and Sustainable Living, Utrecht, the Netherlands
| | - E P M Tjin
- University of Applied Sciences Utrecht, Research Group Healthy and Sustainable Living, Utrecht, the Netherlands
| | - L Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - H A M Neumann
- Department of Dermatology, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
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16
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Meulendijks AM, Franssen WMA, Schoonhoven L, Neumann HAM. A scoping review on Chronic Venous Disease and the development of a Venous Leg Ulcer: The role of obesity and mobility. J Tissue Viability 2019; 29:190-196. [PMID: 31668667 DOI: 10.1016/j.jtv.2019.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The risk factors obesity and reduced mobility are not well known in the development of a Venous Leg Ulcer (VLU). The aim of this scoping review is to explore the mechanisms by which obesity and reduced mobility contribute the development of a VLU in patients with Chronic Venous Disease (CVD). METHODS For this scoping review a search was performed in May 2019 in the Cochrane Library and Pubmed to identify studies on the working mechanisms of obesity and mobility in developing a VLU. Hand searches were performed to find additional studies explaining the working mechanisms (indirectly related to the VLU). Two reviewers independently reviewed the abstracts and full-text articles. RESULTS Twenty-eight studies met our eligibility criteria. Disturbed range of ankle motion and gait can lead to a reduced Calf Muscle Pump (CMP) function which leading to a venous outflow disorder. Increased abdominal pressure due to obesity can lead to a venous outflow obstruction and increased adipose tissue mass results in an increase in adipokine secretion. The venous outflow disorder, outflow obstruction and increased adipokine secretion can all lead to chronic systemic inflammation, increased endothelial permeability and hence microcirculatory dysfunction. This alone can result in a VLU. CONCLUSION Obesity and reduced mobility can lead to a reduction of the CMP function, an increase in abdominal pressure and an increase in adipose tissue mass. This can simultaneously lead to haemodynamic changes in the macro- and microcirculation of the lower extremities and eventually in a VLU. In patients with obesity and reduced mobility the microcirculation alone can lead to skin changes and eventually a VLU. Therefore, early recognition of CVD symptoms in patients with obesity and reduced mobility is crucial to diagnose and treat CVD to prevent a VLU.
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Affiliation(s)
- A M Meulendijks
- University of Applied Sciences Utrecht, Research Group Healthy and Sustainable Living, Utrecht, the Netherlands; University Medical Centre Utrecht, Department Julius Centre for Health Sciences and Primary Care, Nursing Studies, Utrecht, the Netherlands.
| | - W M A Franssen
- University of Hasselt, REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - L Schoonhoven
- University Medical Centre Utrecht, Department Julius Centre for Health Sciences and Primary Care, Nursing Studies, Utrecht, the Netherlands
| | - H A M Neumann
- Erasmus University Medical Centre Rotterdam, Department of Dermatology, Rotterdam, the Netherlands
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Ercan S, Çetin C, Yavuz T, Demir HM, Atalay YB. Evaluation of the Isokinetic Calf Muscle Strength and the Range of Motion of Joint in C3 Chronic Venous Insufficiency. Vasc Specialist Int 2019; 35:95-100. [PMID: 31297359 PMCID: PMC6609024 DOI: 10.5758/vsi.2019.35.2.95] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 11/20/2022] Open
Abstract
Purpose The present study aimed to compare the isokinetic muscle strength and range of motion (ROM) values of the ankle between patients diagnosed with C3 chronic venous insufficiency (group 1, n=57) and healthy individuals (group 2, n=30). Materials and Methods After identifying the venous refilling time (VRT) of all participants, the active ROM of the ankle joint and plantar flexion (PF) and dorsi-flexion (DF) muscle strength in the concentric/concentric mode at angular velocities of 60°/sec and 120°/sec were measured. Results No statistically significant differences were found between the demographic data of groups 1 and 2 (P>0.05). In total, 102 lower extremities were included in group 1 and 60 lower extremities in group 2. The VRT of the patients in group 1 was 15.5±5.6 seconds, the PF ROM of the ankle joint was 39.3°±9.5°, and the DF ROM of the ankle joint was 27°±8°; in group 2, the VRT, PF ROM, and DF ROM were 36±8.1 seconds, 41°±6.2°, and 27.2°±7.5°, respectively. Statistically significant differences were found between the two groups in terms of VRT (P<0.05); however, no statistically significant difference was observed in terms of ankle ROM (P>0.05). Statistically significant difference was found in terms of all parameters of isokinetic muscle strength measurements, such as peak torque, peak torque/body weight, total work done, and ratio (DF/PF) in group 1 (P=0.001). Conclusion The lower extremity muscle strength of patients with chronic venous insufficiency was low, and this weakness was prominent particularly in the direction of PF.
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Affiliation(s)
- Sabriye Ercan
- Department of Sports Medicine, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Cem Çetin
- Department of Sports Medicine, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Turhan Yavuz
- Department of Cardiovascular Surgery, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Hilmi Mustafa Demir
- Department of Sports Medicine, Van Education and Research Hospital, Isparta, Turkey
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Bertochi T, Gomes RZ, Martins M. Ankle joint mobility as a predictor of treatment prognosis in patients with chronic venous insufficiency with venous ulcers. J Vasc Bras 2019; 18:e20180133. [PMID: 31360156 PMCID: PMC6636814 DOI: 10.1590/1677-5449.180133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present study arose from the need to improve treatment of patients with chronic venous insufficiency (CVI) who present with venous ulcers. A total of 40 lower limbs were assessed from 20 patients with healed venous ulcers (C5) or active venous ulcers (C6) who had undergone varicose vein surgery. The relationship between the range of motion of the ankle joint and presence of C5 or C6 venous ulcer was analyzed. For this purpose, normal goniometry findings for this joint were used as a predictor of venous ulcer healing, defined as the outcome. Thus, when identifying reduced ankle joint movement or immobility in these patients, new treatment options could be offered in order to increase joint mobility and prevent or delay CVI complications.
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Affiliation(s)
- Thiago Bertochi
- Hospital Universitário Regional dos Campos Gerais - HURCG, Cirurgia Geral, Ponta Grossa, PR, Brasil
| | - Ricardo Zanetti Gomes
- Hospital Universitário Regional dos Campos Gerais - HURCG, Cirurgia Geral, Ponta Grossa, PR, Brasil
| | - Mario Martins
- Hospital Universitário Regional dos Campos Gerais - HURCG, Cirurgia Geral, Ponta Grossa, PR, Brasil
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Caggiati A, De Maeseneer M, Cavezzi A, Mosti G, Morrison N. Rehabilitation of patients with venous diseases of the lower limbs: State of the art. Phlebology 2018; 33:663-671. [PMID: 29361892 DOI: 10.1177/0268355518754463] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND To date, no document comprehensively focused on the complex issue of the rehabilitation of chronic venous diseases of the lower limbs. METHOD This article overviews and summarizes current strategies concerning venous rehabilitation of lower limbs. RESULTS Venous rehabilitation is based on four main strategies: (1) lifestyle adaptations and occupational therapies; (2) physical therapies; (3) adapted physical activities; (4) psychological and social support. Rehabilitative protocols must be tailored to the specific needs of each patient, depending on the severity of chronic venous disease and on the location and pattern of venous lesion(s), but also on age, motor deficits, co-morbidities and psychosocial conditions. CONCLUSIONS Venous rehabilitation consists of non-pharmacologic and non-surgical interventions aiming at prevention of venous disease progression and complications, reduction of symptoms and improvement of quality of life. Well-designed clinical trials are required to evaluate the efficacy of the described rehabilitative protocols in influencing the evolution of venous disorders.
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Abstract
ZusammenfassungFallbericht: Wir beschreiben den Fall eines 42-jährigen adipösen Mannes, der sich mit fibrinös belegten Ulcera crurum in unserer Klinik vorstellte. Die Ulcera waren umgeben von Hyperpigmentierungen und einer initialen Dermatolipofasziosklerose. Duplexsonographisch zeigte sich eine Stammvarikosis der V. saphena magna am linken Bein. Am rechten Bein waren jedoch weder venöse Insuffizienzen noch Obstruktionen nachweisbar. Hinweise für eine periphere arterielle Verschlusskrankheit, ein Lymphödem oder Infektzei-chen fehlten.Ergebnisse: Durch eine lokale Wundbehand-lung mit Polyurethan-Wundauflagen in Kombination mit einer Kompressionstherapie mit einem 2-lagigen Kompressionssystem konnte nach 8 Monaten eine vollständige Abheilung der Ulcera am rechten Bein erzielt werden. In Zusammenschau mit dem klinischen Bild stellten wir die Diagnose Ulcera crurum bei Adipositas-assoziiertem Dependency-Syndrom.Diskussion: Das Adipositas-assoziierte Dependency Syndrom stellt eine Ursache für hydrostatische Ulcera ohne Vorhandensein von Klappeninsuffizienzen oder Obstruktionen dar und kann als funktionelle Veneninsuffizienz verstanden werden. Pathogenetisch liegt ein andauerndes Herabhängenlassen der Beine aufgrund von eingeschränkter Mobilität zugrunde. Zudem wurde eine Kompression der Beinvenen durch die abdominelle Fettschürze beschrieben. Therapeutisch stehen neben einer konsequenten Kompressionstherapie eine Remobilisierung der Patienten und eine Gewichtsreduktion im Vordergrund.English version available at: www.phlebologieonline.de
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Tavares PA, Landsman V, Gomez N, Ferreiras A, Lopez RA. Association of Venous Leg Ulcers With Ankle Range of Motion in People Attending Chiropractic Mobile Clinics in the Dominican Republic. J Chiropr Med 2017; 16:263-270. [PMID: 29276458 DOI: 10.1016/j.jcm.2017.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 05/27/2017] [Accepted: 08/04/2017] [Indexed: 11/25/2022] Open
Abstract
Objective The goal of the study was to determine if there was an association between chronic venous disorders (CVDs), particularly venous leg ulcers, and ankle range of motion (ROM) in the Dominican Republic. Methods Chronic venous disorders were classified using the clinical manifestations portion (C) of the CEAP (clinical manifestations, etiology, anatomy, pathophysiology) method. The legs of participants attending mobile chiropractic clinics in rural, low-income areas in the Dominican Republic were assessed for clinical signs of CVD and venous ulcers. Ankle ROM was then measured, and photographs of the legs were taken. The 6 clinical stages of CVD were divided into 3 groups: normal legs (normal), no ulcer CVD, and ulcer CVD (healed and active). Multiple linear regression of ankle ROM against CVD grouping was used to test the association. Results Eight of the 837 patients for whom CVD classification was obtained had venous ulcers (healed or active) on at least 1 leg. About 30% relative reduction in ROM (ankle dorsiflexion plus plantar flexion) was observed between the ulcer group and the normal group. Regression analysis comparing legs with ulcers to healthy legs (normal), adjusted for age, gender, indicator for obesity, and previous leg trauma, revealed a significant decrease of approximately 14° (P = .0007) in ankle ROM. Age was also found to be strongly significant in the regression analysis, 1 year of aging was associated with a decrease of 0.16° (P < .0001) in ankle ROM (approximately 1.6° in 10 years). Conclusion A significant decrease was observed in ankle ROM for participants with active and healed leg venous ulcers compared with those without ulcers. There appeared to be an association between venous leg ulcers and ankle ROM in this sample.
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Affiliation(s)
- Patricia A Tavares
- Division of Clinical Education, Canadian Memorial Chiropractic College, North York, Ontario, Canada
| | - Victoria Landsman
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College, North York, Ontario, Canada.,Institute for Work and Health, Toronto, Ontario, Canada
| | | | | | - Ramon A Lopez
- Private Practice, Santo Domingo, Dominican Republic.,Fundación Sol Naciente, Santo Domingo, Dominican Republic
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Brown A. Managing exudate and maceration in venous leg ulceration within the acute health setting. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:S18-S24. [PMID: 29120684 DOI: 10.12968/bjon.2017.26.sup20.s18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Exudate has beneficial effects in normal wound healing but detrimental consequences for chronic wounds. Practitioners need to identify and treat its cause, and manage the exudate and prevent if from damaging periwound skin. Management involves dressings of the most appropriate absorbency and other products, and avoiding maceration of periwound skin; compression therapy is the gold standard treatment for treating oedema and venous leg ulceration. Nurses in acute settings may not have the skills to implement or maintain compression therapy; this article is intended for nurses who may have to manage these patients temporarily while they are admitted to secondary care and may not have the skills.
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Skomudek A, Gilowska I, Jasiński R, Rożek-Piechura K. Analysis of the dynamics of venous blood flow in the context of lower limb temperature distribution and tissue composition in the elderly. Clin Interv Aging 2017; 12:1371-1378. [PMID: 28894359 PMCID: PMC5584775 DOI: 10.2147/cia.s137707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The elderly are particularly vulnerable to degenerative diseases, such as circulatory and respiratory system and vascular system diseases. The objective of this study was therefore to evaluate the distribution of temperature and the dynamics of venous blood flow in the lower limbs (LLs) and to assess the interdependence of these parameters in terms of the somatic components in males and females participating in activities at the University of the Third Age. MATERIALS AND METHODS The study included 60 females (mean age 67.4 years) and 40 males (mean age 67.5 years). A body composition assessment was performed using the bioimpedance technique - Tanita BC-418MA. The following parameters were examined: fat%, fat mass, fat-free mass, and total body water. The minimal, maximal, and mean temperature values and their distributions were examined using infrared thermographic camera VarioCAM Head. Measurements of the venous refilling time and the work of the LL venous pump were examined using a Rheo Dopplex II PPG. RESULTS In males, the mean value of the right LL temperature was 30.58 and the mean value of the left LL was 30.28; the P-value was 0.805769. In females, the mean value of the right LL temperature was 29.58 and the mean value of the left limb was 29.52; the P-value was 0.864773. In males, the right limb blood flow was 34.17 and the left limb blood flow was 34.67; the P-value was 0.359137. In females, the right limb blood flow was 26.89 and the left limb blood flow was 26.09; the P-value was 0.796348. CONCLUSION Research results showed that the temperature distribution and the dynamics of blood flow are not significantly different between the right and left extremities in both males and females. However, significant temperature differences were found between the gender groups. Significantly higher temperature values in both the right and left extremities were recorded in males than in females.
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Affiliation(s)
- Aleksandra Skomudek
- Department of Physical Education and Physiotherapy, Opole University of Technology, Opolskie.,Department of Clinical Physiotherapy
| | - Iwona Gilowska
- Department of Physical Education and Physiotherapy, Opole University of Technology, Opolskie.,Department of Biochemistry and Physiology
| | - Ryszard Jasiński
- Department of Physiotherapy and Occupational Therapy in Conservative and Interventional Medicine, University of Physical Education in Wroclaw, Wroclaw, Poland
| | - Krystyna Rożek-Piechura
- Department of Physiotherapy and Occupational Therapy in Conservative and Interventional Medicine, University of Physical Education in Wroclaw, Wroclaw, Poland
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Iuchi T, Kobayashi M, Tsuchiya S, Ohno N, Dai M, Matsumoto M, Ogai K, Sato A, Sawazaki T, Miyati T, Tanaka S, Sugama J. Objective assessment of leg edema using ultrasonography with a gel pad. PLoS One 2017; 12:e0182042. [PMID: 28792959 PMCID: PMC5549959 DOI: 10.1371/journal.pone.0182042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/11/2017] [Indexed: 11/18/2022] Open
Abstract
Ultrasonography (US) is useful for visual detection of edematous tissues to assess subcutaneous echogenicity. However, visualization of subcutaneous echogenicity is interpreted differently among operators because the evaluation is subjective and individual operators have unique knowledge. This study objectively assessed leg edema using US with a gel pad including fat for normalization of echogenicity in subcutaneous tissue. Five younger adults and four elderly people with leg edema were recruited. We compared assessments of US and limb circumference before and after the intervention of vibration to decrease edema in younger adults, and edema prior to going to sleep and reduced edema in the early morning in elderly people. These assessments were performed twice in elderly people by three operators and reliability, interrater differences, and bias were assessed. For US assessment, echogenicity in subcutaneous tissue was normalized to that of the gel pad by dividing the mean echogenicity of subcutaneous tissue by the mean echogenicity of the gel pad. In younger adults, the normalized subcutaneous echogenicity before the intervention was significantly higher than that after the intervention. In elderly people, echogenicity indicating edema was significantly higher than that after edema reduction. Edema was detected with accuracy rates of 76.9% in younger adults and 75.0% in elderly people. Meanwhile, limb circumference could be used to detect edema in 50.0% of healthy adults and 87.8% of elderly people. The intra-reliability was excellent (intraclass correlation coefficient > 0.9, p < 0.01), and the inter-reliability was good (intraclass correlation coefficient > 0.7, p < 0.01) for normalized subcutaneous echogenicity. Bland-Altman plots revealed that inter-rater differences and systematic bias were small. Normalized subcutaneous echogenicity with the pad can sensitively and objectively assess leg edema with high reliability. Therefore, this method has the potential to become a new gold standard for objective assessment of leg edema in clinical practice.
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Affiliation(s)
- Terumi Iuchi
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Masato Kobayashi
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
- * E-mail:
| | - Sayumi Tsuchiya
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Naoki Ohno
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Misako Dai
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Masaru Matsumoto
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Kazuhiro Ogai
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Aya Sato
- Faculty of Nursing & Social Welfare Sciences, Fukui Prefecture University, Fukui, Japan
| | - Takuto Sawazaki
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tosiaki Miyati
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Shinobu Tanaka
- Faculty of Mechanical Engineering, Institute of Science and Engineering, Kanazawa University, Kanazawa, Japan
| | - Junko Sugama
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
- Institute for Frontier Science Initiative, Kanazawa University, Kanazawa, Japan
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Abstract
Background The tip toe manoeuvre has been promoted as the gold standard plethysmography test for measuring calf muscle pump function. The aim was to compare the tip toe manoeuvre, dorsiflexion manoeuvre and a body weight transfer manoeuvre using the ejection fraction of air-plethysmography and evaluate which has the best pumping effect. Methods Sixty-six archived tracings on 22 legs were retrieved from an air-plethysmography workshop and analysed. Pumping performance was measured using the calf volume reduction after each manoeuvre. Results Expressed as median [inter-quartile range], body weight transfer manoeuvres resulted in a significantly greater ejection fraction (%) than tip toe manoeuvres at 59.7 [53.5-63.9] versus 42.6 [30.5-52.6], P < 0.0005 (Wilcoxon). There was no significant difference in the ejection fraction between the tip toe manoeuvre versus dorsiflexion manoeuvre, P = 0.615. The repeatability (confidence interval: 95%) of 66 ejection fraction tests was excellent: tip toe manoeuvre (±1.2), dorsiflexion manoeuvre (±1.3) and body weight transfer manoeuvre (±1.6). Conclusion The body weight transfer manoeuvre appears to be a better method of measuring the full potential of the calf muscle pump with a 40.1% relative increase in the ejection fraction compared to a tip toe manoeuvre. Exercises which involve body weight transfers from one leg to the other may be more important in optimizing calf muscle pump function than ankle movement exercises.
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Affiliation(s)
- Christopher R Lattimer
- 1 Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK.,2 Department of Surgery Cancer, Imperial College, London, UK.,3 West London Vascular and Interventional Centre, Middlesex, UK
| | | | - Evi Kalodiki
- 1 Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK.,2 Department of Surgery Cancer, Imperial College, London, UK.,3 West London Vascular and Interventional Centre, Middlesex, UK
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Sallam RAE, El Ghaweet AI, Regal SAH. Value of combined exercise and ultrasound as an adjunct to compression therapy in chronic venous leg ulcers. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2017. [DOI: 10.4103/1110-161x.205660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ercan S, Çetin C, Yavuz T, Demir HM, Atalay YB. Effects of isokinetic calf muscle exercise program on muscle strength and venous function in patients with chronic venous insufficiency. Phlebology 2017; 33:261-266. [PMID: 28954574 DOI: 10.1177/0268355517695401] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The aim of this study was to observe the change of the ankle joint range of motion, the muscle strength values measured with an isokinetic dynamometer, pain scores, quality of life scale, and venous return time in chronic venous insufficiency diagnosed patients by prospective follow-up after 12-week exercise program including isokinetic exercises. Methods The patient group of this study comprised 27 patients (23 female, 4 male) who were diagnosed with chronic venous insufficiency. An exercise program including isokinetic exercise for the calf muscle was given to patients three days per week for 12 weeks. At the end of 12 weeks, five of the patients left the study due to inadequate compliance with the exercise program. As a result, control data of 22 patients were included. Ankle joint range of active motion, isokinetic muscle strength, pain, quality of life, and photoplethysmography measurements were assessed before starting and after the exercise program. Results Evaluating changes of the starting and control data depending on time showed that all isokinetic muscle strength measurement parameters, range of motion, and overall quality of life values of patients improved. Venous return time values have also increased significantly ( p < 0.05). Conclusion In conclusion, increase in muscle strength has been provided with exercise therapy in patients with chronic venous insufficiency. It has been determined that the increase in muscle strength affected the venous pump and this ensured improvement in venous function and range of motion of the ankle. In addition, it has been detected that pain reduced and quality of life improved after the exercise program.
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Affiliation(s)
- Sabriye Ercan
- 1 Department of Sports Medicine, Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
| | - Cem Çetin
- 2 Department of Sports Medicine, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Turhan Yavuz
- 3 Department of Cardiovascular Surgery, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Hilmi M Demir
- 4 Department of Sports Medicine, Van Education and Research Hospital, Van, Turkey
| | - Yurdagül B Atalay
- 2 Department of Sports Medicine, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
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Li Y, Guan XH, Wang R, Li B, Ning B, Su W, Sun T, Li HY. Active Ankle Movements Prevent Formation of Lower-Extremity Deep Venous Thrombosis After Orthopedic Surgery. Med Sci Monit 2016; 22:3169-76. [PMID: 27600467 PMCID: PMC5024560 DOI: 10.12659/msm.896911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The aim of this study was to assess the preventive value of active ankle movements in the formation of lower-extremity deep venous thrombosis (DVT), attempting to develop a new method for rehabilitation nursing after orthopedic surgery. Material/Methods We randomly assigned 193 patients undergoing orthopedic surgery in the lower limbs into a case group (n=96) and a control group (n=97). The control group received routine nursing while the case group performed active ankle movements in addition to receiving routine nursing. Maximum venous outflow (MVO), maximum venous capacity (MVC), and blood rheology were measured and the incidence of DVT was recorded. Results On the 11th and 14th days of the experiment, the case group had significantly higher MVO and MVC than the control group (all P<0.05). The whole-blood viscosity at high shear rate and the plasma viscosity were significantly lower in the case group than in the control group on the 14th day (both P<0.05). During the experiment, a significantly higher overall DVT incidence was recorded in the control group (8 with asymptomatic DVT) compared with the case group (1 with asymptomatic DVT) (P=0.034). During follow-up, the case group presented a significantly lower DVT incidence (1 with symptomatic DVT and 4 with asymptomatic DVT) than in the control group (5 with symptomatic DVT and 10 with asymptomatic DVT) (P=0.031). Conclusions Through increasing MVO and MVC and reducing blood rheology, active ankle movements may prevent the formation of lower-extremity DVT after orthopedic surgery.
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Affiliation(s)
- Ye Li
- Operation Room, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Xiang-Hong Guan
- Central Laboratory, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Rui Wang
- Department of Nursing, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Bin Li
- Outpatient Operating Room, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Bo Ning
- Department of Andrology, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Wei Su
- Department of Burn, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Tao Sun
- Operation Room,Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Hong-Yan Li
- Operation Room, Linyi People's Hospital, Linyi, Shandong, China (mainland)
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Atkin L, Stephenson J, Parfitt G, Reel S, Ousey K, Fallon B. An investigation to assess ankle mobility in healthy individuals from the application of multi-component compression bandages and compression hosiery. J Foot Ankle Res 2016; 9:18. [PMID: 27390590 PMCID: PMC4936284 DOI: 10.1186/s13047-016-0151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/23/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND An investigation was undertaken to compare the effect of multi-component compression bandages and compression hosiery kits on individuals' range of ankle motion whilst wearing typical and medical footwear, and barefoot. METHODS A convenience sample of 30 healthy individuals recruited from the staff and student population at the University of Huddersfield, UK. Plantarflexion/dorsiflexion range of ankle motion (ROAM) was measured in participants over 6 steps in every combination of typical, medical and no footwear; and multi-component bandages, compression hosiery and no garments. RESULTS Controlling for age, gender and garments, the use of typical footwear was associated with a mean increase in ROAM of 2.54° at best estimate compared with barefoot; the use of medical footwear was associated with a mean decrease in ROAM of 1.12° at best estimate compared with barefoot. Controlling for age, gender and footwear, the use of bandaging was associated with a mean decrease in ROAM of 2.51° at best estimate compared with no garments. Controlling for age, gender and footwear, the use of hosiery was not associated with a significant change in ROAM compared with no garments. CONCLUSIONS Bandages appear to restrict ROAM more than hosiery when used in conjunction with a variety of footwear types.
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Affiliation(s)
- Leanne Atkin
- />School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
- />Vascular Nurse Specialist, Mid Yorkshire NHS Trust, Huddersfield, UK
| | - John Stephenson
- />Biomedical Statistics, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Grace Parfitt
- />School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Sarah Reel
- />Podiatry, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Karen Ousey
- />Advancing Clinical Practice, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Brandon Fallon
- />School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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Humphreys C, Moffatt C, Hood V. Risk of falling for people with venous leg ulcers: a literature review. Br J Community Nurs 2016; 21 Suppl 3:S34-8. [PMID: 26940732 DOI: 10.12968/bjcn.2016.21.sup3.s34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Little is known about the risk of falling for people with venous leg ulcers (VLUs), and this subject has not been considered in UK populations. Many problems associated with living with VLUs are also known risk factors for sustaining a fall. This literature review considered the question: 'Do community-dwelling older adults with VLUs have different outcomes in physical function measures used to assess the risk of falling compared with those without VLUs?' METHOD A review of quantitative literature relating to measures of physical function in people with and without VLUs was undertaken, the development of which was guided by the PRISMA guidelines. FINDINGS People with VLUs have poorer scores in measures of physical function than in people without. Reliability of studies included in the review was hampered by small sample sizes and threats to internal validity and generalisability. CONCLUSIONS People with VLUs may be at a greater risk of falling owing to limitations in balance and mobility. Improving physical function may result in ulcer healing and better quality of life. Reducing falls risk may also lead to improved patient safety and enhanced care outcomes. Further research is needed to better understand the problem.
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Affiliation(s)
- Catriona Humphreys
- Senior Physiotherapist, Nottingham University Hospitals NHS Trust, England
| | - Christine Moffatt
- Professor of Clinical Nursing Research, Faculty of Medicine and Health Sciences, University of Nottingham, England
| | - Victoria Hood
- Lecturer, Faculty of Medicine and Health Sciences, University of Nottingham, England
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Yildiz CE, Conkbayir C, Huseynov E, Sayin OA, Tok O, Kaynak G, Cebi D, Ugurlucan M, Kantarci F, Inan M. The efficiency of O-(beta-hydroxyethyl)-rutosides in reducing the incidence of superficial venous insufficiency in patients with calf muscle pump dysfunction. Phlebology 2016; 32:179-184. [PMID: 26924360 DOI: 10.1177/0268355516635466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We aimed to evaluate the efficiency of O-(beta-Hydroxyethyl)-rutosides (Oxerutin) in reducing the incidence of venous system disease among patients with calf muscle pump dysfunction secondary to immobilization due to lower-limb fractures. Methods A total of 60 patients with lower-limb fractures and immobilized in plaster casts were included in this study randomized into control (n = 30; mean: 30.37 ± 6.03 years; 73.3% males; no treatment) and experiment (n = 30; mean: 31.67 ± 4.76 years; 66.6% males; Oxerutin, 500 mg po q12hr) treatment groups. Doppler ultrasound was performed to evaluate the effect of oxerutin on the alterations in the venous circulation. Results Patients in the control group were determined to be more commonly affected from the below-knee immobilization in terms of venous dysfunction in the great saphenous vein in the below-knee region when compared with the patients in the oxerutin treatment group (46.7 vs. 13.3%, respectively; p = 0.011). Incidence of reflux in the small saphenous vein was more common in the control group during the healing period when compared with the experiment group (40.0 vs. 10.0%, respectively; p = 0.017). None of the patients developed venous thrombosis. Conclusions In conclusion, the impairment of the lower extremity muscle pump should be considered as an important risk factor for venous disease, and should be evaluated. O-(beta-Hydroxyethyl)-rutosides during 6-8 week cast immobilization for a lower limb fracture may be an effective prophylactic regimen in reducing the incidence of reflux in the below-knee superficial veins.
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Affiliation(s)
- Cenk Eray Yildiz
- 1 Department of Cardiovascular Surgery, Istanbul University Institute of Cardiology, Istanbul, Turkey
| | - Cenk Conkbayir
- 2 Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Eldeniz Huseynov
- 3 Department of Radiology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Omer Ali Sayin
- 4 Department of Cardiovascular Surgery, Istanbul University Medical Faculty, Istanbul, Turkey
| | - Okan Tok
- 5 Department of Orthopedics and Traumatology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Gokhan Kaynak
- 5 Department of Orthopedics and Traumatology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Deniz Cebi
- 3 Department of Radiology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Murat Ugurlucan
- 4 Department of Cardiovascular Surgery, Istanbul University Medical Faculty, Istanbul, Turkey
| | - Fatih Kantarci
- 3 Department of Radiology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Muharrem Inan
- 5 Department of Orthopedics and Traumatology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Falls, Balance Confidence, and Lower-Body Strength in Patients Seeking Outpatient Venous Ulcer Wound Care. Adv Skin Wound Care 2016; 29:85-93. [PMID: 26765161 DOI: 10.1097/01.asw.0000476071.11690.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE & ABSTRACT To provide information about a quality improvement project examining falls in persons seeking outpatient wound care. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to:1. Describe the scope of the problem and the related quality improvement project. 2. Delineate the results of the project and their implications for treatment of patients with venous ulcers. OBJECTIVE The authors aim to examine fall occurrence and fall injuries in persons seeking outpatient wound care and to compare falls, balance confidence, and lower-body strength in persons with injection-related venous ulcers (IRVUs) versus persons with venous ulcers (VUs) related to other risk factors besides injection drugs (VUs-other). DESIGN This quality improvement project used a cross-sectional, comparative design. Participants responded to demographic questions, the Activities-specific Balance Confidence (ABC) Scale, fear of falling, fall numbers, and injuries and performed the 30-second chair-rise test. SETTING Outpatient wound service. PATIENTS Patients (N = 106; mean age, 59.94 years) included men (66%) and women. RESULTS Sixty patients reported falling; 47 were recurrent fallers. Twenty patients stated they were injured, but did not go to an emergency department. A higher number of total falls was significantly related to more comorbidities. Total falls were significantly related to fear of falling and ABC Scale scores. Those with VUs-other had significantly more comorbidities and higher body mass index values than those with IRVUs. Those with IRVUs were comparable to those VUs-other on number of falls and fear of falling, respectively. Those with IRVUs (7.30) performed significantly more chair rises than those with VUs-other (4.72). Persons with IRVUs had significantly higher ABC Scale scores (63.24%) than those with VUs-other (49.38%). CONCLUSIONS Falls are a common occurrence in persons seeking outpatient wound care. Despite greater strength sufficient to perform more chair rises among those with IRVUs, fall rates were comparable to those of weaker individuals with other types of VUs. With the high occurrence of falls during the project, long-term risk for fall injury would be high. Further research is needed to clarify interactions between VU risk and patient factors such as strength, age, agility, and impaired cognition.
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Yim E, Richmond NA, Baquerizo K, Van Driessche F, Slade HB, Pieper B, Kirsner RS. The effect of ankle range of motion on venous ulcer healing rates. Wound Repair Regen 2015; 22:492-6. [PMID: 25041619 DOI: 10.1111/wrr.12186] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 04/09/2014] [Indexed: 11/27/2022]
Abstract
Limitation of ankle movement may contribute to calf muscle pump failure, which is thought to contribute to venous leg ulcer formation, which affects nearly 1 million Americans. We therefore wished to study ankle movement in patients with venous leg ulcers and its effect on healing. Using goniometry, we measured baseline ankle range of motion in venous leg ulcer patients from a Phase 2 dose-finding study of an allogeneic living cell bioformulation. Two hundred twenty-seven patients were enrolled in four active treatment groups and one standard-care control group, all receiving compression therapy. Goniometry data from a control group of 49 patients without venous disease, from a previous study, was used for comparison. We found patients with active venous leg ulcers had significantly reduced ankle range of motion compared with the control group (p = 0.001). After 12 weeks of therapy, baseline ankle range of motion was not associated with healing, as there was no significant difference between healed and nonhealed groups, suggesting that ankle range of motion is not important in venous leg ulcer healing or, more likely, is overcome by compression. However, patients with venous ulcers located on the leg (as opposed to the ankle) had significantly higher ankle range of motion for plantar flexion and inversion (p = 0.021 and p = 0.034, respectively) and improved healing with both cell bioformulation and standard care (p = 0.011), suggesting that wound location is an important variable for ankle range of motion as well as for healing outcomes.
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Affiliation(s)
- Elizabeth Yim
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Kim TI, Forbang NI, Criqui MH, Allison MA. Association of foot and ankle characteristics with progression of venous disease. Vasc Med 2015; 20:105-11. [DOI: 10.1177/1358863x14568443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although risk factors have been identified for the cross-sectional prevalence of venous disease, few studies have investigated risk factors for venous disease progression. Therefore, the aim of this study was to investigate the relationship between foot and ankle characteristics and the progression of venous disease. A total of 1025 participants from the San Diego Population Study were assessed at baseline and at follow-up 11 years later. Risk factors were assessed by questionnaire and physical measurements, while venous disease was determined by physical examination and Duplex ultrasound. Change in venous disease from baseline to 11-year follow-up was characterized as stable or progression. Those with venous disease progression were less likely to spend increased time lying per day, more likely to have a history of hypertension, lie supine for a surgical procedure greater than an hour, and report an occupation that was professional, technical, administrative, or management. Those with a normal arch reported the greatest degree of plantar flexion. In multivariable logistic regression, including adjustment for weight-bearing arch characteristics, greater dorsiflexion (per 5 degrees) was significantly associated with progression of venous disease (OR = 1.11, p = 0.01). A weight-bearing flat arch compared to a weight-bearing normal arch was of borderline significance as a protective factor against progression of venous disease with adjustment for dorsiflexion (OR = 0.56, p = 0.07). Our results indicate that the ability to have higher levels of dorsiflexion is a risk factor for the progression of venous disease, and suggest a role for connective tissue laxity in the pathogenesis of venous disease.
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Affiliation(s)
- Tanner I Kim
- John A Burns School of Medicine, Department of Geriatric Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Nketi I Forbang
- Department of Family and Preventative Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Michael H Criqui
- Department of Family and Preventative Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Matthew A Allison
- Department of Family and Preventative Medicine, University of California, San Diego, La Jolla, CA, USA
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Parker TJ, Broadbent JA, McGovern JA, Broszczak DA, Parker CN, Upton Z. Provisional Matrix Deposition in Hemostasis and Venous Insufficiency: Tissue Preconditioning for Nonhealing Venous Ulcers. Adv Wound Care (New Rochelle) 2015; 4:174-191. [PMID: 25785239 PMCID: PMC4352700 DOI: 10.1089/wound.2013.0462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Indexed: 01/07/2023] Open
Abstract
Significance: Chronic wounds represent a major burden on global healthcare systems and reduce the quality of life of those affected. Significant advances have been made in our understanding of the biochemistry of wound healing progression. However, knowledge regarding the specific molecular processes influencing chronic wound formation and persistence remains limited. Recent Advances: Generally, healing of acute wounds begins with hemostasis and the deposition of a plasma-derived provisional matrix into the wound. The deposition of plasma matrix proteins is known to occur around the microvasculature of the lower limb as a result of venous insufficiency. This appears to alter limb cutaneous tissue physiology and consequently drives the tissue into a 'preconditioned' state that negatively influences the response to wounding. Critical Issues: Processes, such as oxygen and nutrient suppression, edema, inflammatory cell trapping/extravasation, diffuse inflammation, and tissue necrosis are thought to contribute to the advent of a chronic wound. Healing of the wound then becomes difficult in the context of an internally injured limb. Thus, interventions and therapies for promoting healing of the limb is a growing area of interest. For venous ulcers, treatment using compression bandaging encourages venous return and improves healing processes within the limb, critically however, once treatment concludes ulcers often reoccur. Future Directions: Improved understanding of the composition and role of pericapillary matrix deposits in facilitating internal limb injury and subsequent development of chronic wounds will be critical for informing and enhancing current best practice therapies and preventative action in the wound care field.
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Affiliation(s)
- Tony J. Parker
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - James A. Broadbent
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jacqui A. McGovern
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Daniel A. Broszczak
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christina N. Parker
- Institute of Health and Biomedical Innovation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zee Upton
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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Influence of Manual Lymphatic Drainage on Health-Related Quality of Life and Symptoms of Chronic Venous Insufficiency: A Randomized Controlled Trial. Arch Phys Med Rehabil 2015; 96:283-91. [DOI: 10.1016/j.apmr.2014.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 09/12/2014] [Accepted: 09/16/2014] [Indexed: 11/24/2022]
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Sultan MJ, Zhing T, Morris J, Kurdy N, McCollum CN. Compression stockings in the management of fractures of the ankle: a randomised controlled trial. Bone Joint J 2014; 96-B:1062-9. [PMID: 25086122 DOI: 10.1302/0301-620x.96b8.32941] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this randomised controlled trial, we evaluated the role of elastic compression using ankle injury stockings (AIS) in the management of fractures of the ankle. A total of 90 patients with a mean age of 47 years (16 to 79) were treated within 72 hours of presentation with a fracture of the ankle, 31 of whom were treated operatively and 59 conservatively, were randomised to be treated either with compression by AIS plus an Aircast boot or Tubigrip plus an Aircast boot. Male to female ratio was 36:54. The primary outcome measure was the functional Olerud-Molander ankle score (OMAS). The secondary outcome measures were; the American Orthopaedic Foot and Ankle Society score (AOFAS); the Short Form (SF)-12v2 Quality of Life score; and the frequency of deep vein thrombosis (DVT). Compression using AIS reduced swelling of the ankle at all time points and improved the mean OMAS score at six months to 98 (95% confidence interval (CI) 96 to 99) compared with a mean of 67 (95% CI 62 to 73) for the Tubigrip group (p < 0.001). The mean AOFAS and SF-12v2 scores at six months were also significantly improved by compression. Of 86 patients with duplex imaging at four weeks, five (12%) of 43 in the AIS group and ten (23%) of 43 in the Tubigrip group developed a DVT (p = 0.26). Compression improved functional outcome and quality of life following fracture of the ankle. DVTs were frequent, but a larger study would be needed to confirm that compression with AISs reduces the incidence of DVT.
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Affiliation(s)
- M J Sultan
- University Hospital of South Manchester, Wythenshawe M23 9LT, UK
| | - T Zhing
- University Hospital of South Manchester, Wythenshawe M23 9LT, UK
| | - J Morris
- University Hospital of South Manchester, Wythenshawe M23 9LT, UK
| | - N Kurdy
- University Hospital of South Manchester, Wythenshawe M23 9LT, UK
| | - C N McCollum
- University Hospital of South Manchester, Wythenshawe M23 9LT, UK
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Aguilar-Ferrándiz ME, Moreno-Lorenzo C, Matarán-Peñarrocha GA, García-Muro F, García-Ríos MC, Castro-Sánchez AM. Effect of a Mixed Kinesio Taping–Compression Technique on Quality of Life and Clinical and Gait Parameters in Postmenopausal Women With Chronic Venous Insufficiency: Double-Blinded, Randomized Controlled Trial. Arch Phys Med Rehabil 2014; 95:1229-39. [DOI: 10.1016/j.apmr.2014.03.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 03/04/2014] [Accepted: 03/21/2014] [Indexed: 12/21/2022]
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Guirro ECDO, Guirro RRDJ, Dibai-Filho AV, Montezuma T, Vaz MMDOLL. Decrease in Talocrural Joint Mobility is Related to Alteration of the Arterial Blood Flow Velocity in the Lower Limb in Diabetic Women. J Phys Ther Sci 2014; 26:553-6. [PMID: 24764632 PMCID: PMC3996420 DOI: 10.1589/jpts.26.553] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/04/2013] [Indexed: 12/25/2022] Open
Abstract
[Purpose] The purpose of this study was to correlate the talocrural range of motion
(ROM) and blood flow velocity in the lower limb arteries of diabetic women. [Subjects and
Methods] Thirty women were divided into a control group (G1), consisting of 15 sedentary
right-handed subjects (41.27 ± 7.24 years old) who had no history of blood system
disorder, and a diabetes group (G2), consisting of 15 sedentary right-handed subjects
(57.87 ± 6.20 years old) who had type 2 diabetes mellitus. Talocrural ROM was measured by
using goniometry for dorsiflexion and plantar flexion movements. In addition, blood flow
velocity of the dorsalis pedis, posterior tibial, and popliteal arteries was also
assessed. [Results] No significant differences were found between the groups by comparing
talocrural ROM and arterial blood velocity. However, a significant association was found
in G2 only between the following variables: plantar flexion and blood flow velocity of the
dorsalis pedis artery (rs = 0.57), plantar flexion and blood flow velocity of the
popliteal artery (rs = 0.50), and dorsiflexion and blood flow velocity of the posterior
tibial artery (rs = 0.57). [Conclusion] The decrease in talocrural ROM is related to a
decrease in the arterial blood flow velocity in diabetic women.
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Affiliation(s)
- Elaine Caldeira de Oliveira Guirro
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Rinaldo Roberto de Jesus Guirro
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Almir Vieira Dibai-Filho
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Thais Montezuma
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Maíta Mara de Oliveira Lima Leite Vaz
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Brazil
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White-Chu EF, Conner-Kerr TA. Overview of guidelines for the prevention and treatment of venous leg ulcers: a US perspective. J Multidiscip Healthc 2014; 7:111-7. [PMID: 24596466 PMCID: PMC3930479 DOI: 10.2147/jmdh.s38616] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Comprehensive care of chronic venous insufficiency and associated ulcers requires a multipronged and interprofessional approach to care. A comprehensive treatment approach includes exercise, nutritional assessment, compression therapy, vascular reconstruction, and advanced treatment modalities. National guidelines, meta-analyses, and original research studies provide evidence for the inclusion of these approaches in the patient plan of care. The purpose of this paper is to review present guidelines for prevention and treatment of venous leg ulcers as followed in the US. The paper further explores evidence-based yet pragmatic tools for the interprofessional team to use in the management of this complex disorder.
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Affiliation(s)
- E Foy White-Chu
- Oregon Health and Science University, Portland VA Medical Center, Portland, OR
| | - Teresa A Conner-Kerr
- Winston-Salem State University, Department of Physical Therapy, Winston Salem, NC, USA
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Williams KJ, Ayekoloye O, Moore HM, Davies AH. The calf muscle pump revisited. J Vasc Surg Venous Lymphat Disord 2014; 2:329-34. [PMID: 26993396 DOI: 10.1016/j.jvsv.2013.10.053] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/30/2013] [Accepted: 10/27/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chronic venous disease (CVD) defines the spectrum of manifestations of venous disease that originate as a result of ambulatory venous hypertension. Thus far, the role of the calf muscle pump in the development and potentiation of CVD has been overlooked and understated in the clinical setting, with much greater emphasis placed on reflux and obstruction. The aim of this review is to explore the level of significance that calf muscle pump function or dysfunction bears on the development and potentiation of CVD. METHODS EMBASE and MEDLINE databases were searched with keywords "calf" AND "muscle" AND "pump" AND "venous" AND "insufficiency" AND ("lower limb*" OR "leg*"), screened for cross-sectional and longitudinal studies relating to chronic venous insufficiency, highlighting the role of the calf muscle pump in CVD and the extent to which the calf muscle pump is impaired in these cases. This resulted in the inclusion of 10 studies. RESULTS Compared with healthy subjects, patients with CVD have a reduced ejection fraction (15.9%; P < .001) and an increased venous filling index (4.66 mL/s; P < .001), indicating impairment in calf muscle pump ejection ability as well as poor venous competence. Calf muscle pump dysfunction is present in 55% of patients with CVD in the literature, but this did not reach significance on meta-analysis. Isotonic exercise programs in patients with active and healed ulcers have been shown to increase calf muscle pump function but not venous competence. DISCUSSION Calf muscle pump failure is a therapeutic target in the treatment of CVD. Evidence suggests that isotonic exercise treatment may be an effective method of increasing the hemodynamic performance of the calf muscle pump. CONCLUSIONS This review emphasizes the requirement for more attention to be placed on the treatment of calf muscle pump failure in cases of CVD by use of exercise treatment programs or other methods, which may be of clinical importance in managing symptomatic disease. To establish this in routine clinical practice, these results would need to be replicated in appropriate clinical trials. It would also be logical to look at other modifiable muscle pumps, such as the thigh and foot, and to explore the potential benefit of electrical devices acting on the leg (eg, electrical muscular or neuromuscular stimulation), especially for those patients in whom exercise capacity is limited.
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Affiliation(s)
- Katherine J Williams
- Academic Section of Vascular Surgery, Imperial College London, London, United Kingdom
| | | | - Hayley M Moore
- Academic Section of Vascular Surgery, Imperial College London, London, United Kingdom
| | - Alun H Davies
- Academic Section of Vascular Surgery, Imperial College London, London, United Kingdom.
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A novel assessment of flexibility by microcirculatory signals. SENSORS 2013; 14:478-91. [PMID: 24380926 PMCID: PMC3926570 DOI: 10.3390/s140100478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/03/2013] [Accepted: 12/17/2013] [Indexed: 11/16/2022]
Abstract
Flexibility testing is one of the most important fitness assessments. It is generally evaluated by measuring the range of motion (RoM) of body segments around a joint center. This study presents a novel assessment of flexibility in the microcirculatory aspect. Eighteen college students were recruited for the flexibility assessment. The flexibility of the leg was defined according to the angle of active ankle dorsiflexion measured by goniometry. Six legs were excluded, and the remaining thirty legs were categorized into two groups, group H (n = 15 with higher flexibility) and group L (n = 15 with lower flexibility), according to their RoM. The microcirculatory signals of the gastrocnemius muscle on the belly were monitored by using Laser-Doppler Flowmetry (LDF) with a noninvasive skin probe. Three indices of nonpulsatile component (DC), pulsatile component (AC) and perfusion pulsatility (PP) were defined from the LDF signals after signal processing. The results revealed that both the DC and AC values of the group H that demonstrated higher stability underwent muscle stretching. In contrast, these indices of group L had interferences and became unstable during muscle stretching. The PP value of group H was a little higher than that of group L. These primary findings help us to understand the microcirculatory physiology of flexibility, and warrant further investigations for use of non-invasive LDF techniques in the assessment of flexibility.
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Aguilar-Ferrándiz ME, Castro-Sánchez AM, Matarán-Peñarrocha GA, García-Muro F, Serge T, Moreno-Lorenzo C. Effects of Kinesio Taping on Venous Symptoms, Bioelectrical Activity of the Gastrocnemius Muscle, Range of Ankle Motion, and Quality of Life in Postmenopausal Women With Chronic Venous Insufficiency: A Randomized Controlled Trial. Arch Phys Med Rehabil 2013; 94:2315-2328. [DOI: 10.1016/j.apmr.2013.05.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/07/2013] [Accepted: 05/21/2013] [Indexed: 11/17/2022]
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Abstract
OBJECTIVES With aging of injection users and the high occurrence of venous disease in their legs, falls are a potential health problem. We examined falls and balance confidence in persons with (VU+) and without (VU-) injection-related venous ulcers (VUs). METHODS This study used a cross-sectional, retrospective, comparative design with 31 participants VU+ and 30 VU- recruited in a medical clinic. Participants' legs were assessed for clinical manifestations of venous disease. Participants completed background and fall questionnaires and the Activities-specific Balance Confidence (ABC) Scale. RESULTS Participants included 35 men and 26 women (mean age = 54 years); 93% were African American. Falling in the past year was reported by 65% of patients VU+ and 40% VU- (P = 0.048); 29 of these patients fell 2 or more times in the past year. Higher scores on the ABC Scale (N = 61) were significantly related to fewer falls (r = -0.68). Activities-specific Balance Confidence scores were lower/worse for the patients VU+ (P = 0.039). Area under the receiver operating curve for patients VU+ was significant; we found area under the curve of 0.84 and a cutoff score of 80.3% for ABC predictive of recurrent fallers with sensitivity of 84% and specificity of 83%. The ABC test had an internal consistency reliability of 0.97. CONCLUSIONS Persons VU+ reported worse balance confidence and more falls than those without these ulcers. The ABC test was related to falls. With aging of injection users and increased occurrence of VUs, examining balance confidence and falls is crucial in long-term patient safety.
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Aguilar-Ferrándiz ME, Castro-Sánchez AM, Matarán-Peñarrocha GA, Guisado-Barrilao R, García-Ríos MC, Moreno-Lorenzo C. A randomized controlled trial of a mixed Kinesio taping–compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency. Clin Rehabil 2013; 28:69-81. [DOI: 10.1177/0269215512469120] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To investigate the effect of a mixed Kinesio taping treatment in women with chronic venous insufficiency. Design: A double-blinded randomized clinical trial. Setting: Clinical setting. Participants: One hundred and twenty postmenopausal women with mild–moderate chronic venous insufficiency were randomly assigned to an experimental group receiving standardized Kinesio taping treatment for gastrocnemius muscle enhancement and ankle functional correction, or to a placebo control group for simulated Kinesio taping. Main outcomes variables: Venous symptoms, pain, photoplethysmographic measurements, bioelectrical impedance, temperature, severity and overall health were recorded at baseline and after four weeks of treatment. Results: The 2 × 2 mixed model ANCOVA with repeated measurements showed statistically significant group * time interaction for heaviness ( F = 22.99, p = 0.002), claudication ( F = 8.57, p = 0.004), swelling ( F = 22.58, p = 0.001), muscle cramps ( F = 7.14, p = 0.008), venous refill time (right: F = 9.45, p = 0.023; left: F = 14.86, p = 0.001), venous pump function (right: F = 35.55, p = 0.004; left: F = 17.39 p = 0.001), extracellular water (right: F = 35.55, p = 0.004; left: F = 23.84, p = 0.001), severity ( F = 18.47, p = 0.001), physical function ( F = 9.15, p = 0.003) and body pain ( F = 3.36, p = 0.043). Both groups reported significant reduction in pain. Conclusion: Mixed Kinesio taping-compression therapy improves symptoms, peripheral venous flow and severity and slightly increases overall health status in females with mild chronic venous insufficiency. Kinesio taping may have a placebo effect on pain.
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Kelechi TJ, Mueller M, Zapka JG, King DE. Cryotherapy and ankle motion in chronic venous disorders. OPEN JOURNAL OF NURSING 2012; 2:379-387. [PMID: 23516043 DOI: 10.4236/ojn.2012.24056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study compared ankle range of motion (AROM) including dorsiflexion, plantar flexion, inversion and eversion, and venous refill time (VRT) in leg skin inflamed by venous disorders, before and after a new cryotherapy ulcer prevention treatment. Fifty-seven-individuals participated in the randomized clinical trial; 28 in the experimental group and 29 received usual care only. Results revealed no statistically significant differences between the experimental and usual care groups although AROM measures in the experimental group showed a consistent, non-clinically relevant decrease compared to the usual care group except for dorsiflexion. Within treatment group comparisons of VRT results showed a statistically significant increase in both dorsiflexion and plantar flexion for patients with severe VRT in the experimental group (6.9 ± 6.8; p = 0.002 and 5.8 ± 12.6; p = 0.02, respectively). Cryotherapy did not further restrict already compromised AROM, and in some cases, there were minor improvements.
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Affiliation(s)
- Teresa J Kelechi
- College of Nursing, Medical University of South Carolina, Charleston, USA
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Brown A. Life-style advice and self-care strategies for venous leg ulcer patients: what is the evidence? J Wound Care 2012; 21:342-4, 346, 348-50. [DOI: 10.12968/jowc.2012.21.7.342] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A. Brown
- East of England Strategic Health Authority, UK
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Sultan MJ, McKeown A, McLaughlin I, Kurdy N, McCollum CN. Elastic stockings or Tubigrip for ankle sprain: a randomised clinical trial. Injury 2012; 43:1079-83. [PMID: 22365595 DOI: 10.1016/j.injury.2012.01.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 01/17/2012] [Accepted: 01/26/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ankle sprains are common and generally believed to be benign and self-limiting. However, a significant proportion of patients with ankle sprains have persistent symptoms for months or even years. AIMS The study aimed to evaluate whether elastic stockings improve recovery following ankle sprain. METHODOLOGY All patients within 72 h of ankle sprain were identified in Accident & Emergency or the Fracture Clinic. Consenting patients, stratified for sex, were randomised to either: (i) Tubigrip or (ii) class II below knee elastic stockings (ESs, Medi UK Ltd.) which were fitted immediately and worn until the patient was pain-free and fully mobile. The deep veins of the injured legs were imaged by duplex Doppler for deep vein thrombosis (DVT) at 4 weeks. Outcome was compared using the American Orthopaedic Foot and Ankle Score (AOFAS) and SF12v2 for quality of life. RESULTS In the 36 randomised patients, the mean (95% confidence interval (CI)) circumference of the injured ankle treated by ES was 23.5 (23-24)cm initially and 22 (22-23) and 22 (21-22.5)cm at 4 and 8 weeks (p<0.001) compared with 24 (23-25) cm initially and 24 (23-25) and 24 (23-24.5) cm using Tubigrip (p<0.001). By 8 weeks, the mean AOFAS and SF12v2 scores were significantly improved by ES at 99 (8.1) and 119 (118-121) compared with 88 (11) and 102 (99-107) with Tubigrip (p<0.001). Of the 34 duplex images at 4 weeks, none had a DVT. CONCLUSION Elastic compression improves recovery following ankle sprain.
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Affiliation(s)
- Muhammad J Sultan
- Academic Surgery Unit, University Hospital of South Manchester, Manchester M23 9LT, UK
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Alcayaga Fritis M, Campillay Guzmán J, Aguirre Cortés M. La úlcera venosa provoca limitación significativa del rango articular de tobillo en pacientes adultos sometidos a terapia compresiva. Medwave 2010. [DOI: 10.5867/medwave.2010.09.4777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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50
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Kelechi TJ, McNeil RB. A pilot study of venous photoplethysmography screening of patients with chronic venous disorders. Appl Nurs Res 2010; 23:178-83. [PMID: 20643329 DOI: 10.1016/j.apnr.2008.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 06/24/2008] [Accepted: 06/30/2008] [Indexed: 11/24/2022]
Abstract
In office and clinical practice settings, standard methods do not exist to objectively quantify lower extremity venous dysfunction. This pilot feasibility study examined venous refill time, an objective measure of skin microcirculation reflux, using photoplethysmography in 13 patients with known chronic venous disorders. The test was found to be feasible and easy to administer and provided objective data to corroborate clinical signs. Further research is needed to evaluate and validate the relationships among clinical signs, comorbid conditions, and objective findings with the severity of venous dysfunction in patients with suspected or known chronic venous disorders.
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Affiliation(s)
- Teresa J Kelechi
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, MSC 160, USA.
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