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Herraiz-Ahijado B, Folguera-Álvarez C, Verdú-Soriano J, Mori-Vara P, Rico-Blázquez M. Active legs: Impact of physical activity as an adjuvant treatment in the healing of venous ulcers in primary care: a RCT protocol study. BMC Nurs 2023; 22:65. [PMID: 36899351 PMCID: PMC9999587 DOI: 10.1186/s12912-023-01214-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Venous ulcers usually present a torpid evolution with a negative impact on patients' quality of life. In primary care, they account for 2.5% of nursing consultations and their treatment represents high costs for national health systems. These patients usually have a low level of physical activity, with muscle pump dysfunction of the lower limbs, which may improve with increased physical activity. The purpose of this study is to analyse the effectiveness of a structured intervention involving physical activity and exercise (Active Legs) as an adjuvant treatment in improving healing of chronic venous ulcers at 3 months follow-up. METHODS A randomized, multicentre clinical trial. A total of 224 individuals receiving primary nursing care with a diagnosis of venous ulcer, with a diameter of 1 cm or greater and an ankle-brachial index between 0.8 and 1.3, able to comply with the study requirements and consenting to participate, will be sequentially included (112 per group). Both groups will receive the standard treatment in primary care, with cleansing, debridement and healing in a moist environment together with multilayer compression therapy. The intervention group will also receive a structured educational intervention involving lower limb physical exercise and daily ambulation guidelines. The primary response variables will be complete healing -understood as complete and sustained epithelialisation for at least 2 weeks- and time to healing. The secondary variables will be degree of healing, ulcer area, quality of life, pain and variables related to the healing process, prognosis, and recurrences. Sociodemographic variables, adherence to treatment and satisfaction variables will also be recorded. Data will be collected at baseline, at 3 months and at 6 months follow-up. Survival analysis (Kaplan-Meier and Cox) will be performed to measure primary effectiveness. Intention-to-treat analysis. DISCUSSION If the intervention is effective, a cost-effectiveness analysis could be conducted and implemented as an additional intervention in the usual venous ulcer treatment in primary care. TRIAL REGISTRATION NCT04039789. [ https://ClinicalTrials.gov ]. 07/11/2019.
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Affiliation(s)
- Borja Herraiz-Ahijado
- Sanchinarro Healthcare Center. Primary Care Assistance Management, Madrid Health Service, Calle San Martín de Porres, 6., Madrid, 28035, Spain. .,Research Network on Chronicity, Primary Care and Health Promotion (RICORS-RICAPPS), Instituto de Salud Carlos III, Madrid, Spain. .,Gregorio Marañon Health Research Institute, Madrid Health Service, Madrid, Spain. .,Nursing Department. Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain. .,PhD student. Doctoral Program in "Cuidados en Salud", Universidad Complutense de Madrid, Madrid, Spain.
| | - Carmen Folguera-Álvarez
- Research Network on Chronicity, Primary Care and Health Promotion (RICORS-RICAPPS), Instituto de Salud Carlos III, Madrid, Spain.,Gregorio Marañon Health Research Institute, Madrid Health Service, Madrid, Spain.,Nursing Department. Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain.,La Paz Healthcare Center. Primary Care Assistance Management, Madrid Health Service, Rivas-Vaciamadrid, Spain.,Research Group on Public Health - Lifestyles, nursing methodology and care in the community environment, Universidad Complutense de Madrid, Madrid, Spain
| | - José Verdú-Soriano
- Faculty of Health Sciences. Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Alicante, Spain
| | - Pilar Mori-Vara
- Nursing Department. Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain.,Health Innovation Research Group. Nursing Department. Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - Milagros Rico-Blázquez
- Research Network on Chronicity, Primary Care and Health Promotion (RICORS-RICAPPS), Instituto de Salud Carlos III, Madrid, Spain.,Gregorio Marañon Health Research Institute, Madrid Health Service, Madrid, Spain.,Nursing Department. Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain.,Health Innovation Research Group. Nursing Department. Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain.,Research Unit. Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
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Shi C, Dumville JC, Cullum N, Connaughton E, Norman G. Compression bandages or stockings versus no compression for treating venous leg ulcers. Cochrane Database Syst Rev 2021; 7:CD013397. [PMID: 34308565 PMCID: PMC8407020 DOI: 10.1002/14651858.cd013397.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Leg ulcers are open skin wounds on the lower leg that can last weeks, months or even years. Most leg ulcers are the result of venous diseases. First-line treatment options often include the use of compression bandages or stockings. OBJECTIVES To assess the effects of using compression bandages or stockings, compared with no compression, on the healing of venous leg ulcers in any setting and population. SEARCH METHODS In June 2020 we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions by language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials that compared any types of compression bandages or stockings with no compression in participants with venous leg ulcers in any setting. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed studies using predetermined inclusion criteria. We carried out data extraction, and risk-of-bias assessment using the Cochrane risk-of-bias tool. We assessed the certainty of the evidence according to GRADE methodology. MAIN RESULTS We included 14 studies (1391 participants) in the review. Most studies were small (median study sample size: 51 participants). Participants were recruited from acute-care settings, outpatient settings and community settings, and a large proportion (65.9%; 917/1391) of participants had a confirmed history or clinical evidence of chronic venous disease, a confirmed cause of chronic venous insufficiency, or an ankle pressure/brachial pressure ratio of greater than 0.8 or 0.9. The average age of participants ranged from 58.0 to 76.5 years (median: 70.1 years). The average duration of their leg ulcers ranged from 9.0 weeks to 31.6 months (median: 22.0 months), and a large proportion of participants (64.8%; 901/1391) had ulcers with an area between 5 and 20 cm2. Studies had a median follow-up of 12 weeks. Compression bandages or stockings applied included short-stretch bandage, four-layer compression bandage, and Unna's boot (a type of inelastic gauze bandage impregnated with zinc oxide), and comparator groups used included 'usual care', pharmacological treatment, a variety of dressings, and a variety of treatments where some participants received compression (but it was not the norm). Of the 14 included studies, 10 (71.4%) presented findings which we consider to be at high overall risk of bias. Primary outcomes There is moderate-certainty evidence (downgraded once for risk of bias) (1) that there is probably a shorter time to complete healing of venous leg ulcers in people wearing compression bandages or stockings compared with those not wearing compression (pooled hazard ratio for time-to-complete healing 2.17, 95% confidence interval (CI) 1.52 to 3.10; I2 = 59%; 5 studies, 733 participants); and (2) that people treated using compression bandages or stockings are more likely to experience complete ulcer healing within 12 months compared with people with no compression (10 studies, 1215 participants): risk ratio for complete healing 1.77, 95% CI 1.41 to 2.21; I2 = 65% (8 studies with analysable data, 1120 participants); synthesis without meta-analysis suggests more completely-healed ulcers in compression bandages or stockings than in no compression (2 studies without analysable data, 95 participants). It is uncertain whether there is any difference in rates of adverse events between using compression bandages or stockings and no compression (very low-certainty evidence; 3 studies, 585 participants). Secondary outcomes Moderate-certainty evidence suggests that people using compression bandages or stockings probably have a lower mean pain score than those not using compression (four studies with 859 participants and another study with 69 ulcers): pooled mean difference -1.39, 95% CI -1.79 to -0.98; I2 = 65% (two studies with 426 participants and another study with 69 ulcers having analysable data); synthesis without meta-analysis suggests a reduction in leg ulcer pain in compression bandages or stockings, compared with no compression (two studies without analysable data, 433 participants). Compression bandages or stockings versus no compression may improve disease-specific quality of life, but not all aspects of general health status during the follow-up of 12 weeks to 12 months (four studies with 859 participants; low-certainty evidence). It is uncertain if the use of compression bandages or stockings is more cost-effective than not using them (three studies with 486 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS If using compression bandages or stockings, people with venous leg ulcers probably experience complete wound healing more quickly, and more people have wounds completely healed. The use of compression bandages or stockings probably reduces pain and may improve disease-specific quality of life. There is uncertainty about adverse effects, and cost effectiveness. Future research should focus on comparing alternative bandages and stockings with the primary endpoint of time to complete wound healing alongside adverse events including pain score, and health-related quality of life, and should incorporate cost-effectiveness analysis where possible. Future studies should adhere to international standards of trial conduct and reporting.
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Affiliation(s)
- Chunhu Shi
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Gill Norman
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Prevalence and characteristics of older people with pressure ulcers and legs ulcers, in nursing homes in Barcelona. J Tissue Viability 2021; 30:108-115. [PMID: 33485786 DOI: 10.1016/j.jtv.2021.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nursing home residents are vulnerable to chronic wounds. However, the prevalence data are scarce. AIM The purpose of this study was to determine the prevalence of pressure ulcers and/or leg ulcers in nursing home residents, and describe the characteristics of the nursing homes, the residents and the wounds, as well as possible associations between these characteristics. METHODS This was a cross-sectional survey of nursing home residents over the age of 65 in 168 facilities in Barcelona. Those presenting category II-IV pressure ulcers and/or leg ulcers were included. The data were collected by observation/examination. Descriptive, bivariate, and multivariate analyses were performed. RESULTS The overall prevalence of pressure ulcers and leg ulcers combined was 4.4% (3.5% were pressure ulcers and 0.9% were leg ulcers). In small nursing homes with less nursing staff, the overall prevalence was greater than in large nursing homes (5.6% vs 3.8% [p = 0.01]). As expected, residents with pressure ulcers had higher pressure ulcer risk, worse dependence and cognitive status, urinary and faecal incontinence, and most were underweight. However, residents with leg ulcers had worse venous and arterial impairment and also were overweight. A multivariate analysis showed that pressure ulcers were statistically significantly associated with faecal incontinence (OR = 0.28, 95% CI = 0.09-0.81) and dyslipidaemia (OR = 0.21, 95% CI = 0.06-0.66), and leg ulcers were statistically significantly associated with venous insufficiency (OR = 4.93, 95% CI = 1.65-15.34). The characteristics of gluteal and ischial pressure ulcers, a high prevalence of infection, and a low reference to biofilm by nurses, in both types of wounds, suggest that these aspects are not adequately taken into account. CONCLUSIONS Pressure ulcers and leg ulcers, mainly pressure ulcers, remain a public health problem in nursing homes. Further studies are required to confirm the associations found in this study.
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Folguera-Álvarez C, Garrido-Elustondo S, Rico-Blázquez MM, Esparza-Garrido MI, Verdú-Soriano J. [Effectiveness of double-layered compression therapy against crepe bandage for healing venous ulcers in primary care. Randomized clinical trial]. Aten Primaria 2020; 52:712-721. [PMID: 32278578 PMCID: PMC8054279 DOI: 10.1016/j.aprim.2020.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/19/2020] [Accepted: 01/22/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate if the two-layer bandage is more effective than the crepe bandage in the healing of venous ulcers after 12 weeks of follow-up. DESIGN Randomized multicentre controlled clinical trial. LOCATION 22 Primary Health Centers of Madrid. PARTICIPANTS Over 18 years old, with diagnosis of venous ulcers. 93 patients were randomized, 56 in the double layer group and 37 in the crepe group. Withdrawals: 16 in double layer group, 7 in crepe group. INTERVENTIONS Control group: usual clinical practice: treatment of the wound and bandage with crepe. Experimental group: same usual clinical practice for wound treatment and bandage with double layer. MAIN MEASUREMENTS Primary outcome: complete healing at 12 weeks. SECONDARY OUTCOMES severity of ulceration, health-related quality of life, adverse events. Blind evaluation of the response variable. RESULTS Complete healing: in crepe group, 25, 67.5% (95% CI 50.2-81.9) and in double layer group, 32, 57.1% (95% CI 43.2-70.3). No evidence of a difference in both groups, RR=1.10 (95% CI 0.864-1.424). The basal severity of the ulcers is associated with the healing time. HR=0.86 (95% CI 0.78-0.94). Our data showed a significant improvement in health-related quality of life, total and in the of cosmesis and emotional dimensions. No evidence of a difference in both groups. We didn't find serious adverse events in any of the groups. CONCLUSIONS We didn't find significant differences in the healing between the two bandages evaluated. Both are appropriate for ulcer healing and to improve the health-related quality of life.
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Affiliation(s)
- Carmen Folguera-Álvarez
- Centro de Salud La Paz, Gerencia Asistencial de Atención Primaria de Madrid, Madrid, España; Facultad de Enfermería, Universidad Complutense, Madrid, España.
| | - Sofía Garrido-Elustondo
- REDISECC: Red de Investigación en Servicios de Salud en Enfermedades Crónicas; Unidad Docente Multiprofesional Sureste, Gerencia Asistencial de Atención Primaria de Madrid, Madrid, España
| | - Mili Milagros Rico-Blázquez
- REDISECC: Red de Investigación en Servicios de Salud en Enfermedades Crónicas; Unidad de Investigación, Gerencia Asistencial de Atención Primaria de Madrid, Madrid, España; Facultad de Enfermería, Universidad Complutense, Madrid, España
| | | | - José Verdú-Soriano
- Departamento de Enfermería Comunitaria, Medicina Preventiva, Salud Pública e Historia de la Ciencia, Facultad de Ciencias de la Salud, Universidad de Alicante, San Vicente del Raspeig, Alicante, España
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Folguera-Álvarez C, Garrido-Elustondo S, Rico-Blázquez M, Verdú-Soriano J. Factors Associated With the Quality of Life of Patients With Venous Leg Ulcers in Primary Care: Cross-Sectional Study. INT J LOW EXTR WOUND 2020; 21:521-528. [PMID: 33103540 DOI: 10.1177/1534734620967562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The presence of venous leg ulcers (VLU) is associated with emotional disorders in individuals who have conditions, such as depression, anxiety, and sleeping problems, which result in a reduced perceived quality of life by these individuals. The study aim was to describe the perceived quality of life and associated factors for individuals with VLU. We conducted a cross-sectional study in 22 primary care health centers with a sample of 93 individuals with VLU. The variables collected were the following: perceived quality of life measured with Spanish version of the Charing Cross Venous Ulcer Questionnaire (CCVUQ-e), ulcer severity measured with the RESVECH 2.0 Score, demographic variables, and those related to the healing process. The results showed a mean CCVUQ-e score of 47.4 ± 11.8 points (Mean ± SD), with the most affected dimension being the emotional status, followed by cosmesis, social interaction, and domestic activities. The mean RESVECH 2.0 score was 11.1 ± 3.7 points. An association was found between ulcer-related pain and poorer quality of life (P < .05, t test) and between erythema in perilesional skin and poorer quality life (P < .05, t test). The signs of infection and inflammation in the VLUs were as follows: increasing exudate, friable tissue, and biofilm-compatible tissue, which were associated with a poorer quality of life (P < .05, t test). The multivariate model was statistically significant and explained a variability of 26% in the CCVUQ-e score. This study confirms that wound severity, pain, and signs of infection in VLU decrease the perceived quality of life of individuals with these wounds.
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Affiliation(s)
- Carmen Folguera-Álvarez
- La Paz Healthcare Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Sofia Garrido-Elustondo
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain.,Research Unit. Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Milagros Rico-Blázquez
- Universidad Complutense de Madrid, Madrid, Spain.,Research Unit. Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
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Domingues EAR, Kaizer UAO, Lima MHM. Effectiveness of the strategies of an orientation programme for the lifestyle and wound-healing process in patients with venous ulcer: A randomised controlled trial. Int Wound J 2018; 15:798-806. [PMID: 29808613 PMCID: PMC7949876 DOI: 10.1111/iwj.12930] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 03/19/2018] [Indexed: 11/30/2022] Open
Abstract
This study aimed to evaluate the effect of strategies of a lifestyle orientation programme on patients with venous ulcer in elastic compression therapy. This was a single-blind, 2-arm, randomised clinical controlled trial. The primary outcome included the reduction of the wound surface area. The secondary outcomes included the perception of pain, questionnaire of ulcer status, and quality of life. Seventy-one patients with ulcers of venous aetiology were randomised into 2 arms: control group (CG) and intervention group (IG), with a 12-week follow up. The CG was provided with the routine guidelines of the health services. Meanwhile, the IG was provided with lifestyle guidelines regarding the physiopathology of a venous ulcer, importance of compression therapy, physical exercises and rest in 4 face-to-face and 2 telephone interviews. The IG had significant improvement on the wound healing on 30, 60, and 90 days of follow up when compared with the CG (P = .0197; P = .0472; P = .0116). There were no statistical differences between groups; both had improvement in the quality of life and pain perception. Our results demonstrated that elastic compression therapy along with guidelines on lifestyle is effective adjunctive treatment to promote wound healing in patients with leg ulcers.
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Tidhar D, Keren E, Brandin G, Yogev M, Armer J. Effectiveness of compression bandaging education for wound care nurses. J Wound Care 2017; 26:625-631. [DOI: 10.12968/jowc.2017.26.11.625] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- D. Tidhar
- Department of Physical Therapy, Maccabi Healthcare Services, Netivot, Israel
| | - E. Keren
- Department of Hard to Heal Wound Clinic, Maccabi Healthcare Services, Beer Sheva, Israel
| | - G. Brandin
- Department of Hard to Heal Wound Clinic, Maccabi Healthcare Services, Beer Sheva, Israel
| | - M. Yogev
- Department of Physical Therapy, Maccabi Healthcare Services, Beer Sheva & Arad, Israel
| | - J.M. Armer
- Sinclair School of Nursing, University of Missouri-Columbia, US
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