Randomized study assessing the influence of supervised exercises on ankle joint mobility in patients with venous leg ulcerations

Abstract

IntroductionThe aim of the study was to assess the influence of a supervised programme of exercises on ankle joint mobility in patients with venous leg ulcerations.Material and methodsThe study was carried out between 2008 and 2009 at the Venous Ulcer Treatment Outpatient Clinic and Clinic of General and Vascular Surgery of the Dr Jan Biziel University Hospital no. 2 in Bydgoszcz. It was a randomized control study in which 32 patients with venous leg ulcerations were qualified. Patients with ulcerations were randomized to 2 groups – 16 patients were included in the group with a supervised programme of exercises and the other 16 patients were included in the control group performing physical exercises by themselves, without supervision. The ranges of ankle joint mobility were assessed before, during and after the end of the 9-week exercise programme. A 32 cm goniometer with a scale from 0° to 180° with accuracy to 1° was used for measurements.ResultsIn both groups a substantial increase of ankle joint mobility (p < 0.05) was observed. The total ankle joint mobility after completion of the exercises was significantly higher in the group performing exercises under the supervision of a nurse. Having a significant effect on the mobility of the ankle were the ulceration area, the extent of lipodermatosclerosis, and the intensity of symptoms and signs of CVI (p < 0.05).ConclusionsSupervised physical exercises broaden the range of ankle joint mobility. They should constitute an integral part of a holistic model of care for patients with venous leg ulcerations.

What is the effect of exercise on wound healing in patients with venous leg ulcers? A systematic review

“…Details of each of the included studies are summarised in Table . Settings were diverse, including outpatient clinics, university hospitals, and patient homes (Table ). Primary outcomes differed among the studies, although all studies reported wound characteristics (time to heal, proportion of ulcers healed, and ulcer recurrence).…”

“…Three studies described adequate methods of allocation sequence and concealment and were at low risk of selection bias (Figure ). The remainder ( n = 3) reported these methods unclearly and were at risk of selection bias. All studies were at risk of performance bias, with none of the studies reporting adequate participant blinding.…”

“…Studies that included self‐reported outcomes (pain, quality of life, and adverse events) were at risk of detection bias in the measurement of these outcomes and 1 study did not clearly report their losses to follow up . We judged 4 studies at low risk of selective reporting bias as they reported primary outcomes fully.…”

“…Attrition bias was unlikely in the majority of the studies due to few participant losses to follow up ( n = 5), and 1 study did not clearly report their losses to follow up . We judged 4 studies at low risk of selective reporting bias as they reported primary outcomes fully. However, 2 studies selectively reported outcomes; they measured risk in 1 study ( n = 1) and high risk in 1 study ( n = 1) …”

Prevention of recurrent venous ulceration

“…Chronic venous insufficiency and ulceration, as well as post-treatment cicatrix can be associated with ankle joint abnormalities -its reduced mobility affecting plantar and dorsal flexure of the foot and associated deficiency of muscle-articular pump, a mechanism that stimulates the venous return together with the vascular-valvular system regulating the value of hydrostatic pressure [19,20].…”