Systematic review and meta-analysis of exercise therapy for venous leg ulcer healing and recurrence

Turner, Benedict R H; Jasionowska, Sara; Machin, Matthew; Javed, Azfar; Gwozdz, Adam; Shalhoub, Joseph; Onida, Sarah; Davies, Alun H.

doi:10.1016/j.jvsv.2022.09.003

Cited by 4 publications

(5 citation statements)

References 37 publications

(128 reference statements)

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“…The remaining articles underwent a meticulous full‐text review, resulting in the further exclusion of 124 studies. Ultimately, a mere 4 studies 24 , 25 , 26 , 27 satisfied our stringent inclusion criteria. The process of literature selection is delineated in a flow chart presented in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…A compilation of eight studies, including four systematic reviews/meta‐analyses, 24 , 25 , 26 , 27 has provided elucidation of the outcomes relevant to ulcer healing. Exercise has demonstrated efficacy in augmenting rates of ulcer healing, as evidenced by the pooled risk difference (RD) of 0.17 (95% CI: 0.06–0.28; p = 0.003) (refer to Figure 2 ).…”

Section: Resultsmentioning

confidence: 99%

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Effects of exercise in treating patients with venous leg ulcers: An umbrella review

Shen,

Xing,

Jiang

et al. 2024

International Wound Journal

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Venous leg ulcers (VLUs) represent a substantial challenge within the healthcare landscape, thereby necessitating efficacious therapeutic strategies. Exercise has been investigated as a prospective intervention to bolster the management of VLUs. The objective of this comprehensive review is to systematically scrutinize and appraise the extant body of evidence pertaining to the impact of exercise on the treatment of patients diagnosed with VLUs. A comprehensive literature search was executed across multiple databases, encompassing PubMed, the Cochrane Library, Web of Science, Embase, and Google Scholar. The methodological rigour was evaluated utilizing the Assessment of Multiple Systematic Reviews 2 (AMSTAR‐2) instrument, while the quality of the evidence was appraised via the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system. The relative efficacy of exercise interventions on outcomes related to VLUs, including rates of wound healing, total range of motion in the ankle joint, and adherence rates, was synthesized. Data were consolidated employing fixed‐effects models, and the impact of exercise on these outcomes was visually represented through the use of forest plots. The methodological foundation of this investigation comprised four systematic reviews and meta‐analyses, each characterized by an intermediate level of methodological rigour and evidence quality. Subsequent analyses revealed that exercise interventions exert a multifaceted and favourable impact on the therapeutic landscape of VLUs. These interventions distinctly contribute to the enhancement of wound healing rates (risk difference 0.17, 95% confidence interval [CI]: 0.06–0.28) and the extension of ankle range of motion (mean difference [MD] 6.10, 95% CI: 4.61–7.59). Furthermore, Pooled adherence rate was 0.70 (95% CI: 0.20–2.45) with no significant heterogeneity. In conclusion, although existing evidence supports the positive impact of exercise training on VLUs, higher‐quality research is still needed to deepen our understanding of its effects and provide more specific guidance for clinical practice.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Effects of exercise in treating patients with venous leg ulcers: An umbrella review

Shen,

Xing,

Jiang

et al. 2024

International Wound Journal

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“…Considering the outcomes according to the analysis of reviews, compression is more effective than no compression. Nevertheless, there is low-quality evidence between the different compression methods to speculate the superiority of one method over another [13][14][15][16][17]. A prospective, randomized, comparative study shows that intermittent pneumatic compression systems, stockings, and multi-layer bandaging are very useful and effective in treating venous leg ulcers.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical effect of these bandages might differ or depend on the practitioner's experience or skill in achieving the correct amount of pressure. Therefore, meta-analysis or review articles on this issue may not reflect the real-world experience [13][14][15]. The four-layer bandaging system provides very effective results in ulcer healing.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis on the effect of compression therapy reported that there was no significant difference in the distribution of payment rates among different compression methods [13][14][15][16][17]. O'Meara et al found out in another meta-analysis that the fourlayer bandage system seems to be much more effective than shortstretch bandaging regarding the healing period.…”

Section: Discussionmentioning

confidence: 99%

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The management of venous leg ulcers: Effects of four-layer bandage system

Ulusoy,

Iscan

2023

Turk J Vasc Surg

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Aim: Chronic Venous Ulcer (CVU) accounts for nearly 70% of all chronic leg ulcers (CLU), seriously impacting the quality of life and creating a heavy economic burden. Here, we present CVU therapy with a four-layer bandage system in 113 patients retrospectively treated by the General Surgery Chronic Wound Unit and Cardiovascular Surgery Department. Material and Methods: From January 2022 to January 2023, 113 patients with CVU were evaluated retrospectively. All patients were documented by color Doppler ultrasonography (CDUS), ulcer size, and demographics. If there were multiple ulcers, the largest one was assessed. Immobile patients and patients with an Ankle Brachial Index (ABI) of <0.7 were excluded. Debridement, exercise, venoactive drugs, and a four-layer bandage system were performed for all patients. The primary outcome was to assess the ulcer healing, and the secondary outcome was to obtain the recurrence rate and the treatment compatibility of patients. Results: The mean age of the patients was 60.73±11.3 (28-91) years and 77.9% were male. Body Mass Index (BMI) was 30.4±7.7 kg/m2 (min:18-max:51 kg/m2). The mean follow-up period was 18.82±13.4 weeks. Pseudomonas aeruginosa (38%) and Staphylococcus aureus (31.8%) were the most identified microorganisms. Four patients experienced recurrence of the CVU (3.5%). The older patients had larger ulcers than the younger patients. Female patients had larger-sized ulcers (p=0.001). Completely healed ulcers were 26.5% of the total. The four-layer compression bandage was applied 12 times for per patient. The mean healing period was 23.2±13.8 weeks. The mean healing rate was 4.17±3.78% for a week. The multivariant analysis revealed that age and pain had negatively affected the ulcer healing. Conclusion: The management of CVU is challenging and needs a multidisciplinary approach. Compression is the main goal of the treatment. Surgical or endovenous therapies may be beneficial for decreasing ulcer recurrence. For patients with slow ulcer healing, adjuvant treatment modalities such as patient education, smoking cessation, diet and lifestyle modification, and exercise should be recommended.

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Testing the feasibility of a co-designed intervention, comprising self-managed, home-based, exercise training with embedded behavioural support and compression therapy for people with venous leg ulcers receiving treatment at home (FISCU-II)

Klonizakis,

Gumber,

McIntosh

et al. 2023

Clinical and Experimental Dermatology

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Background Venous leg ulcers heal slowly, are painful and costly for healthcare systems, and also affect patients’ quality of life. Previous work suggests that supervised exercise training used in combination with compression therapy may offer clinical benefits. However there is a large population of people with VLUs, who are unable to access such an intervention due to frailty and age. Objective Our primary aim was to assess the feasibility of FISCU Home (a co-designed, 12-week home-based, self-managed, lifestyle programme based on exercise and behaviour support), as an adjunct therapy to compression in people with VLUs. Methods Forty people with VLUs (121 excluded/22 refused), receiving treatment at home, were recruited from community nursing and tissue viability teams and newspaper advertisement. Participants were randomized 1:1 either to exercise with behaviour support (thrice/week) plus compression therapy or compression only. The feasibility of the programme was assessed using progression criteria that included exercise attendance rate, loss to follow-up, patient preference(s) and adverse events. Baseline assessments were repeated at 12 weeks and 6 months. Secondary outcomes (i.e., ulcer recurrence, healing rate and healing time) were also documented at these intervals. Intervention and healthcare utilization costs were calculated. Results Recruitment rate was 65%, while 75% of the exercise group participants attended all scheduled exercise sessions. All participants completed their compression therapy. No serious adverse or exercise-related adverse events were reported. Median ulcer healing time was shorter in the exercise group (29 (7-108) vs 42 (6-116) weeks). Conclusions The feasibility and acceptability of both a home-based, exercise-based, lifestyle intervention in conjunction with compression therapy, and the study procedures are supported.

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Systematic review and meta-analysis of exercise therapy for venous leg ulcer healing and recurrence

Cited by 4 publications

References 37 publications

Effects of exercise in treating patients with venous leg ulcers: An umbrella review

Effects of exercise in treating patients with venous leg ulcers: An umbrella review

The management of venous leg ulcers: Effects of four-layer bandage system

Testing the feasibility of a co-designed intervention, comprising self-managed, home-based, exercise training with embedded behavioural support and compression therapy for people with venous leg ulcers receiving treatment at home (FISCU-II)

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