The Clinical Effectiveness of Two Compression Stocking Treatments on Venous Leg Ulcer Recurrence

Abstract

Venous leg ulcers affect up to 3% of people aged 65 years and older, present significant pain and suffering, and are associated with long episodes of health care. These chronic wounds recur at rates of up to 69%. A double blind randomized controlled trial was conducted in a home nursing setting in Victoria, Australia to compare the effectiveness of a 23 to 32 mm Hg (moderate) and a 34 to 46 mm Hg (high) compression stocking treatment on venous ulcer recurrence. Participants (n = 100) were monitored for 26 weeks. Study wound recurrence was low (11.8%), and the average time to recurrence was 77.91 days. Adherence to treatment was low (44%) with nonadherence significantly higher in the high-compression stocking group, χ(2)(1) = 8.827, P = .003. Regression modeling found that adherence to treatment significantly predicted study wound recurrence, Wald(1) = 7.917, P = .005. Estimated hazard ratios showed that participants who did not adhere were 9 times more likely to have their wound recur. Risk of recurrence was 3 times greater for those randomized to moderate compression when compared with the high-compression stocking. Implementing strategies that optimize adherence to compression will reduce ulcer recurrence. Once this has been realized, the potential to adhere to high-compression treatment would further reduce the risk of recurrence.

Chronic wounds in Australia: A systematic review of key epidemiological and clinical parameters

“…In most studies, recurrence was defined as a new ulcer developing after the patient healed and could be on the other leg or in another location. Some measured the number of people with a current VLU who reported a previous VLU; this ranged from “half”, assumed to be 50.0%, to 81.7% . Other studies measured recurrence after healing within 5 weeks: 23.1%; at 3 months, ranging from 5.6% to 36.0%; at 6 months: 73.5%; and at 12 months, ranging from 16.7% to 20.0% .…”

“…Other studies measured recurrence after healing within 5 weeks: 23.1%; at 3 months, ranging from 5.6% to 36.0%; at 6 months: 73.5%; and at 12 months, ranging from 16.7% to 20.0% . Other studies reported a median time to recurrence ranging from 11.1 to 63.0 weeks …”

“…Similarly, recurrence may have been measured as recurrence of a known wound or history of previous chronic wound(s) of the same aetiology as the current wound. Non‐standardised definitions also resulted in variability in outcomes between studies—for example, the two studies reporting on rates of infection in VLUs, which included comparable cohorts and involved similar research methods, reported highly discrepant rates of infection: 5.9% and 58.1% . Different definitions precluded a meta‐analysis and resulted in difficulties reporting results in meaningful ways.…”

The experience of self‐management following venous leg ulcer healing

“…, Kapp et al . ). Other actions include exercise and leg elevation (Flaherty ), use of moisturisers (Finlayson et al .…”

Prevenção de recidiva de úlcera varicosa: um estudo de coorte

“…This data is similar to other authors' findings, who obtained an annual prevalence of varicose ulcer corresponding to 1.69% among the elderly. This health problem is considered significant for these people (15,16) and for the health sector, considering that the life expectancy is rising and that, in the next 40 years, the number of elderly people is expected to double. (17) Although no association was found between the instruction level and relapse or the emergence of a new ulcer, patients with a lower level of instruction (illiterate and functional illiterate) were predominant in terms of relapse and the development of a new injury, while patients with secondary and higher education did not present such events.…”