The effect of ankle range of motion on venous ulcer healing rates

Yim, Elizabeth; Richmond, Nicholas A.; Baquerizo, Katherine; Driessche, Freya Van; Slade, Herbert B.; Pieper, Barbara; Kirsner, Robert S.

doi:10.1111/wrr.12186

Cited by 19 publications

(7 citation statements)

References 19 publications

(46 reference statements)

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“…However, a group effect was noted for those who adhered to the exercise protocol, highlighting an important finding that the intervention is effective is improving ROAM as a self-management program. However, a recent study has suggested that ankle range of motion is not important in VLU healing or, more likely, is overcome by compression (35). Further research is warranted.…”

Section: Discussionmentioning

confidence: 98%

Evaluating the effectiveness of a self‐management exercise intervention on wound healing, functional ability and health‐related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial

O’Brien

Finlayson

Kerr

et al. 2016

International Wound Journal

182

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Exercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. The objectives of this research were to assess the impact of an exercise intervention in addition to routine evidence-based care on the healing rates, functional ability and health-related quality of life for adults with venous leg ulcers (VLUs). This study included 63 patients with VLUs. Patients were randomised to receive either a 12-week exercise intervention with a telephone coaching component or usual care plus telephone calls at the same timepoints. The primary outcome evaluated the effectiveness of the intervention in relation to wound healing. The secondary outcomes evaluated physical activity, functional ability and health-related quality of life measures between groups at the end of the 12 weeks. A per protocol analysis complemented the effectiveness (intention-to-treat) analysis to highlight the importance of adherence to an exercise intervention. Intention-to-treat analyses for the primary outcome showed 77% of those in the intervention group healed by 12 weeks compared to 53% of those in the usual care group. Although this difference was not statistically significant due to a smaller than expected sample size, a 24% difference in healing rates could be considered clinically significant. The per protocol analysis for wound healing, however, showed that those in the intervention group who adhered to the exercise protocol 75% or more of the time were significantly more likely to heal and showed higher rates for wound healing than the control group (P = 0·01), that is, 95% of those who adhered in the intervention group healed in 12 weeks. The secondary outcomes of physical activity, functional ability and health-related quality of life were not significantly altered by the intervention. Among the secondary outcomes (physical activity, functional ability and health-related quality of life), intention-to-treat analyses did not support the effectiveness of the intervention. However, per protocol analyses revealed encouraging results with those participants who adhered more than 75% of the time (n = 19) showing significantly improved Range of Ankle Motion from the self-management exercise programme (P = 0·045). This study has shown that those participants who adhere to the exercise programme as an adjunctive treatment to standard care are more likely to heal and have better functional outcomes than those who do not adhere to the exercises in conjunction with usual care.

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Section: Discussionmentioning

confidence: 98%

Evaluating the effectiveness of a self‐management exercise intervention on wound healing, functional ability and health‐related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial

O’Brien

Finlayson

Kerr

et al. 2016

International Wound Journal

182

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“…Chronic venous insufficiency (CVI) is caused by calf‐muscle pump failure, which propels venous blood flow, coupled with abnormal retrograde flow or reflux . Most commonly, dilated veins or incompetent valves are at fault.…”

Section: Venous Leg Ulcersmentioning

confidence: 99%

Lower‐extremity ulcers: diagnosis and management

2015

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Chronic wounds of the lower extremities are occurring with increasing prevalence. They affect millions of individuals annually, representing both a significant health risk and a large economic burden. Chronic wounds are associated with increased mortality and substantial morbidity due to infection, pain, limitation of daily activities, and psychosocial consequences. To manage these wounds effectively, clinicians must be able to diagnose and manage their aetiology. Diagnosis starts with determining whether the wound is one of the four most common chronic wounds: venous leg ulcers, diabetic foot ulcers, pressure ulcers and arterial ulcers. Moreover, despite many recent advances in wound care, the challenge of managing chronic wounds is complicated by the lack of consistently accepted diagnostic methods and wound-care standards. We present a comprehensive yet condensed approach to managing lower-extremity ulcers, from diagnosis to basic management.

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“…Specifically, passive ankle motion was performed [14], with the fixed arm of the goniometer located on the leg axis, aligning the movable arm with the foot axis. We performed all procedures in an office setting by trained physical therapists.…”

Section: Interventionsmentioning

confidence: 99%

“…This failure can, however, be prevented by an improvement in calf muscle pump function achieved through physical exercise [12]. Furthermore, ankle range of motion is an important component in the activation of the calf muscle pump [13], based on a previously reported relationship between venous ulcer healing and the improvement of ankle range of motion for plantar flexion and inversion [14]. Also, we observed that ankle joint range of the movement might also be affected by lymphatic drainage of ulcerated limbs, although this can be reversed through lymphatic drainage [15].…”

Section: Introductionmentioning

confidence: 99%