Venous leg ulcer management in Australian primary care: Patient and clinician perspectives

Weller, Carolina; Richards, Catelyn; Turnour, Louise; Team, Victoria

doi:10.1016/j.ijnurstu.2020.103774

Cited by 21 publications

(15 citation statements)

References 36 publications

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“…In some instances, participants did not get any health information on VLU management at all. This most certainly appears to be a missed opportunity for clinicians to build patients’ agency and provide an opportunity for shared decision making ( Weller et al, 2021 ). Previous studies have examined the relationship between the delivery of health information, the development of greater patient health literacy and improved adherence to health-promoting behaviors ( Miller et al, 2014 ).…”

Section: Discussionmentioning

confidence: 99%

Patient Explanation of Adherence and Non-Adherence to Venous Leg Ulcer Treatment: A Qualitative Study

et al. 2021

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The aim of this study was to understand which factors influence patients’ adherence to venous leg ulcer treatment recommendations in primary care. We adopted a qualitative study design, conducting phone interviews with 31 people with venous leg ulcers in Melbourne, Australia. We conducted 31 semi-structured phone interviews between October and December 2019 with patients with clinically diagnosed venous leg ulcers. Participants recruited to the Aspirin in Venous Leg Ulcer Randomized Control Trial and Cohort study were invited to participate in a qualitative study, which was nested under this trial. We applied the Theoretical Domains Framework to guide the data analysis. The following factors influenced patients’ adherence to venous leg ulcer treatment: understanding the management plan and rationale behind treatment (Knowledge Domain); compression-related body image issues (Social Influences); understanding consequences of not wearing compression (Beliefs about Consequences); feeling overwhelmed because it’s not getting better (Emotions); hot weather and discomfort when wearing compression (Environmental Context and Resources); cost of compression (Environmental Context and Resources); ability to wear compression (Beliefs about Capabilities); patience and persistence (Behavioral Regulation); and remembering self-care instructions (Memory, Attention and Decision Making). The Theoretical Domains Framework was useful for identifying factors that influence patients’ adherence to treatment recommendations for venous leg ulcers management. These factors may inform development of novel interventions to optimize shared decision making and self-care to improve healing outcomes. The findings from this article will be relevant to clinicians involved in management of patients with venous leg ulcers, as their support is crucial to patients’ treatment adherence. Consultation with patients about VLU treatment adherence is an opportunity for clinical practice to be targeted and collaborative. This process may inform guideline development.

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Section: Discussionmentioning

confidence: 99%

Patient Explanation of Adherence and Non-Adherence to Venous Leg Ulcer Treatment: A Qualitative Study

et al. 2021

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“…The recurrence rate in the first three months post healing has been reported at 36%, 12 and more than one in four patients experience multiple episodes of recurrent ulceration and recurrence in their lifetime 13 . VLUs cause physical pain, discomfort and mobility issues 14,15 . Repeated cycles of VLU healing and recurrence cause emotional distress and lead to poor quality of life (QoL) 16,17 .…”

Section: Introductionmentioning

confidence: 99%

“…13 VLUs cause physical pain, discomfort and mobility issues. 14,15 Repeated cycles of VLU healing and recurrence cause emotional distress and lead to poor quality of life (QoL). 16,17 Adjunct physical activity (PA) treatments, such as exercise, may improve healing rates and reduce VLU recurrence when used in conjunction with compression therapy.…”

Section: Introductionmentioning

confidence: 99%

Effects of physical activity as an adjunct treatment on healing outcomes and recurrence of venous leg ulcers: A scoping review

Qiu

Osadnik

Team

et al. 2022

Wound Repair Regeneration

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Healing time is protracted and ulcer recurrence is common in patients with venous leg ulcers. Although compression is the mainstay treatment, many patients do not heal timely. Physical activity may be a clinically effective adjunct treatment to compression to improve healing outcomes. This scoping review provides a broad overview of the effect of physical activity as an adjunct treatment to compression on wound healing and recurrence. We followed the six‐step framework developed by Arksey and O'Malley. We searched electronic databases and trial registration websites for relevant studies and ongoing trials. Two authors independently screened and selected articles. Findings were presented in a descriptive statistical narrative summary. We consulted and presented our findings to the wound consumer group to ensure the relevance of our study. Physical activity interventions in 12 out of the 16 eligible studies consisted of only one component, eight studies were resistance exercises, three studies reported ankle and/or foot range of motion exercises, and one study reported aerobic/walking exercises. The remaining four studies involved multicomponent exercise interventions. Resistance exercise combined with ankle and/or foot range of motion exercise minimised ulcer size on day 12 (intervention group: 4.55 ± 1.14 cm2 vs. control group: 7.43 ± 0.56 cm2) and improved calf muscle pump performance on day 8 (ejection fraction: 40%–65%; residual volume fraction: 56%–40%). We identified one study that reported ulcer recurrence rate with no clinical difference in the intervention group versus the control group (i.e., 12% in intervention vs. 5% in control). Our review identified that resistance exercise was the most common type of physical activity intervention trialled in the published literature. Resistance exercise combined with ankle and/or foot range of motion exercise appears to be effective adjunct treatments; however, the overall evidence is still relatively weak as most programmes had a short intervention period which limited clinical outcomes.

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“…Venous leg ulcers (VLUs) are the most common chronic lower limb wounds, 1 which accounts for almost 80% of all lower‐extremity wounds found in the community 2 . VLUs are caused by venous hypertension that result from chronic venous insufficiency and impaired calf muscle 3 .…”

Section: Introductionmentioning

confidence: 99%

Investigating quality of life instrument measurement properties for adults with active venous leg ulcers: A systematic review

Liu

Team

Qiu

et al. 2022

Wound Repair Regeneration

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The primary objective of this systematic review was to identify which quality of life instruments have been applied in published studies of patients with active venous leg ulcers. Our secondary objective was to map the measurement properties of each identified quality of life instrument and to inform future recommendations for clinical practice and research. We searched CINAHL, Ovid Medline, Ovid Emcare and ProQuest to identify studies published from 1 January 2000 to 31 July 2021. Eleven studies that utilised quality of life instruments in adults with active venous leg ulcers met the inclusion criteria. Thirteen quality of life instruments were identified as some studies utilised both generic and condition-specific quality of life instruments. Six out of nine (6/9) instruments were rated 'very good' of methodological quality on internal consistency; 1/7 studies rated 'adequate' on reliability; 2/4 rated 'adequate' on content validity; 3/6 studies rated 'adequate' on structural validity; 5/6 rated 'adequate' on hypotheses testing for construct and 2/6 studies rated 'adequate' on responsiveness. There is limited evidence of measurement properties of quality of life instruments for people with active venous leg ulcers. The Venous Leg Ulcer Quality of Life Questionnaire (VLU-QoL) could be provisionally recommended for use although from our review it is clear further studies to assess VLU-QoL measurement properties are needed to inform future recommendations for clinical practice and research.

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Venous leg ulcer management in Australian primary care: Patient and clinician perspectives

Cited by 21 publications

References 36 publications

Patient Explanation of Adherence and Non-Adherence to Venous Leg Ulcer Treatment: A Qualitative Study

Patient Explanation of Adherence and Non-Adherence to Venous Leg Ulcer Treatment: A Qualitative Study

Effects of physical activity as an adjunct treatment on healing outcomes and recurrence of venous leg ulcers: A scoping review

Investigating quality of life instrument measurement properties for adults with active venous leg ulcers: A systematic review

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