Factors associated with recurrence of venous leg ulcers: a survey and retrospective chart review

Abstract

Background: Chronic venous leg ulcers have a significant impact on older individuals' well-being and health care resources. Unfortunately after healing, up to 70% recur.

Objective: To examine the relationships between leg ulcer recurrence and physical activity, compression, nutrition, health, psychosocial indicators and self-care activities in order to provide information for preventive strategies.

Design: Survey and retrospective chart review.

Settings: Two metropolitan hospital and three community-based leg ulcer clinics.

Subjects: A sample of 122 community living patients with leg ulcer of venous aetiology which had healed between 12 and 36 months prior to the survey.

Methods: Data were collected from medical records on demographics, medical history and previous ulcer history and treatments; and from self-report questionnaires on physical activity, nutrition, psychosocial measures, ulcer recurrences and history, compression and other self-care activities. All variables clinically or statistically significantly associated with recurrence at the bivariate level were entered into a logistic regression model to determine their independent influences on recurrence.

Results: Median follow-up time was 24 months (range 12-40 months). Sixty-eight percent of participants had recurred. Bivariate analysis found recurrence was positively associated with ulcer duration, cardiac disease, a body mass index< or =20, scoring as at risk of malnutrition and depression; and negatively associated with increased physical activity, leg elevation, wearing Class 2 (20-25 mmHg) or Class 3 (30-40 mmHg) compression hosiery, and higher self-efficacy scores. After adjusting for all variables, an h/day of leg elevation (OR=0.04, 95% CI=0.01-0.17), days/week in Class 2 or 3 compression hosiery (OR=0.53, 95% CI=0.34-0.81), Yale Physical Activity Survey score (OR=0.95, 95% CI=0.92-0.98), cardiac disease (OR=5.03, 95% CI=1.01-24.93) and General Self-efficacy scores (OR=0.83, 95% CI=0.72-0.94) remained significantly associated (p<0.05) with recurrence.

Conclusions: Results indicate a history of cardiac disease is a risk factor for recurrence; while leg elevation, physical activity, compression hosiery and strategies to improve self-efficacy are likely to prevent recurrence.