- Original Article
- Open access
- Published:
Value of combined exercise and ultrasound as an adjunct to compression therapy in chronic venous leg ulcers
Egyptian Rheumatology and Rehabilitation volume 44, pages 77–82 (2017)
Abstract
Introduction
Chronic venous leg ulcers are very difficult to treat and take very long time to heal. Compression therapy remains the mainstay of venous ulcer conservative treatment.
Aim
The aim of this study was to evaluate the effectiveness of combined therapeutic exercises and ultrasound as an adjunct to compression therapy for the treatment of chronic venous leg ulcers.
Settings and design
This study is a prospective randomized case-controlled one.
Patients and methods
Seventy-two patients with chronic venous leg ulcers were recruited from outpatient clinics. Weallocated patients to four groups of 15 patients each. Group I was treated with therapeutic exercise program in addition to compression therapy. Group II was treated with underwater ultrasound and compression therapy. Group III was treated with therapeutic exercises as in group I and underwater ultrasound as in group II, in addition to compression therapy. Group IV was treated with compression therapy. The duration of follow-up was 12 weeks. Treatment outcome was assessed using the visual analogue scale for pain, ulcer size, the pressure ulcer scale for healing, maximum ankle dorsiflexion and plantar flexion using a plastic goniometer.
Results
Venous ulcer healing was greatest in patients receiving combined exercise and ultrasound in addition to compression therapy. Combined therapeutic exercises and ultrasound were well tolerated and no adverse reactions were noted. Patients receiving therapeutic exercises alone or ultrasound alone showed lesser degrees of improvements. No significant improvements were observed in any variable in patients who received compression therapy alone.
Conclusion
Combined prescription of exercises and ultrasound as an adjunct to compression therapy would be a more effective means of promoting chronic venous ulcer healing, when standard compression therapy have failed. It is safe, easy and well tolerated and should be considered as adjunctive therapy in patients with venous leg ulcers.
References
Carpentier PH, Maricq HR, Biro C, Ponçot-Makinen CO, Franco A. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France. J Vasc Surg 2004; 40:650–659.
O’Brien J, Finlayson K, Kerr G, Edwards H. 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. Int Wound J 2016; [Epub ahead of print].
Weller CD, Evans S, Reid CM, Wolfe R, McNeil J. Protocol for a pilot randomised controlled clinical trial to compare the effectiveness of a graduated three layer straight tubular bandaging system when compared to a standard short stretch compression bandaging system in the management of people with venous ulceration: 3VSS2008. Trials 2010; 11:26.
Tew GA, Michaels J, Crank H, Middleton G, Gumber A, Klonizakis M. Supervised exercise training as an adjunctive therapy for venous leg ulcers: study protocol for a randomised controlled trial. Trials 2015; 16:443.
O’Meara S, Cullum N, Nelson E. Compression for venous leg ulcers. Cochrane Database Syst Rev 2009; DOI: 10.1002/14651858.CD000265. pub2.
Abbade LP, Lastória S, de Almeida Rollo H, Stolf HO. A sociodemographic, clinical study of patients with venous ulcer. Int J Dermatol 2005; 44:989–992.
Drew P, Posnett J, Rusling L, Wound Care Audit Team. The cost of wound care for a local population in England. Int Wound J 2007; 4:149–155.
Dix FP, Brooke R, McCollum CN. Venous disease is associated with an impaired range of ankle movement. Eur J Vasc Endovasc Surg 2003; 25:556–561.
Kelechi TJ, Mueller M, Zapka JG, King DE. Cryotherapy and ankle motion in chronic venous disorders. Open J Nurs 2012; 2:379–387.
Padberg FT Jr, Johnston MV, Sisto SA. Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial. J Vasc Surg 2004; 39:79–87.
Jull A, Parag V, Walker N, Maddison R, Kerse N, Johns T. The prepare pilot RCT of home-based progressive resistance exercises for venous leg ulcers. J Wound Care 2009; 18:497–503.
Roaldsen KS, Biguet G, Elfving B. Physical activity in patients with venous leg ulcer – between engagement and avoidance. A patient perspective. Clin Rehabil 2011; 25:275–286.
O’Brien J, Finlayson K, Kerr G, Edwards H. The perspectives of adults with venous leg ulcers on exercise: an exploratory study. J Wound Care 2014; 23:496–498.
Yim E, Kirsner RS, Gailey RS, Mandel DW, Chen SC, Tomic-Canic M. Effect of physical therapy on wound healing and quality of life in patients with venous leg ulcers: a systematic review. JAMA Dermatol 2015; 151:320–327.
Voigt J, Wendelken M, Driver V, Alvarez OM. Low-frequency ultrasound (20–40 kHz) as an adjunctive therapy for chronic wound healing: a systematic review of the literature and meta-analysis of eight randomized controlled trials. Int J Low Extrem Wounds 2011; 10:190–199.
Escandon J, Vivas AC, Perez R, Kirsner R, Davis S. A prospective pilot study of ultrasound therapy effectiveness in refractory venous leg ulcers. Int Wound J 2012; 9:570–578.
Maan ZN, Januszyk M, Rennert RC, Duscher D, Rodrigues M, Fujiwara T, et al. Noncontact, low-frequency ultrasound therapy enhances neovascularization and wound healing in diabetic mice. Plast Reconstr Surg 2014; 134:402e–411e.
Chuang LH, Soares MO, Watson JM, Bland JM, Cullum N, Iglesias C, et al. VenUS III team: economic evaluation of a randomized controlled trial of ultrasound therapy for hard-to-heal venous leg ulcers. Br J Surg 2011; 98:1099–1106.
Watson JM, Kang’ombe AR, Soares MO, Chuang LH, Worthy G, Bland JM, et al. VenUS III Team. Use of weekly, low dose, high frequency ultrasound for hard to heal venous leg ulcers: the VenUS III randomised controlled trial. BMJ 2011; 342:d1092.
Yim E, Richmond NA, Baquerizo K, Van Driessche F, Slade HB, Pieper B, Kirsner RS. The effect of ankle range of motion on venous ulcer healing rates. Wound Repair Regen 2014; 22:492–496.
Samuels JA, Weingarten MS, Margolis DJ, Zubkov L, Sunny Y, Bawiec CR, et al. Low-frequency (<100 kHz), low-intensity (<100 mW/cm(2)) ultrasound to treat venous ulcers: a human study and in vitro experiments. J Acoust Soc Am 2013; 134:1541–1547.
Gibbons GW, Orgill DP, Serena TE, Novoung A, O’Connell JB, Li WW, Driver VR. A prospective, randomized, controlled trial comparing the effects of noncontact, low-frequency ultrasound to standard care in healing venous leg ulcers. Ostomy Wound Manage 2015; 61:16–29.
Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg 1995; 21:635–645.
Wollina U, Heinig B, Naumann G, Scheibe A, Schmidt WD, Neugebauer R. Effects of low-frequency ultrasound on microcirculation in venous leg ulcers. Indian J Dermatol 2011; 56:174–179.
O’Brien J, Edwards H, Stewart I, Gibbs H. A home-based progressive resistance exercise programme for patients with venous leg ulcers: a feasibility study. Int Wound J 2013; 10:389–396.
Davies JA, Bull RH, Farrelly IJ, Wakelin MJ. A home-based exercise programme improves ankle range of motion in long-term venous ulcer patients. Phlebology 2007; 22:86–89.
Franek A, Chmielewska D, Brzezinska-Wcislo L, Slezak A, Blaszczak E. Application of various power densities of ultrasound in the treatment of leg ulcers. J Dermatolog Treat 2004; 15:379–386.
Taradaj J, Franek A, Cierpka L, Brzezinska-Wcislo L, Blaszczak E, Polak A, et al. Early and long-term results of physical methods in the treatment of venous leg ulcers: randomized controlled trial. Phlebology 2011; 26: 237–245.
Harrison MB, Vandenkerkhof EG, Hopman WM, Graham ID, Carley ME, Nelson EA, Canadian Bandaging Trial Group. The Canadian Bandaging Trial: evidence-informed leg ulcer care and the effectiveness of two compression technologies. BMC Nurs 2011; 10:20.
Stacey MC, Burnand KG, Layer GT, Pattison M, Browse NL. Measurement of the healing of venous ulcers. Aust N Z J Surg 1991; 61:844–848.
Thomas DR, Rodeheaver GT, Bartolucci AA, Franz RA, Sussman C, Ferrell BA, et al. Pressure ulcer scale for healing: derivation and validation of the PUSH tool. The PUSH Task Force. Adv Wound Care 1997; 10:96–101.
Ratliff CR, Rodeheaver GT. Use of the PUSH tool to measure venous ulcer healing. Ostomy Wound Manage 2005; 51:58–60.
Edwards H, Finlayson K, Skerman H, Alexander K, Miaskowski C, Aouizerat B, Gibb M. Identification of symptom clusters in patients with chronic venous leg ulcers. J Pain Symptom Manage 2014; 47:867–875.
Schultz GS, Barillo DJ, Mozingo DW, Chin GA, Wound Bed Advisory Board Members. Wound bed preparation and a brief history of TIME. Int Wound J 2004; 1:19–32.
Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, et al. Society for Vascular Surgery; American Venous Forum. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53(Suppl):2S–48S.
Klonizakis M, Tew G, Michaels J, Saxton J. Exercise training improves cutaneous microvascular endothelial function in post-surgical varicose vein patients. Microvasc Res 2009; 78:67–70.
Heinen M, Borm G, van der Vleuten C, Evers A, Oostendorp R, van Achterberg T. The Lively Legs self-management programme increased physical activity and reduced wound days in leg ulcer patients: results from a randomized controlled trial. Int J Nurs Stud 2012; 49:151–161.
Young SR, Dyson M. The effect of therapeutic ultrasound on angiogenesis. Ultrasound Med Biol 1990; 16:261–269.
Francis CW, Onundarson PT, Carstensen EL, Blinc A, Meltzer RS, Schwarz K, Marder VJ. Enhancement of fibrinolysis in vitro by ultrasound. J Clin Invest 1992; 90:2063–2068.
Dalecki D. Mechanical bioeffects of ultrasound. Annu Rev Biomed Eng 2004; 6:229–248.
Tan J, Abisi S, Smith A, Burnand KG. A painless method of ultrasonically assisted debridement of chronic leg ulcers: a pilot study. Eur J Vasc Endovasc Surg 2007; 33:234–238.
Serena T, Lee SK, Lam K, Attar P, Meneses P, Ennis W. The impact of noncontact, nonthermal, low-frequency ultrasound on bacterial counts in experimental and chronic wounds. Ostomy Wound Manage 2009; 55:22–30.
Gravante G, Sorge R, Giordan N, Georgescu SR, Morariu SH, Stoicescu I, Clatici V. Multicenter clinical trial on the performance and tolerability of the Hyaluronic acid-collagenase ointment for the treatment of chronic venous ulcers: a preliminary pilot study. Eur Rev Med Pharmacol Sci 2013; 17:2721–2727.
Taradaj J, Franek A, Brzezinska-Wcislo L, Cierpka L, Dolibog P, Chmielewska D, et al. The use of therapeutic ultrasound in venous leg ulcers: a randomized, controlled clinical trial. Phlebology 2008; 23: 178–183.
Pieper B, Templin TN, Birk TJ, Kirsner RS. Effects of injection – drug injury on ankle mobility and chronic venous disorders. J Nurs Scholarsh 2007; 39:312–318.
Yim E, Vivas A, Maderal A, Kirsner RS. Neuropathy and ankle mobility abnormalities in patients with chronic venous disease. JAMA Dermatol 2014; 150:385–389.
O’Brien JA, Finlayson KJ, Kerr G, Edwards HE. Testing the effectiveness of a self-efficacy based exercise intervention for adults with venous leg ulcers: protocol of a randomised controlled trial. BMC Dermatol 2014; 14:16.
Davids JR, Rowan F, Davis RB. Indications for orthoses to improve gait in children with cerebral palsy. J Am Acad Orthop Surg 2007; 15: 178–188.
Author information
Authors and Affiliations
Corresponding author
Additional information
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Sallam, R.A.E., El Ghaweet, A.I. & Regal, S.A.H. Value of combined exercise and ultrasound as an adjunct to compression therapy in chronic venous leg ulcers. Egypt Rheumatol Rehabil 44, 77–82 (2017). https://doi.org/10.4103/1110-161X.205660
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.4103/1110-161X.205660