Patient behavior that contributes to recurrent venous leg ulcers: a followup to patient education

Background: Venous leg ulcers (VLU) affect approximately 1% of those 65+ years old with healthcare expenditures ranging between $2.5 and $3.5 million annually. VLU recurrence rates can be as high as 60-70%. Whether patients adhere to recommendations, such as such as compression and elevation of the affected limb, which may affect recurrence, is unknown.

 Purpose:  The purpose of the study was to describe patients’ adherence to clinical recommendations for preventing recurrent VLUs.

Design:  cross-sectional cohort

Subjects and Setting:  Eligible subjects were patients discharged from 1 of 7 wound clinics (6 hospital outpatient and 1 community) with a healed VLU within 1-36 months prior to treatment for a recurrent VLU. 71 patients (59% male, 67(14) years old (mean(sd)) with a recurrent VLU completed a confidential anonymous questionnaire administered by wound care clinicians at each site.

Methods:  Investigators developed a questionnaire with 27 questions that addressed multiple issues relevant to ulcer recurrence, including compliance with compression, leg elevation, changes in medical condition, satisfaction with educational information provided as well as demographics. Frequency and percentage of survey responses were analyzed.

Results:  The majority of the patients (73%) reported that they wore their stockings every day, and elevated their legs (87%) as they had been instructed. Sixteen patients (25%) reported a weight gain since their last visit to the clinic.  Nine (56%) of these patients admitted to a gain of 10-50+ pounds.  Most of the patients (90%) were satisfied that they received enough information at discharge to care for their legs.

Conclusion:  The majority of patients with recurrent VLU reported adhering to recommendations for preventing VLU. Weight gain was the principal problem and ia a factor  that WOC nurses can target to prevent.  Findings suggest that prevention of weight gain should be examined as a possible intervention to prevent VLU recurrence in future studies.