Venous leg symptoms in healthy subjects assessed during prolonged standing

Venous disorders as an occupational disease - a systematic review on epidemiology, pathophysiology, and modification strategies

Forced postures are common in the workplace. Work in the primary economic sector is characterised by a high degree of physical activity and movement; however, activities in the secondary and tertiary sectors commonly require workers to stand or sit. An expansion of the tertiary sector in recent decades has meant that people in industrialised and emerging economies primarily sit or stand at work. The aim of the systematic review was to identify occupational factors relating to the presence of chronic venous disease (CVD), to place these in the context of developments in the workplace, and to determine whether measures are in place to prevent CVD. We performed a systematic literature review to analyse studies assessing work-related risk factors for CVD. We searched for publications in the PubMed database, the clinic library of BG Hospital Bergmannstrost Halle, and the registry of the German Statutory Accident Insurance. Using occupation-specific keyword combinations, we identified 27,522 publications. The publications underwent an automatic and manual filtering process according to the PRISMA guidelines and 81 publications qualified for the review. Ultimately 25 studies were included in the systematic review. All of the subjects of the studies worked in the secondary and tertiary sectors. No studies looked at the relationship between venous disorders and primary sector occupations. Standing at work for more than four hours a day, repeated heavy lifting, and cumulative time working in a sitting or standing position are risk factors for the development of CVD. Sitting is less of a risk factor than standing or walking. Occupational history and the patient's activity profile are important diagnostic tools which can help confirm a diagnosis and justify treatment when findings are inconsistent. Compression therapy is the primary form of secondary and tertiary prevention. There continues to be a lack of primary preventive measures related to workplace design.

Physical Health and Mental Fatigue Disability Associated with Long COVID: Baseline Results from a US Nationwide Cohort

BACKGROUND

Persistent symptoms after severe acute respiratory disease coronavirus 2 (SARS-COV-2; long COVID) occur in 10%-55% of individuals, but the impact on daily functioning and disability remains unquantified.

METHODS

To characterize disability associated with long COVID, we analyzed baseline data from an online, US-based cohort study. Adult participants included those reporting a history of COVID-19 (n = 8874) or never having COVID-19 (n = 633) without prior disability. The main outcomes were self-reported physical mobility, instrumental activities of daily living (IADL), and mental fatigue disability, assessed by measuring 5 disability components: difficulty walking a quarter mile or climbing 10 stairs (mobility), difficulty doing light or heavy housework (IADL), and Wood Mental Fatigue Inventory score (mental fatigue).

RESULTS

Of 7926 participants with long COVID, 65% were classified with at least one disability, as compared with 6% and 14% for resolved COVID and no COVID, respectively. Additionally, 22% were classified as disabled in all 3 categories. Age, prior comorbidity, increased body mass index, female sex, COVID-19 hospitalization, non-white/multi-race were associated with higher disability burden. Dizziness and heavy limbs at infection were associated with disability regardless of hospitalization. Dyspnea and tremors were associated with disability in non-hospitalized individuals. Vaccination was protective against disability.

CONCLUSIONS

We observed a high burden of new disability associated with long COVID, which has serious implications for individual and societal health. Longitudinal evaluation of COVID-19 patients is necessary to identify patterns of recovery and treatment options.

Comparison of Physiological Effects Induced by Two Compression Stockings and Regular Socks During Prolonged Standing Work

OBJECTIVE

The goal of this study was to evaluate and compare lower-leg muscle fatigue, edema, and discomfort induced by the prolonged standing of security guards wearing regular socks and those wearing 15-20 or 20-30 mmHg compression stockings as intervention.

BACKGROUND

Compression stockings are sometimes used by individuals standing all day at work. However, quantitative evidence showing their potential benefits for lower-leg health issues in healthy individuals during real working conditions is lacking.

METHOD

Forty male security employees participated in the study. All were randomly assigned to the control or one of the two intervention groups (I15-20 or I20-30). Lower-leg muscle twitch force, volume, and discomfort ratings were measured before and after their regular 12-hr standing work shift.

RESULTS

Significant evidence of lower-leg long-lasting muscle fatigue, edema, and discomfort was observed after standing work for guards wearing regular socks. However, no significant changes were found for guards wearing either compression stockings.

CONCLUSION

In healthy individuals, compression stockings seem to attenuate efficiently the tested outcomes in the lower leg resulting from prolonged standing.

APPLICATION

Occupational activities requiring prolonged standing may benefit from 15-20 or 20-30 mmHg compression stockings. As similar benefits were observed for both levels of compression, the lower level may be sufficient.

Comparison of intermittent pneumatic compression device and compression stockings for workers with leg edema and pain after prolonged standing: a prospective crossover clinical trial

BACKGROUND

During prolonged standing, insufficient calf muscle pumping accompanies venous stasis and hypertension in the lower legs, resulting in valve dysfunction, venous wall problems, and sub-sequent inflammation. Compression therapy, which includes medical compression stockings (MCS) and mechanical intermittent pneumatic compression (IPC), is one of the most effective therapeutic interventions for treating chronic venous diseases. This study aimed to compare the therapeutic effect among resting, IPC and MCS alone, and IPC with MCS in long-standing workers (> 8 h daily).

METHODS

This crossover trial was conducted with 39 participants with complaints of leg edema and pain whose work involved standing for more than 8 h daily. Four treatment protocols were established for each visit as follows: protocol A (not wear MCS during work and rest without IPC after work), protocol B (wear MCS during work and rest without IPC after work), protocol C (not wear MCS during work and treat with IPC after work), and protocol D (wear MCS during work and treat with IPC after work). The primary outcome was the visual analogue scale (VAS) score for leg pain. The secondary outcomes were leg volume (mL), circumference (cm), extracellular fluid/total body fluid (ECF/TBF), and extracellular water/total body water (ECW/TBW) through bioelectrical impedance analysis. Outcomes were assessed before work (T0), after work (T1), and 60 min after intervention (T2).

RESULTS

All four protocols had significantly increased leg pain after work (T0-1) but improved 60 min after intervention (T1-2), particularly protocol C (decreased VAS by 1.9). When leg swelling was compared at T0 and T1, protocols A and C showed significant increases in leg volume and circumference, indicating significant work-induced edema, whereas protocols B and D showed no change or even a decrease. After interventions, leg volume and circumference significantly decreased in protocols A and C, although protocols B and C did not show significant improvement. The ECF/TBF and ECW/TBW of all protocols decreased after interventions.

CONCLUSIONS

Leg pain and edema after prolonged standing (T1-T2) in adults were safely and effectively improved by both IPC alone and IPC with MCS. Although the use of MCS during the workday did not show improvement in leg pain immediately after work (T0-T1), both MCS with resting and MCS with IPC decreased leg pain at T1-T2 and prevented leg edema at T0-T1.

TRIAL REGISTRATION

This trial protocol was registered at the Clinical Research Information Service (KCT0005383, the date of first registration: 08/09/2020).

The Effect of Standing Mats on Biomechanical Characteristics of Lower Limbs and Perceived Exertion for Healthy Individuals during Prolonged Standing

Objective

To identify the effect of standing mats on biomechanical characteristics of lower limbs and perceived exertion for healthy adult individuals during a prolonged standing task.

Methods

32 healthy college students were recruited in the randomized and cross-over designed trial according to the effect size and statistical power. After collecting the anthropometric data, each participant was asked to finish 2 sessions of 4-hour prolonged standing tasks on standing mats (MS) and hard ground (GS) in a random order and with a 72-hour interval rest. The plantar pressure distribution, foot morphology, and scores of the BESS (balance error scoring system) would be recorded pre- and posteach task. The Borg Rating of Perceived Exertion (RPE) would be collected during the whole task. Paired-samples t test was adopted to analyse the before and after difference within group and independent-samples t test was adopted to analyse the difference between groups separately.

Results

(1) A prolonged standing task on both MS and GS have a negative effect on RPE and balance performance. (2) The negative effect on RPE and balance performance induced by MS is significantly smaller than that induced by GS. (3) Compared to GS, prolonged standing on MS has a lower peak plantar pressure and an implicit decrease in navicular drop and AHI (arch index).

Conclusion

Standing mat tends to alleviate the fatigue induced by prolonged standing in lower limbs, optimize the distribution of plantar pressure, and maintain the stability.

Improvement of occupational leg edema and discomforts (RCT)

BACKGROUND: Edema and subjective leg complaints (e.g. pain, heaviness) after long standing or sitting, are defined as orthostatic leg complaints or occupational edema. Compression hosiery should help to prevent or decrease those symptoms. OBJECTIVE: Assess the effects on leg discomforts and leg volume and wearing comfort in two medical below-knee compression stocking types (A vs. B) with an interface pressure of 18 –20 mmHg and a below-knee-low-pressure support stocking (LPSS) with an interface pressure of 8–10mmHg (C). METHODS: Two different types of below-knee medical compression stockings and a LPSS were examined in this randomized, blinded, crossover trial in volunteers having leg discomforts and edema after being in an upright position during the day. Participants were divided into two cohorts, and each type of stocking was worn for three consecutive days in one week with a subsequent washout phase. The assessment of effects and wearing comfort was ascertained by questionnaires. Volume changes in the lower leg were measured with the Bodytronic 600® (Bauerfeind AG, Zeulenroda, Germany). RESULTS: A significant reduction of lower leg volume (mean stocking A: 204.7 ml; mean stocking B: 153.5 ml; mean stocking C: 48.2 ml) and a significant reduction of the life-quality dimension leg-complaints (p <  0.0001) was achieved by all three types of stockings. Compared to the LPSS both compression stockings decreased the lower leg volume significantly more (p <  0.001) and had a significant better fit (p <  0.001). CONCLUSION: Below-knee medical compression stockings with an interface pressure 18–21mmHg and LPSS with an interface pressure of 8–10 mmHg reduce significantly occupational orthostatic edema and leg discomforts which are due to long standing and sitting activities.

The impact of lower limb chronic venous disease on quality of life: patient and physician perspectives

Aim: This research compared patient and physician perceptions of quality of life (QoL) in C0-4 chronic venous disease (CVD). Methods: Qualitative standardized phone interviews were conducted with 100 patients and 60 specialists from Brazil, China, the Czech Republic, Italy and Russia. Results: In addition to the impact of physical symptoms on QoL, patient interviews revealed a high aesthetic and emotional burden of C0-4 CVD that contributes to social isolation and affects relationships. Physicians were aware of the physical impact but underestimated the other implications of CVD on their patients' QoL. Conclusion: Healthcare professional awareness of the overall impact of CVD on QoL needs improvement. All aspects of QoL should be assessed in order to manage CVD effectively.

Walking instead of standing

Background: Leg discomfort is common in the general population. Volume increase and discomfort in the lower legs especially occur in occupations with long standing or sitting periods and less movement. Are both related to each other? Patients and methods: A time-controlled standing period of 15 min was performed in this nonrandomized controlled study to investigate the change and temporal relationship of volume increase and the occurrence of lower leg discomfort. Sensations of discomfort and the urge to move were queried using a numerical rating scale from 0 to 10 (NRS). Correlation analysis was conducted between the lower leg volume and the data regarding the discomfort and urge to move in each subject. Further, linear mixed effect models were performed to detect a causal relationship between the lower leg volume and the sensations of discomfort/urge to move in the standing period. Results: Lower leg volume increased by an average of 63 ml (p<0.001) during the standing period. The sensations of discomfort increased by a mean of 3.46 points on the NRS (p<0.001) during orthostasis. Participants' urge to move increased by 3.47 points on the NRS (p<0.001) during the standing period. A significant correlation was shown between the increase of lower leg volume and the occurrence of discomfort sensation in 9 out of 15 subjects (p<0.05) and between the increase of lower leg volume and the urge to move in 11 out of 15 subjects (p<0.05). Association was shown between volume increase and symptoms in linear mixed effects models. Conclusions: Prolonged standing with lack of movement leads to an increase in the lower leg volume and a sensation of discomfort in venous healthy subjects. Causal relationships are indicated between these variables by linear mixed effects models.

Intermittent pneumatic compression for prolonged standing workers with leg edema and pain

Even healthy individuals often encounter leg venous symptoms such as heaviness, pain, and swelling especially after prolonged standing work. Intermittent pneumatic compression (IPC) is a widely used simple therapy for preventing deep vein thrombosis and for treating lymphedema and chronic venous insufficiency. However, IPC has not been evaluated for its effect in relieving venous symptoms of healthy people.This was single center, cross-over study to investigate the effect of IPC for 20 healthy volunteers who usually stand on duty and complain of leg pain and swelling. The primary outcome was pain (measured using a visual analogue scale) and secondary outcomes were leg circumference and volume. Three different interventions included natural rest, sequential mode of IPC, and circular mode of IPC. Outcomes were measured before work and immediately after work (T1), after 30 minutes of intervention (T2), and 30 minutes of rest after intervention (T3).Pain and leg circumferences were significantly improved at T2 and T3 compared with those at T1. Sequential and circular IPC led to significantly greater improvement in pain and leg circumferences than just natural rest, but there was no difference in its effect according to the 2 modes of IPC. Leg volume was reduced significantly at T2 and T3 as compared with T1 in all 3 interventions, but effects did not differ among 3 intervention groups.IPC is effective for reducing leg pain and circumferences more than natural rest in healthy adults with prolonged standing work, without causing adverse events.

Compression Stocking Length Effects on Oedema, Pain, and Satisfaction in Nursing Students: A Pilot Randomized Trial

Professional practitioners who are required to stand for long periods of time frequently complain about vein-related symptoms. Compression stocking are effective for vein-related symptoms, but there is not enough evidence on the effect of the length of compression stockings for nursing students. To compare oedema, pain, and satisfaction according to different lengths of compression stockings worn by female nursing students. This study was conducted as a randomized clinical trial. The participants included 20 female nursing students in their first semester of clinical practice training. Compression stockings with 25–32 mmHg pressure were used in the study; the participants were divided into two groups based on the length of compression stocking: knee length and thigh length. Differences between groups regarding pain, oedema, and satisfaction were analysed using t-tests, paired t-tests, and Mann–Whitney U tests, when appropriate. There were no significant differences in pain, oedema, and satisfaction between the two groups. However, pain in right legs of the thigh-length stocking group significantly increased after clinical training shift compared with that before the shift (t = −2.377, p = 0.041). Both groups reported high satisfaction. There were no differences in pain, oedema, and satisfaction in both legs based on the length of compression stockings, but side effects appeared in participants wearing the thigh-length stockings; nevertheless, satisfaction was high in both groups. It may be important to suggest nursing students to wear knee-length compression stockings during clinical practice training.

Muscular and Vascular Issues Induced by Prolonged Standing With Different Work-Rest Cycles With Active or Passive Breaks

OBJECTIVE

The aim of this study was to evaluate the long-lasting motor, behavioral, physiological, and perceptual effects of prolonged standing work in three work-rest cycle conditions including passive or active rest breaks.

BACKGROUND

Muscle fatigue has been evidenced after prolonged standing work through physiological and neuromotor measures. It has been postulated that muscle fatigue induced by prolonged work could be attenuated by appropriate scheduling of work and rest periods. However, investigations in this domain remain limited.

METHOD

Thirty participants simulated standing work for 5 hr with work-rest cycles of short, medium, or long standing periods including passive or active breaks. Lower-leg muscle twitch force (MTF), muscle oxygenation, lower-leg volume, postural stability, force control, and discomfort perception were quantified on 2 days.

RESULTS

Prolonged standing induced significant changes in all measures immediately after 5 hr of work, indicating a detrimental effect in long-lasting muscle fatigue, performance, discomfort, and vascular aspects. Differences in the measures were not significant between work cycles and/or break type.

CONCLUSION

Similar physiological and motor alterations were induced by prolonged standing. The absence of difference in the effects induced by the tested work-rest cycles suggests that simply altering the work-rest cycle may not be sufficient to counteract the effects of mainly static standing work. Finally, standing for 3 hr or more shows clear detrimental effects.

APPLICATION

Prolonged standing is likely to contribute to musculoskeletal and vascular symptoms. A limitation to less than 3 hr of mostly static standing in occupational activities could avoid alterations leading to these symptoms.

The Significance of Pain in Chronic Venous Disease and its Medical Treatment

Chronic venous disease (CVeD) is a highly prevalent condition in the general population, and it has a significant impact on quality of life. While it is usually manifested by obvious signs, such as varicose veins and venous ulcers, other symptoms of the disease are less specific. Among the other symptoms, which include heaviness, swelling, muscle cramps and restless legs, pain is the symptom that most frequently compels CVeD patients to seek medical aid. However, there is a substantial discrepancy between pain severity and clinically detectable signs of CVeD, questioned by several opposing studies. Further evaluation is needed to clarify this subject, and to analyse whether pain development predicts objective CVeD progression. General management of CVeD starts with advising lifestyle changes, such as lowering body mass index and treating comorbidities. However, the mainstay of treatment is compression therapy, with the additional use of pharmacological substances. Venoactive drugs proved to be the drugs of choice for symptom alleviation and slowing the progression of CVeD, with micronized purified flavonoid fraction being the most effective one. Interventional therapy is reserved for advanced stages of the disease.