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Rook B, van Rijn MJE, Jansma EP, van Montfrans C. Effect of exercise after a deep venous thrombosis: A systematic review. J Eur Acad Dermatol Venereol 2024; 38:289-301. [PMID: 37731155 DOI: 10.1111/jdv.19523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
Post-thrombotic syndrome (PTS) is a common complication after deep vein thrombosis (DVT) and has a major impact on physical symptoms, quality of life (QoL) and economic costs. Relatively simple lifestyle interventions as physical exercise might reduce PTS severity and increase QoL. To evaluate the direct and long-term effects of physical activity in patients with an acute or previous DVT. We conducted a systematic review through an additional search from 2007 up to March 2022, to complement the comprehensive systematic review of Kahn et al. Articles evaluating the effect of exercise after a DVT including symptoms, QoL and the incidence and severity of PTS, were included. Quality of the studies was assessed using a GRADE-like checklist and results were reported according to the PRISMA Statement. Ten studies were included, seven randomized controlled trials and three cohort studies. We identified three types of physical activity based on timing and duration; (1) early mobilisation in the acute phase of the DVT; (2) short duration exercise 1 year after DVT and (3) prolonged exercise during follow-up after a previous DVT. Early mobilisation showed improvement in QoL and pain reduction and after 2 years it resulted in a significant reduction of PTS severity. Prolonged supervised exercise resulted in improvement of QoL. In addition, positive effects on symptoms of venous insufficiency and muscle functions were observed. None of the included studies reported an increased risk of PTS or worsening of symptoms due to physical activity. Physical exercise after a DVT is safe, improves QoL, reduces pain and decreases PTS severity. Lifestyle intervention such as guided individualized training programs can be a useful supplementary therapy for patients after a DVT or for PTS patients. Optimal training programs may be identified by further studies that improve patient-oriented outcomes for both adults and children after a DVT.
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Affiliation(s)
- B Rook
- Emergency Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - M J E van Rijn
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E P Jansma
- Head of Medical Information Specialists, Leiden University, Leiden, The Netherlands
| | - C van Montfrans
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
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Bissacco D, Mosti G, D'Oria M, Lomazzi C, Casana R, Morrison N, Caggiati A. Rationale and current evidence of aquatic exercise therapy in venous disease: A narrative review. Vascular 2023; 31:1026-1034. [PMID: 35586921 DOI: 10.1177/17085381221102783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic venous disorders (CVD) of the lower limbs can be treated with different strategies. Typically, conservative management is based on compression therapy, anticoagulants and venoactive drugs. Endovenous treatments remain the gold standard to treat saphenous insufficiency, with sclerotherapy and surgery maintaining a role in selected cases. In addition, several 'unconventional' approaches have been proposed to prevent CVD progression and complications, minimize symptoms and improve the quality of life and postoperative outcomes. Among these, balneotherapy and aquatic exercises are proving as valid and effective supporting treatments, as mentioned in a growing number of scientific publications. Moreover, aquatic protocols have been studied for both venous and lymphatic insufficiency. For these reasons, they were mentioned in the last CVD guidelines provided by the European Society for Vascular Surgery. The aim of this narrative review is to overview and summarize current literature evidences on the role and effectiveness of aquatic rehabilitative protocols in CVD, reviewing old and current literature. Furthermore, the physical basis of the effects of water immersion on lower limb venous and tissues modifications are also described.
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Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Mosti
- Angiology Department, MD Barbantini Clinic, Lucca, Italy
| | - Mario D'Oria
- Vascular and Endovascular Surgery Unit, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Chiara Lomazzi
- Vascular Surgery Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Renato Casana
- Vascular Surgery Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
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de Moraes Silva MA, Nakano LC, Cisneros LL, Miranda F. Balneotherapy for chronic venous insufficiency. Cochrane Database Syst Rev 2023; 1:CD013085. [PMID: 36622745 PMCID: PMC9828836 DOI: 10.1002/14651858.cd013085.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Chronic venous insufficiency (CVI) is a progressive and common disease that affects the superficial and deep venous systems of the lower limbs. CVI is characterised by valvular incompetence, reflux, venous obstruction or a combination of these symptoms, with consequent distal venous hypertension. Clinical manifestations of CVI include oedema, pain, skin changes, ulcerations and dilated skin veins in the lower limbs. It places a large financial burden on health systems. There is a wide variety of treatment options for CVI, ranging from surgery and medication to compression and physiotherapy. Balneotherapy (treatments involving water) may be a relatively cheap and efficient way to deliver physiotherapy to people with CVI. This is an update of a review first published in 2019. OBJECTIVES To assess the effectiveness and safety of balneotherapy for the treatment of people with chronic venous insufficiency. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 28 June 2022. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials comparing balneotherapy to no treatment or other types of treatment for CVI. We also included studies that used a combination of treatments. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. disease severity, 2. health-related quality of life (HRQoL) and 3. ADVERSE EFFECTS Our secondary outcomes were 1. pain, 2. oedema, 3. leg ulcer incidence and 4. skin pigmentation changes. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We included nine randomised controlled trials involving 1126 participants with CVI. Seven studies evaluated balneotherapy versus no treatment, one study evaluated balneotherapy versus a phlebotonic drug (melilotus officinalis), and one study evaluated balneotherapy versus dryland exercises. We downgraded our certainty in the evidence due to a lack of blinding of participants and investigators, participant-reported outcomes and imprecision. Balneotherapy versus no treatment Balneotherapy compared to no treatment probably results in slightly improved disease severity signs and symptoms scores as assessed by the Venous Clinical Severity Score (VCSS; mean difference (MD) -1.75, 95% confidence interval (CI) -3.02 to -0.49; 3 studies, 671 participants; moderate-certainty evidence). Balneotherapy compared to no treatment may improve HRQoL as assessed by the Chronic Venous Insufficiency Quality of Life Questionnaire 2 (CIVIQ2) at three months, but we are very uncertain about the results (MD -10.46, 95% CI -19.21 to -1.71; 2 studies, 153 participants; very low-certainty evidence). The intervention may improve HRQoL at 12 months (MD -4.48, 95% CI -8.61 to -0.36; 2 studies, 417 participants; low-certainty evidence). It is unclear if the intervention has an effect at six months (MD -2.99, 95% CI -6.53 to 0.56; 2 studies, 436 participants; low-certainty evidence) or nine months (MD -6.40, 95% CI -13.84 to 1.04; 1 study, 59 participants; very low-certainty evidence). Balneotherapy compared with no treatment may have little or no effect on the occurrence of adverse effects. The main adverse effects were thromboembolic events (odds radio (OR) 0.35, 95% CI 0.09 to 1.42; 3 studies, 584 participants; low-certainty evidence), erysipelas (OR 2.58, 95% CI 0.65 to 10.22; 2 studies, 519 participants; low-certainty evidence) and palpitations (OR 0.33, 95% CI 0.01 to 8.52; 1 study, 59 participants; low-certainty evidence). No studies reported any serious adverse effects. Balneotherapy compared with no treatment may improve pain scores slightly at three months (MD -1.12, 95% CI -1.35 to -0.88; 2 studies, 354 participants; low-certainty evidence); and six months (MD -1.02, 95% CI -1.25 to -0.78; 2 studies, 352 participants; low-certainty evidence). Balneotherapy compared with no treatment may have little or no effect on oedema (measured by leg circumference) at 24 days to three months, but we are very uncertain about the results (standardised mean difference (SMD) 0.32 cm, 95% CI -0.70 to 1.34; 3 studies, 369 participants; very low-certainty evidence). Balneotherapy compared with no treatment may have little or no effect on the incidence of leg ulcers at 12 months, but we are very uncertain about the results (OR 1.06, 95% CI 0.27 to 4.14; 2 studies, 449 participants; very low-certainty evidence). Balneotherapy compared with no treatment may slightly reduce skin pigmentation changes as measured by the pigmentation index at 12 months (MD -3.60, 95% CI -5.95 to -1.25; 1 study, 59 participants; low-certainty evidence). Balneotherapy versus melilotus officinalis For the comparison balneotherapy versus a phlebotonic drug (melilotus officinalis), there was little or no difference in pain symptoms (OR 0.29, 95% CI 0.03 to 2.87; 1 study, 35 participants; very low-certainty evidence) or oedema (OR 0.21, 95% CI 0.02 to 2.27; 1 study, 35 participants; very low-certainty evidence), but we are very uncertain about the results. The study reported no other outcomes of interest. Balneotherapy versus dryland exercise For the comparison balneotherapy versus dryland exercise, evidence from one study showed that balneotherapy may improve HRQoL as assessed by the Varicose Vein Symptom Questionnaire (VVSymQ), but we are very uncertain about the results (MD -3.00, 95% CI -3.80 to -2.20; 34 participants, very low-certainty evidence). Balneotherapy compared with dryland exercises may reduce oedema (leg volume) after five sessions of treatment (right leg: MD -840.70, 95% CI -1053.26 to -628.14; left leg: MD -767.50, 95% CI -910.07 to -624.93; 1 study, 34 participants, low-certainty evidence). The study reported no other outcomes of interest. AUTHORS' CONCLUSIONS For the comparison balneotherapy versus no treatment, we identified moderate-certainty evidence that the intervention improves disease severity signs and symptoms scores slightly, low-certainty evidence that it improves pain and skin pigmentation changes, and very low-certainty evidence that it improves HRQoL. Balneotherapy compared with no treatment made little or no difference to adverse effects, oedema or incidence of leg ulcers. Evidence comparing balneotherapy with other interventions was very limited. To ensure adequate comparison between trials, future trials should standardise measurements of outcomes (e.g. disease severity signs and symptoms score, HRQoL, pain and oedema) and follow-up time points.
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Affiliation(s)
| | - Luis Cu Nakano
- Division of Vascular and Endovascular Surgery, Department of Surgery, Paulista School of Medicine - Federal University of São Paulo, São Paulo, Brazil
| | - Lígia L Cisneros
- Department of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Fausto Miranda
- Division of Vascular and Endovascular Surgery, Department of Surgery, Paulista School of Medicine - Federal University of São Paulo, São Paulo, Brazil
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Kim DS, Won YH, Ko MH. Comparison of intermittent pneumatic compression device and compression stockings for workers with leg edema and pain after prolonged standing: a prospective crossover clinical trial. BMC Musculoskelet Disord 2022; 23:1007. [PMID: 36419142 PMCID: PMC9685841 DOI: 10.1186/s12891-022-05975-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/12/2022] [Indexed: 11/26/2022] Open
Abstract
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).
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Affiliation(s)
- Da-Sol Kim
- grid.411545.00000 0004 0470 4320Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea ,grid.411545.00000 0004 0470 4320Research Institute of Clinical Medicine, Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Yu Hui Won
- grid.411545.00000 0004 0470 4320Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea ,grid.411545.00000 0004 0470 4320Research Institute of Clinical Medicine, Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Myoung-Hwan Ko
- grid.411545.00000 0004 0470 4320Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea ,grid.411545.00000 0004 0470 4320Research Institute of Clinical Medicine, Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Thibert A, Briche N, Vernizeau BD, Mougin-Guillaume F, Béliard S. Systematic review of adapted physical activity and therapeutic education of patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord 2022; 10:1385-1400. [PMID: 35810994 DOI: 10.1016/j.jvsv.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/04/2022] [Accepted: 05/03/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Chronic venous disease (CVD), comprising impaired lower limb venous return, will lead to chronic distal venous pressure overload manifested by various clinical signs and symptoms and resulting in diminished quality of life. The CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) classification of CVD distinguishes six stages (C0-C6) using clinical, etiologic, anatomic, and pathophysiologic parameters. In the present study, we analyzed the effects of adapted physical activity (APA) and patient-oriented therapeutic education (PTE) programs on the clinical signs, symptoms, and quality of life of patients with CVD. METHODS Our analysis, in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) recommendations, included a search of PubMed, CINAHL and LiSSa databases, using a single search equation. RESULTS A total of 21 studies were selected for analysis. The analysis revealed first, that patients at stage C0 to C5 had had access to an APA program. This therapy alleviated the clinical signs and symptoms and improved the patients' quality of life. The beneficial effects of APA were greater in the programs that had included aquatic activities than in the program that were exclusively dry-land programs. Second, patients at stage C6 had predominantly followed a PTE program. This therapy showed beneficial effects on the clinical signs and symptoms. However, the quality of life had rarely been assessed. CONCLUSIONS At present, APA and PTE programs comprise useful and complementary therapeutic options for the care of patients with CVD. Two of the studies included in our review had evaluated the effects of combining these two approaches, notably in the context of balneotherapy, and reported promising results.
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Affiliation(s)
- Axelle Thibert
- Independent Adapted Physical Activity Teacher, Dole, France; Functional Unit of Vascular Medicine, Hospital Centre Louis-Pasteur, Dole, France
| | - Nicolas Briche
- Functional Unit of Vascular Medicine, Hospital Centre Louis-Pasteur, Dole, France
| | | | - Fabienne Mougin-Guillaume
- EA3920, Platform Exercise Performance Health Innovation, University of Bourgogne Franche-Comté, CHRU Jean Minjoz, Besançon, France
| | - Samuel Béliard
- Functional Unit of Vascular Medicine, Hospital Centre Louis-Pasteur, Dole, France; EA3920, Platform Exercise Performance Health Innovation, University of Bourgogne Franche-Comté, CHRU Jean Minjoz, Besançon, France; PEPITE EA4267, Platform Exercise Performance Health Innovation, University of Bourgogne Franche-Comté, Besançon, France.
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de Almeida ILGI, Figueiredo PHS, Silva WT, Mendonça VA, Lacerda ACR, Lima VP, Bastone ADC, Costa HS. Reliability and validity of specific quality of life assessment questionnaires related to chronic venous insufficiency: a systematic review. J Vasc Bras 2022; 21:e20210229. [PMID: 36407663 PMCID: PMC9639578 DOI: 10.1590/1677-5449.202102292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 08/05/2022] [Indexed: 12/23/2022] Open
Abstract
This systematic review aimed to discuss the main findings regarding the reliability and validity of health-related quality of life questionnaires for chronic venous insufficiency. Searches were performed on the MEDLINE, CINAHL, Web of Science, LILACS, and Scopus databases. The search terms used were related to "venous insufficiency", and "quality of life". The CIVIQ-20 and CIVIQ-14 instruments had adequate internal consistency and both were able to discriminate disease severity. The VEINES-QoL showed adequate internal consistency but was not able to discriminate disease severity. Most studies did not demonstrate a correlation between VEINES-QoL and the mental component of the SF-36. The AVVQ had inadequate reliability but its validity was also doubtful when compared to the SF-36. The VARIShort demonstrated good internal consistency, reproducibility, and validity, but only the original study was included. For venous leg ulcers, the CCVUQ showed adequate reliability and validity when compared to VLU-QoL.
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Affiliation(s)
| | | | - Whesley Tanor Silva
- Universidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM, Diamantina, MG, Brasil.
| | | | | | - Vanessa Pereira Lima
- Universidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM, Diamantina, MG, Brasil.
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Nepomuceno de Souza I, Fernandes de Oliveira LF, Geraldo Izalino de Almeida IL, Ávila MR, Silva WT, Trede Filho RG, Pereira DAG, de Oliveira LFL, Lima VP, Scheidt Figueiredo PH, Costa HS. Impairments in ankle range of motion, dorsi and plantar flexors muscle strength and gait speed in patients with chronic venous disorders: A systematic review and meta-analysis. Phlebology 2022; 37:496-506. [DOI: 10.1177/02683555221094642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To verify the differences in ankle range of motion (ROM), muscle strength of dorsi and plantar flexors, and gait speed among healthy subjects, and patients with chronic venous disorders (CVD) with and without venous leg ulcer. Methods A systematic review and meta-analysis ( http://osf.io/b7n3k ) were conducted following a search of MEDLINE, Web of Science, CINAHL, LILACS, Scopus, and EMBASE databases. Results Eight papers were included. The ankle ROM was significantly lower both in dorsiflexion and plantar flexion in patients with venous leg ulcer when compared to healthy individuals and CVD patients without venous leg ulcer. The muscle strength of the plantar flexors and gait speed were reduced in CVD patients when compared to healthy ones. Conclusion Impaired muscle strength and gait speed can be detected in CVD patients compared to healthy individuals, and ankle ROM tends to be reduced in CVD patients even in the absence of venous leg ulcers.
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Affiliation(s)
- Iara Nepomuceno de Souza
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Lucas Fróis Fernandes de Oliveira
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | | | - Matheus Ribeiro Ávila
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Whesley Tanor Silva
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Renato Guilherme Trede Filho
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
- Postgraduate course in Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Danielle Aparecida Gomes Pereira
- Physiotherapy Department, School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Luciano Fonseca Lemos de Oliveira
- Physiotherapy Department, School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Vanessa Pereira Lima
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
- Postgraduate course in Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Pedro Henrique Scheidt Figueiredo
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
- Postgraduate course in Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Henrique Silveira Costa
- Physiotherapy Department, Biological and Health Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
- Postgraduate course in Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
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Espeit L, Rimaud D, Le Mat F, Cudel C, Micol I, Bertoletti L, Chaigneau C, Millet GY, Lapole T. Fatigue, physical activity and quality of life in people self-reporting symptoms of chronic venous disease. J Vasc Surg Venous Lymphat Disord 2022; 10:1147-1154.e1. [PMID: 35714904 DOI: 10.1016/j.jvsv.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to quantify fatigue and quality of life (QoL) in people self-reporting chronic venous disease (CVD) symptoms or at risk of CVD within a large cohort representative of the French population. The relationship between self-reported physical activity and both fatigue and QoL was also investigated. We hypothesised that a greater fatigue and impaired QoL would exist in participants self-reporting CVD symptoms, with the impairments being attenuated in those with greater level of physical activity. METHODS Using a web-based, custom and adaptive survey, 3,008 participants were asked to self-report the presence of common symptoms and risk factors of CVD. Fatigue, QoL and physical activity were assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, the Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ-14) and the Godin-Shepard Leisure-Time Physical Activity Questionnaire (GSLTPAQ), respectively. RESULTS 32% of the participants were categorized as having CVD symptoms whereas 50% were categorized as at risk of CVD. Fatigue was greater in participants with CVD symptoms than non-CVD participants (p < 0.001), with the score of participants at risk of CVD being intermediate (p ≤ 0.001). QoL was more impaired in participants with CVD symptoms compared to participants at risk of CVD (p < 0.001). In participants with CVD symptoms, there were relationships between fatigue and QoL (p < 0.001) and between physical activity and fatigue (p < 0.001). Despite the relationship between physical activity and QoL not reaching significance (p = 0.067), a lower QoL was found in insufficiently active as compared to active (p < 0.001) and moderately active (p < 0.001) participants with CVD symptoms. CONCLUSIONS Participants self-reporting CVD symptoms suffer from greater fatigue and impaired QoL. In this population, a higher level of physical activity is associated with reduced fatigue and a tendency toward improved QoL.
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Affiliation(s)
- Loïc Espeit
- Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France
| | - Diana Rimaud
- Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France
| | - Franck Le Mat
- Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France
| | - Claire Cudel
- SIGVARIS SAS, Z.I. Sud d'Andrézieux Rue Barthélémy Thimonnier, 42170 St-Just St-Rambert Cedex, France
| | - Isabelle Micol
- SIGVARIS SAS, Z.I. Sud d'Andrézieux Rue Barthélémy Thimonnier, 42170 St-Just St-Rambert Cedex, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU Saint-Etienne, Saint-Etienne, France; INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, SAINBIOSE, UJM Saint-Etienne, F-42055, Saint-Etienne, France; INSERM, CIC1408, CHU Saint-Etienne, F-42055, Saint-Etienne, France
| | - Cyril Chaigneau
- SIGVARIS SAS, Z.I. Sud d'Andrézieux Rue Barthélémy Thimonnier, 42170 St-Just St-Rambert Cedex, France
| | - Guillaume Y Millet
- Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France; Institut Universitaire de France (IUF)
| | - Thomas Lapole
- Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France.
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De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, Giannoukas A, Gohel M, de Graaf R, Hamel-Desnos C, Jawien A, Jaworucka-Kaczorowska A, Lattimer CR, Mosti G, Noppeney T, van Rijn MJ, Stansby G, Esvs Guidelines Committee, Kolh P, Bastos Goncalves F, Chakfé N, Coscas R, de Borst GJ, Dias NV, Hinchliffe RJ, Koncar IB, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, Björck M, Labropoulos N, Lurie F, Mansilha A, Nyamekye IK, Ramirez Ortega M, Ulloa JH, Urbanek T, van Rij AM, Vuylsteke ME. Editor's Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg 2022; 63:184-267. [PMID: 35027279 DOI: 10.1016/j.ejvs.2021.12.024] [Citation(s) in RCA: 242] [Impact Index Per Article: 121.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 01/12/2023]
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10
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Carpentier PH, Satger B, Sandrin B. Patient Education in Spa Resorts: Experience from a French National Program for Patients with Chronic Venous Insufficiency. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031176. [PMID: 35162199 PMCID: PMC8834367 DOI: 10.3390/ijerph19031176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 12/04/2022]
Abstract
The prognosis of chronic venous insufficiency (CVI) is greatly depending upon the ability of the patients to optimize their health-related behaviors (mainly compliance to compression stockings, physical activity and diet). As this is usually challenging for the patients, we developed a therapeutic education program (TEP) aiming at helping them to achieve these optimizations. We report here the preliminary results obtained with this program. This structured TEP was developed by a working group of 15 health professionals to be used during the regular French spa 3-week treatment course for CVI patients. The program included three interactive workshops aiming at improving the patients’ knowledge, skills and motivation, two educational consultations allowing to set and follow-up their personal action plans and a built-in evaluation. It was implemented in spa resorts specialized in CVI. Among the first 150 patients (116 women and 34 men, mean age 69 years old (SD 8 years), 49% had post-thrombotic disease. Compliance to the education workshops was 98%. After a 3-month follow-up, 83% of the patients fully achieved at least one behavioral objective. Quality of life, as assessed by the CIVIQ 2 auto-questionnaire, improved at 3 months (p = 0.0024) and 9 months (p = 0.018). These results demonstrate the feasibility of a TEP for CVI patients and its ability to improve their health-related behaviors, opening the way for the development of similar programs for other chronic diseases in the setting of spa resorts.
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Affiliation(s)
- Patrick H. Carpentier
- Centre de Recherche Universitaire de La Léchère, Université Grenoble-Alpes, 73260 La Léchère, France;
- Correspondence: ; Tel.: +33-4-7922-6265
| | - Bernadette Satger
- Centre de Recherche Universitaire de La Léchère, Université Grenoble-Alpes, 73260 La Léchère, France;
| | - Brigitte Sandrin
- Association Française pour le Développement de l’Education Thérapeutique 18, Passage de la Bonne Graine, 75011 Paris, France;
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11
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Shah R, Sadhu S. Role of physiotherapy interventions in treating varicose veins. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_605_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Gastaldi G, Pannier F, Roztočil K, Lugli M, Mansilha A, Haller H, Rabe E, VAN Rijn MJ. Chronic venous disease and diabetic microangiopathy: pathophysiology and commonalities. INT ANGIOL 2021; 40:457-469. [PMID: 34547884 DOI: 10.23736/s0392-9590.21.04664-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic venous disease and diabetes mellitus are highly prevalent and debilitating conditions affecting millions of individuals globally. Although these conditions are typically considered as separate entities, they often co-exist which may be important in both understanding their pathophysiology and determining the best treatment strategy. Diabetes mellitus is twice as common in patients with chronic venous disease compared with the general population. Notably, a large proportion of patients with diabetes mellitus present with venous disorders, although this is often overlooked. The etiology of chronic venous disease is multifactorial, involving hemodynamic, genetic, and environmental factors which result in changes to the venous endothelium and structural wall as well as inflammation. Inflammation, endothelial dysfunction and hyperfiltration or leakage, are commonly observed in diabetes mellitus and cause various diabetic microvascular complications. Both diseases are also influenced by the increased expression of adhesion molecules, chemokines, and cytokines, and are characterized by the presence of vessel hypertension. Consequently, despite differences in etiology, the pathophysiology of both chronic venous disease and diabetic microangiopathy appears to be driven by endothelial dysfunction and inflammation. Treatment strategies should take the co-existence of chronic venous disease and diabetic microangiopathy into account. Compression therapy is recommended in inflammatory conditions that have an edema component as seen in both chronic venous disease and diabetes mellitus. Lifestyle changes like weight loss and exercise, will improve metabolic state and lower inflammation and should be promoted in these patients. Additionally, both patient populations may benefit from venoactive drugs.
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Affiliation(s)
- Giacomo Gastaldi
- Division of Endocrinology Diabetology Nutrition and Patient Education, Geneva University Hospitals, Geneva, Switzerland
| | - Felizitas Pannier
- Private Clinic Phlebology and Dermatology, Bonn, Germany.,Department of Dermatology, University of Cologne, Cologne, Germany
| | - Karel Roztočil
- Department of Transplantational and Vascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marzia Lugli
- Unit of Vascular Surgery, Cardiovascular Department, Hesperia Hospital, Modena, Italy
| | - Armando Mansilha
- Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Angiology and Vascular Surgery, Hospital de S. João, Porto, Portugal
| | - Hermann Haller
- Hannover Medical School, Department of Nephrology and Hypertension, Hannover, Germany
| | - Eberhard Rabe
- Department of Dermatology (Emeritus), University of Bonn, Bonn, Germany
| | - Marie Josee VAN Rijn
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands -
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13
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Czarnecka J, Kobos E, Sienkiewicz Z. Disease acceptance and social support in patients with peripheral vascular diseases treated in the surgical ward. Nurs Open 2021; 8:2949-2961. [PMID: 34355524 PMCID: PMC8510715 DOI: 10.1002/nop2.1007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/24/2021] [Accepted: 07/10/2021] [Indexed: 11/11/2022] Open
Abstract
Aim The purpose of this study is a comparative analysis of the degree of disease acceptance and social support in patients with peripheral vascular diseases and other medical conditions treated in surgery ward. Design A cross‐sectional study. Methods This cross‐sectional study compares disease acceptance and social support in a group of 212 patients with peripheral vascular diseases and other conditions treated in surgery ward. A standardized Acceptance of Illness Scale (AIS) and Social Support Scale were used to collect the research data. Results Overall, on the AIS, 14% of patients with surgical diseases and 34% of patients with vascular diseases had a low disease acceptance rate. A high level of support was demonstrated in 41% of study participants with surgically treated diseases and in 17% of participants with vascular diseases.
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Affiliation(s)
- Józefa Czarnecka
- Department of Development of Nursing, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Kobos
- Department of Development of Nursing, Social and Medical Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Zofia Sienkiewicz
- Department of Development of Nursing, Social and Medical Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
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14
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Silva KLS, Figueiredo EAB, Lopes CP, Vianna MVA, Lima VP, Figueiredo PHS, Costa HS. The impact of exercise training on calf pump function, muscle strength, ankle range of motion, and health-related quality of life in patients with chronic venous insufficiency at different stages of severity: a systematic review. J Vasc Bras 2021; 20:e20200125. [PMID: 34093685 PMCID: PMC8147883 DOI: 10.1590/1677-5449.200125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exercise training (ET) is an important tool in the management of patients with chronic venous insufficiency (CVI). The objective of this article was to discuss the effects of ET on the calf pump, functional parameters, and quality of life of patients with mild and advanced CVI. A systematic review was conducted and eleven studies were included. In patients with mild CVI, ET was effective for improving venous reflux, muscle strength, ankle range of motion, and quality of life. In advanced CVI patients, ET increased ejection fraction, reduced residual volume fraction, and improved muscle strength and ankle range of motion, but did not change venous reflux indices or quality of life. It is concluded that ET is effective for improving calf pump function, muscle strength, and ankle range of motion in CVI. In patients with mild CVI, additional benefits were observed in quality of life.
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Affiliation(s)
- Keity Lamary Souza Silva
- Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil
| | - Eduardo Augusto Barbosa Figueiredo
- Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil
| | - Cíntia Pimenta Lopes
- Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil
| | | | - Vanessa Pereira Lima
- Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Diamantina, MG, Brasil
| | - Pedro Henrique Scheidt Figueiredo
- Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Diamantina, MG, Brasil
| | - Henrique Silveira Costa
- Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Diamantina, MG, Brasil
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15
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Mosti G, Caggiati A. The effects of water immersion and walking on leg volume, ankle circumference and epifascial thickness in healthy subjects with occupational edema. Phlebology 2021; 36:473-480. [PMID: 33407051 DOI: 10.1177/0268355520984065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Balneotherapy has been considered beneficial in patients with chronic venous disease due to patient-reported positive outcomes on improvement of symptoms and quality of life.Study aim: Assessing the effects of prolonged water immersion (WI) on leg edema and epifascial thickness and to compare these data with those achieved after continuous walking on ground. MATERIAL AND METHODS On three consecutive days, 14 otherwise healthy volunteers (9 females, 5 males, mean age 53 ± 10 years) affected by occupational edema (OE), defined as the edema developing during the time period of the working day and disappearing overnight, stayed standing immobile in a swimming pool for 30 minutes (30'), continuously walking again for 30' in the same pool and walking on ground for 30' without interruptions in a randomized sequence. Leg volume, ankle circumference and epifascial thickness of both legs were assessed each day before and after each intervention. RESULTS Leg volume showed a median reduction by 4.20% (IQR 5-3.6) (p = 0.0002) after 30' of immobile standing immersion and by 6.50% (IQR 7.30-5.61) (P < 0.0001) when the patients walked in the pool. Ankle circumference showed a median reduction by 2.89% (IQR 4.23-2.03) (p = 0.02) with the subjects staying standing still in water and by 5.98% (IQR 7.47-4.14) (p = 0.0002) after 30' walking in the pool. Epifascial thickness showed a median reduction by 24.35% (IQR 35.26-22.5) (P < 0.0001) when the volunteers remained standing still and by 32.66% (IQR 36.91-28-84) (P < 0.0001), when walking in water. Leg volumetry showed a median reduction by 0.20% (IQR-0.44-0.29) (p = 0.375) after walking on ground for 30'. Ankle circumference and epifascial thickness did not show any difference walking on ground compared to baseline situation. CONCLUSIONS This study showed that 30' of WI, especially when associated with walking, reduced leg volume in otherwise heathy subjects with OE and that walking outside the water did not.
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Affiliation(s)
- Giovanni Mosti
- Angiology Department, MD Barbantini Clinic, Lucca, Italy
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16
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Cavezzi A. Medicine and Phlebolymphology: Time to Change? J Clin Med 2020; 9:E4091. [PMID: 33353052 PMCID: PMC7766771 DOI: 10.3390/jcm9124091] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023] Open
Abstract
Biomedical science is undergoing a reappraisal of its scientific advancement process and of the related healthcare management. Progress in medicine should combine improvements of knowledge, efficacy, and safety of diagnostic/therapeutic procedures, with adequate cost-effectiveness profiles. This narrative review is aimed at assessing in medicine, more specifically in phlebology and lymphology: (a) scientific literature possible biases, (b) the level of evidence, comprehensiveness, and cost-effectiveness of the main therapeutic options, and (c) the possible contribution of integrative and translational medicine. Current medical research may have cognitive biases, or industry-tied influences, which impacts clinical practice. Some reductionism, with an increasing use of drugs and technology, often neglecting the understanding and care of the root causative pathways of the diseases, is affecting biomedical science as well. Aging brings a relevant burden of chronic degenerative diseases and disabilities, with relevant socio-economic repercussions; thus, a major attention to cost-effectiveness and appropriateness of healthcare is warranted. In this scenario, costly and innovative but relatively validated therapies may tend to be adopted in venous and lymphatic diseases, such as varicose veins, leg venous ulcer, post-thrombotic syndrome, pelvic congestion syndrome, and lymphedema. Conversely, a more comprehensive approach to the basic pathophysiology of chronic venous and lymphatic insufficiency and the inclusion of pharmacoeconomics analyses would benefit overall patients' management. Erroneous lifestyle and nutrition, together with chronic stress-induced syndromes, significantly influence chronic degenerative phlebo-lymphatic diseases. The main active epigenetic socio-biologic factors are obesity, dysfunctions of musculo-respiratory-vascular pumps, pro-inflammatory nutrition, hyperactivation of stress axis, and sedentarism. An overall critical view of the scientific evidence and innovations in phebolymphology could be of help to improve efficacy, safety, and sustainability of current practice. Translational and integrative medicine may contribute to a patient-centered approach. Conversely, reductionism, eminence/reimbursement-based decisional processes, patients' lack of education, industry-influenced science, and physician's improvable awareness, may compromise efficacy, safety, appropriateness, and cost-effectiveness of future diagnostic and therapeutic patterns of phlebology and lymphology.
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17
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Rabe E, Pannier F. [What is evidence-based in the treatment of chronic venous insufficiency?]. Internist (Berl) 2020; 61:1230-1237. [PMID: 33141265 DOI: 10.1007/s00108-020-00899-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic venous diseases belong to the most frequent diseases. They can be asymptomatic, cause subjective symptoms or lead to objectif alterations, such as edema, cutaneous alterations and venous leg ulcers. This ultimately results in chronic venous insufficiency (CVI). Varicose veins are a progressive degenerative disease of the venous walls in the superficial venous system of the legs, which can decisively impair the quality of life of those affected. The classification of chronic venous diseases is carried out with the CEAP classification according to clinical, etiological, anatomical and pathophysiological criteria. Instruments, such as the venous clinical severity score, are used for assessment of the severity. The treatment of chronic venous diseases targets the improvement of the subjective complaints and objectifiable alterations. In addition, complications, such as phlebitis and formation of ulcers should be avoided. Invasive procedures, compression treatment and pharmaceutical treatment are complementary and a combination of these procedures can be meaningful. General physical measures, such as propping up the legs and frequent walking, are part of the basic measures for every patient with venous diseases. Compression therapy with medical compression stockings is the gold standard in the noninvasive treatment of symptomatic venous diseases, possibly supplemented by anti-inflammatory drugs. A varicose vein should be eliminated whenever possible. Stripping operations and the less invasive endovenous thermal ablation show comparable results for saphenous vein varicosis. Foam sclerotherapy and percutaneous phlebectomy are the methods of choice for elimination of side branch varicosis; however, recurrences of varicose veins are frequent.
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Affiliation(s)
| | - Felizitas Pannier
- Privatpraxis für Dermatologie und Phlebologie, Helmholtzstr. 4, 53123, Bonn, Deutschland. .,Klinik für Dermatologie und Venerologie, Uniklinik Köln, Köln, Deutschland.
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18
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Volpe EFT, Resqueti VR, da Silva AAM, Gualdi LP, Fregonezi GAF. Supervised exercise protocol for lower limbs in subjects with chronic venous disease: an evaluator-blinded, randomized clinical trial. Trials 2020; 21:414. [PMID: 32430078 PMCID: PMC7238730 DOI: 10.1186/s13063-020-04314-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/10/2020] [Indexed: 11/21/2022] Open
Abstract
Background Chronic venous insufficiency (CVI) causes pathophysiological changes in the lower-limb muscles, particularly the calf muscles, and limits ankle range of motion (ROM). These changes reduce functional activities and decrease quality of life (QOL). Although several studies have shown the benefits of exercise (strengthening the calf muscles to improve calf-muscle pumping and QOL) in patients with CVI, few studies are randomized controlled trials. This has led to a weak indication of exercise for the treatment of patients with CVI. The aim of this study is to analyze the effects of a supervised exercise program to improve calf-muscle endurance as well as QOL in patients with CVI. Methods/design This is an evaluator-blind, randomized clinical trial with an 8-week duration and a follow-up evaluation at week 16. A pilot study with subjects with a CVI diagnosis will be performed to calculate sample size. The participants will be randomly allocated (1:1) into a treatment or a control group (usual care/no intervention). The treatment intervention consists of a bi-weekly supervised exercise program of the lower limbs that will include aerobic training, strengthening and cardiovascular exercises. The participants from both groups will participate in a health education lecture. Primary outcomes are changes in calf-muscle endurance and QOL score. Secondary outcomes are changes in exercise capacity, ankle ROM, electrical muscle activity and cardiac output. The first statistical comparison will be performed after 8 weeks’ intervention. Discussion Patients with CVI may have an impaired calf-muscle pump and decreased exercise capacity. A randomized controlled trial evaluating a supervised exercise program should provide much needed information on the management of CVI to promote health and independence. Trial registration This study was registered on the Brazilian Clinical Trials Database (REBEC) (RBR-57xtk7). The results will be disseminated at scientific events, presentations, and publications in peer-reviewed journals.
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Affiliation(s)
- Esther Fernandes Tinoco Volpe
- PneumoCardioVascular Lab/HUOL Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERRH) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Campus Universitário Central, Caixa Postal 1524/ Campus Universitário Lagoa Nova, Natal, Rio Grande do Norte, CEP: 59078-900, Brazil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Vanessa R Resqueti
- PneumoCardioVascular Lab/HUOL Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERRH) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Campus Universitário Central, Caixa Postal 1524/ Campus Universitário Lagoa Nova, Natal, Rio Grande do Norte, CEP: 59078-900, Brazil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Ana Aline Marcelino da Silva
- PneumoCardioVascular Lab/HUOL Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERRH) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Campus Universitário Central, Caixa Postal 1524/ Campus Universitário Lagoa Nova, Natal, Rio Grande do Norte, CEP: 59078-900, Brazil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Lucien Peroni Gualdi
- PneumoCardioVascular Lab/HUOL Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERRH) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Campus Universitário Central, Caixa Postal 1524/ Campus Universitário Lagoa Nova, Natal, Rio Grande do Norte, CEP: 59078-900, Brazil.,Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte (UFRN), Santa Cruz, Rio Grande do Norte, Brazil
| | - Guilherme A F Fregonezi
- PneumoCardioVascular Lab/HUOL Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERRH) Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Campus Universitário Central, Caixa Postal 1524/ Campus Universitário Lagoa Nova, Natal, Rio Grande do Norte, CEP: 59078-900, Brazil. .,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
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19
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The Feasibility of Underwater Computerised Strain Gauge Plethysmography and the Effects of Hydrostatic Pressure on the Leg Venous Haemodynamics. EJVES Vasc Forum 2020; 47:60-62. [PMID: 33078156 PMCID: PMC7276431 DOI: 10.1016/j.ejvsvf.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/04/2020] [Accepted: 05/11/2020] [Indexed: 11/24/2022] Open
Abstract
Background Strain gauge plethysmography (SGP) is employed to evaluate venous drainage of the lower leg. Methods In this study, SGP was used to evaluate the effects of the hydrostatic pressure (HP) of water on venous volume (VV), expelled volume, and ejection fraction (EF) in 22 healthy legs before and during immersion in water. Results HP reduced VV by 100% and even more during underwater (UW) exercise, making calculation of the UW EF possible. Discussion UW SGP is feasible and indicates that HP improves venous haemodynamics. This study suggests that including UW leg exercise in the rehabilitation protocols of patients with chronic venous disease may be useful. Keywords Strain gauge plethysmography, Underwater compression, Underwater ejection fraction, Underwater venous volume. Hydrostatic pressure reduces the volume of the leg. Hydrostatic pressure increases venous emptying from the leg. In underwater conditions, calf pumping further decreases leg volume.
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20
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Gradalski T, Ochalek K. Lay Caregivers Education in Multicomponent Compression Bandaging in Obese Patients with Lower Limb Edema: A Case-Control Pilot Study. Lymphat Res Biol 2020; 18:428-432. [PMID: 32150495 DOI: 10.1089/lrb.2019.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: A report on the usefulness of the instruction of lay carers in multilayer short-stretch compression bandaging within the initial intensive phase physical treatment of mixed-etiology chronic lower limb edema. Methods and Results: In a group of adult obese patients (including 24 females) with venous insufficiency and chronic bilateral lower limb edema, and without a history of physical therapy, 20 (ambulatory managed) were bandaged once daily (four layers, short stretch with cotton tube, and foam padding underneath) for 3 weeks (Monday-Friday) by skilled physiotherapists, and in 20 cases (education group, EG), the patients' lay carers were educated by these physiotherapists according to the same regime during one session. The outcome measures included limb volume (the method of circumference measurement with a tape at 4 cm intervals) after 1, 3, and 6 months, the time to reach the maintenance phase, the frequency of complementary bandaging during this phase, and the sense of self-efficacy (General Self-Efficacy scale, GSEs). No significant differences were noted between the two groups in the baseline measurements of age, body mass, and limb volume. The carers were able to apply compression bandages in all cases during the observation period. The time to reach the maintenance phase was longer in EG (6 vs. 1 weeks; p < 0.001). A similar median reduction in edema volume was observed at the end of the bandaging period, which continued for 3 and 6 months. It was only in EG that further improvement between 1 and 3 months was observed (p = 0.008). All participants represented an equally high optimistic sense of personal competence (GSEs). Conclusions: The instruction of lay carers in bandaging may provide a simple clinically effective solution for lower limb edema management, thus lowering its costs.
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Affiliation(s)
| | - Katarzyna Ochalek
- St Lazarus Hospice, Krakow, Poland.,Department of Clinical Rehabilitation, Faculty of Motor Rehabilitation, University of Physical Education, Krakow, Poland
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21
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Abstract
BACKGROUND Chronic venous insufficiency (CVI) is a progressive and common disease that affects the superficial and deep venous systems of the lower limbs. CVI is characterised by valvular incompetence, reflux, venous obstruction, or a combination of these with consequent distal venous hypertension. Clinical manifestations of CVI include oedema, pain, skin changes, ulcerations and dilated skin veins in the lower limbs. It can result in a large financial burden on health systems. There is a wide variety of treatment options or therapies for CVI, ranging from surgery and medication to compression and physiotherapy. Balneotherapy (treatments involving water) is a relatively cheap option and potentially efficient way to deliver physical therapy for people with CVI. OBJECTIVES To assess the efficacy and safety of balneotherapy for the treatment of people with chronic venous insufficiency (CVI). SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, AMED and CINAHL databases, the World Health Organization International Clinical Trials Registry Platform and the Clinical Trials.gov trials register to August 2018. We searched the LILACS and IBECS databases. We also checked references, searched citations and contacted study authors to identify additional studies. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials comparing balneotherapy with no treatment or other types of treatment for CVI. We also included studies that used a combination of treatments. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed studies retrieved by the search strategies. Both review authors independently assessed selected studies for complete analysis. We resolved conflicts through discussion. We attempted to contact trial authors for missing data, obtaining additional information. For binary outcomes (leg ulcer incidence and adverse events), we presented the results using odds ratio (OR) with 95% confidence intervals (CI). For continuous outcomes (disease severity, health-related quality of life (HRQoL), pain, oedema, skin pigmentation), we presented the results as a mean difference (MD) with 95% CI. MAIN RESULTS We included seven randomised controlled trials with 891 participants (outpatients in secondary care). We found no quasi-randomised controlled trials. Six studies (836 participants) evaluated balneotherapy versus no treatment. One study evaluated balneotherapy versus a phlebotonic drug (melilotus officinalis) (55 participants). There was a lack of blinding of participants and investigators, imprecision and inconsistency, which downgraded the certainty of the evidence.For the balneotherapy versus no treatment comparison, there probably was no improvement in favour of balneotherapy in disease severity signs and symptom score as assessed using the Venous Clinical Severity Score (VCSS) (MD -1.66, 95% CI -4.14 to 0.83; 2 studies, 484 participants; moderate-certainty evidence). Balneotherapy probably resulted in a moderate improvement in HRQoL as assessed by the Chronic Venous Insufficiency Questionnaire 2 (CVIQ2) at three months (MD -9.38, 95% CI -18.18 to -0.57; 2 studies, 149 participants; moderate-certainty evidence), nine months (MD -10.46, 95% CI -11.81 to -9.11; 1 study; 55 participants; moderate-certainty evidence), and 12 months (MD -4.99, 95% CI -9.19 to -0.78; 2 studies, 455 participants; moderate-certainty evidence). There was no clear difference in HRQoL between balneotherapy and no treatment at six months (MD -1.64, 95% CI -9.18 to 5.89; 2 studies, 445 participants; moderate-certainty evidence). Balneotherapy probably slightly improved pain compared with no treatment (MD -1.23, 95% CI -1.33 to -1.13; 1 study; 390 participants; moderate-certainty evidence). There was no clear effect related to oedema between the two groups at 24 days (MD 43.28 mL, 95% CI -102.74 to 189.30; 2 studies, 153 participants; very-low certainty evidence). There probably was no improvement in favour of balneotherapy in the incidence of leg ulcers (OR 1.69, 95% CI 0.82 to 3.48; 2 studies, 449 participants; moderate-certainty evidence). There was probably a reduction in incidence of skin pigmentation changes in favour of balneotherapy at 12 months (pigmentation index: MD -3.59, 95% CI -4.02 to -3.16; 1 study; 59 participants; low-certainty evidence). The main complications reported included erysipelas (OR 2.58, 95% CI 0.65 to 10.22; 2 studies, 519 participants; moderate-certainty evidence), thromboembolic events (OR 0.35, 95% CI 0.09 to 1.42; 3 studies, 584 participants; moderate-certainty evidence) and palpitations (OR 0.33, 95% CI 0.01 to 8.52; 1 study; 59 participants; low-certainty evidence), with no clear evidence of an increase in reported adverse effects with balneotherapy. There were no serious adverse events reported in any of the studies.For the balneotherapy versus a phlebotonic drug (melilotus officinalis) comparison, we observed no clear difference in pain symptoms (OR 0.29, 95% CI 0.03 to 2.87; 1 study; 35 participants; very low-certainty evidence) and oedema (OR 0.21, 95% CI 0.02 to 2.27; 1 study; 35 participants; very low-certainty evidence). This single study did not report on the other outcomes of interest. AUTHORS' CONCLUSIONS We identified moderate- to low-certainty evidence that suggests that balneotherapy may result in a moderate improvement in pain, quality of life and skin pigmentation changes and has no clear effect on disease severity signs and symptoms score, adverse effects, leg ulcers and oedema when compared with no treatment. For future studies, measurements of outcomes such as disease severity sign and symptom score, quality of life, pain and oedema and choice of time points during follow-up must be standardised for adequate comparison between trials.
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Affiliation(s)
- Melissa Andreia de Moraes Silva
- Universidade Federal de São Paulo (UNIFESP)Interdisciplinary Surgical Science ProgramRua Napoleao de Barros, 420São PauloBrazil
| | - Luis CU Nakano
- Universidade Federal de São PauloDepartment of Surgery, Division of Vascular and Endovascular SurgeryRua Borges Lagoa, 754São PauloSão PauloBrazil04038‐001
| | - Lígia L Cisneros
- Universidade Federal de Minas Gerais (UFMG)Department of PhysiotherapyAv. Presidente Antônio Carlos, 6627 Campus ‐ PampulhaBelo HorizonteMinas GeraisBrazil31270‐901
| | - Fausto Miranda Jr
- Paulista School of Medicine ‐ Federal University of São PauloDivision of Vascular and Endovascular Surgery, Department of Surgery515, Estela St, bloco G cj 81São PauloSPBrazil04011‐002
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Caggiati A, Lattimer C, Kalodiki E, Oberto S, Bergamo G, Kontothanassis D. Underwater Sonography of Leg Veins. EJVES Short Rep 2018; 41:13-15. [PMID: 30505960 PMCID: PMC6251367 DOI: 10.1016/j.ejvssr.2018.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/07/2018] [Accepted: 10/22/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Hydrostatic compression (HC) occurring during body immersion is considered beneficial for venous return from the lower limbs. No study has evaluated the effects of HC on the veins of the lower limbs using duplex ultrasound (DU). The purpose of this study was to use DU to evaluate the morphology and flow of the leg veins during immersion. DESIGN The femoral and great saphenous veins were evaluated before and during immersion in a specifically built pool, in normal and varicose limbs. RESULTS HC reduces vein size in both normal and varicose limbs. During immersion spontaneous flow increases whereas when present, blood reflux decreases. DISCUSSION This pilot, proof of concept study has demonstrated the feasibility of DU investigation of leg veins during immersion. Larger series of underwater DU evaluations of normal and varicose legs are necessary to quantify and better explain the effects of HC on the veins of the lower limb.
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Affiliation(s)
| | - Christopher Lattimer
- Josef Pflug Vascular Laboratory, Ealing Hospital and Imperial College & West London Vascular and Interventional Centre, UK
| | - Evi Kalodiki
- Josef Pflug Vascular Laboratory, Ealing Hospital and Imperial College & West London Vascular and Interventional Centre, UK
| | - Sara Oberto
- Department of Vascular Surgery, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
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de Moraes Silva MA, Nakano LCU, Cisneros LL, Miranda Jr F. Balneotherapy for chronic venous insufficiency. Hippokratia 2018. [DOI: 10.1002/14651858.cd013085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Melissa Andreia de Moraes Silva
- Universidade Federal de São Paulo (UNIFESP); Interdisciplinary Surgical Science Program; Rua Napoleao de Barros, 420 São Paulo São Paulo Brazil
| | - Luis CU Nakano
- Escola Paulista de Medicina, Universidade Federal de São Paulo; Vascular Surgery; Rua Borges Lagoa, 754 São Paulo São Paulo Brazil 04038-001
| | - Lígia L Cisneros
- Universidade Federal de Minas Gerais (UFMG); Department of Physiotherapy; Av. Presidente Antônio Carlos, 6627 Campus - Pampulha Belo Horizonte Minas Gerais Brazil 31270-901
| | - Fausto Miranda Jr
- Paulista School of Medicine - Federal University of São Paulo; Division of Vascular and Endovascular Surgery, Department of Surgery; 515, Estela St, bloco G cj 81 São Paulo SP Brazil 04011-002
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