Identifying risk factors and protective factors for venous leg ulcer recurrence using a theoretical approach: A longitudinal study

• Published in: International journal of nursing studies 2015-06, Vol.52 (6), p.1042-1051
• Main Authors: Finlayson, Kathleen, Wu, Min-Lin, Edwards, Helen E.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Chronic disease; Chronic illnesses; Female; Health care expenditures; Humans; Leg Ulcer - physiopathology; Legs; Longitudinal Studies; Male; Middle Aged; Nursing; Preventive medicine; Protective factor; Quality of life; Recurrence; Risk factor; Risk Factors; Varicose Ulcer - physiopathology; Venous leg ulcer
• ISSN: 0020-7489; 1873-491X
• DOI: 10.1016/j.ijnurstu.2015.02.016

The high recurrence rate of chronic venous leg ulcers has a significant impact on an individual's quality of life and healthcare costs. This study aimed to identify risk and protective factors for recurrence of venous leg ulcers using a theoretical approach by applying a framework of self and family management of chronic conditions to underpin the study. Secondary analysis of combined data collected from three previous prospective longitudinal studies. The contributing studies’ participants were recruited from two metropolitan hospital outpatient wound clinics and three community-based wound clinics. Data were available on a sample of 250 adults, with a leg ulcer of primarily venous aetiology, who were followed after ulcer healing for a median follow-up time of 17 months after healing (range: 3–36 months). Data from the three studies were combined. The original participant data were collected through medical records and self-reported questionnaires upon healing and every 3 months thereafter. A Cox proportion-hazards regression analysis was undertaken to determine the influential factors on leg ulcer recurrence based on the proposed conceptual framework. The median time to recurrence was 42 weeks (95% CI 31.9–52.0), with an incidence of 22% (54 of 250 participants) recurrence within three months of healing, 39% (91 of 235 participants) for those who were followed for six months, 57% (111 of 193) by 12 months, 73% (53 of 72) by two years and 78% (41 of 52) of those who were followed up for three years. A Cox proportional-hazards regression model revealed that the risk factors for recurrence included a history of deep vein thrombosis (HR 1.7, 95% CI 1.07–2.67, p=0.024), history of multiple previous leg ulcers (HR 4.4, 95% CI 1.84–10.5, p=0.001), and longer duration (in weeks) of previous ulcer (HR 1.01, 95% CI 1.003–1.01, p