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Cifuentes-Rodríguez JE, Guerrero-Gamboa S. Intervenciones de estilo de vida en pacientes con úlceras venosas y su asociación con la cicatrización: scoping review. Hacia Promoc. Salud [Internet]. 1 de julio de 2021 [citado 25 de abril de 2024];26(2):211-34. Disponible en: https://revistasojs.ucaldas.edu.co/index.php/hacialapromociondelasalud/article/view/5186
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Johana Enyd Cifuentes-Rodríguez
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Sandra Guerrero-Gamboa
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Objetivos: identificar y describir la evidencia disponible sobre intervenciones de estilo de vida diseñadas para promover la cicatrización y prevenir la recurrencia de úlceras venosas. Métodos: scoping review guiada por el marco metodológico de Arksey y O’Malley, de estudios de intervención publicados entre los años 2008-2020 en idioma inglés, español y portugués en las bases de datos PubMed, Cochrane Library y CINAHL, utilizando las palabras clave: venous leg ulcer, lifestyle intervention, nutritional support, exercise, wound healing, recurrence. Resultados: veinte estudios fueron incluidos en la síntesis. La mayoría de las intervenciones se enfocaron en promover el ejercicio y analizar sus efectos en la cicatrización de las úlceras venosas. Solo cuatro estudios de intervención abordaron el aspecto nutricional de estos pacientes y apenas tres determinaron la recurrencia. Los hallazgos son limitados debido a la diversidad en la concepción y ejecución de las intervenciones disponibles además de las muestras pequeñas en los estudios. Conclusiones: la evidencia existente sugiere que las intervenciones que promueven la actividad física y el ejercicio podrían tener un efecto beneficioso en la cicatrización y prevención de recurrencia de úlceras venosas, sin embargo, falta una base sólida de evidencia en intervenciones de estilo de vida para estos pacientes. La investigación actual proporciona algunas ideas sobre los componentes específicos que deben considerarse al planificar tales intervenciones en el futuro.
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1. Kelechi TJ, Johnson JJ, Yates S. Chronic venous disease and venous leg ulcers: An evidence-based update. J Vasc Nurs [Internet]. 2015;33(2):36-46. Available from: http://dx.doi.org/10.1016/j.jvn.2015.01.003
2. Marinel.lo Roura J, Verdú-Soriano J. Conferencia Nacional de Consenso sobre las Úlceras de la Extremidad Inferior (CONUEI) Documento de consenso 2018 [Internet]. 2nd ed. Ergon, editor. C.O.N.U.E.I. Madrid, España; 2018. 146 p.Disponible en https://www.aeev.net/guias/CONUEI2018AEEVH.pdf
3. Weller CD, Buchbinder R, Johnston RV. Interventions for helping people adhere to compression treatments for venous leg ulceration. Cochrane Database Syst Rev. 2016;2016(3).
4. Green J, Jester R, McKinley R, Pooler A. The impact of chronic venous leg ulcers: a systematic review. J Wound Care [Internet]. 2014;23(12):601-12. Available from http://www.ncbi.nlm.nih.gov/pubmed/25492276
5. Phillips P, Lumley E, Duncan R, Aber A, Woods H, Jones G, et al. A Systematic Review of Qualitative Research into people´s experiences of living with venous leg ulcers. J Adv Nurs. 2018;74(3):550-63.
6. Onida S, Davies AH. Predicted burden of venous disease. Phlebology. 2016;31:74-9.
7. O’Donnell TF, Passman MA, Marston WA, Ennis WJ, Dalsing M, Kistner RL, et al. Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg.2014;60(2):3S-59S.
8. Evans R, Kuhnke JL, Burrows C, Kayssi A, Labrecque C, O’Sullivan-Drombolis D, et al. Best Practice Recommendations for the Prevention and Management of Venous Leg Ulcers. 2019. Report No.: A supplement of Wound Care Canada.
9. Asociación Española de Enfermería Vascular y Heridas. Guía de Práctica Clínica. Consenso sobre úlceras vasculares y pie diabético de la Asociación Española de Enfermería Vascular y Heridas (AEEVH). Tercera. Madrid, España; 2017 p. 140.
10. Harding K, Dowsett C, Fias L, Jelnes R, Mosti G, Oien R, et al. Simplifying Venous Leg Ulcer Management [Internet]. 2015. Available from www.woundsinternational.com
11. Nelson EA, Bell-Syer SEM. Compression for preventing recurrence of venous ulcers. Cochrane database Syst Rev. 2014;9(22):CD002303.
12. Jindal R, Dekiwadia DB, Krishna PR, Khanna AK, Patel MD, Padaria S. Evidence-Based Clinical Practice Points for the Management of Venous Ulcers. Indian J Surg. 2018;80(2):171-82.
13. Wounds UK. Best Practice Statement: Addressing complexities in the management of venous leg ulcers. [Internet]. London; 2019 p. 5-30. Available from www.wounds-uk.com
14. Nettel F, Rodríguez N, Nigro J, González M, Conde A, Muñoa A, et al. Primer consenso latinoamericano de úlceras venosas. Rev Mex Angiol [Internet]. 2013;41(1):95-126. Disponible en http://www.medigraphic.com/pdfs/revmexang/an-2013/an133b.pdf
15. Heinen MM, van Achterberg T, op Reimer WS, van de Kerkhof PCM, de Laat E. Venous leg ulcer patients: a review of the literature on lifestyle and pain-related interventions. J Clin Nurs [Internet]. 2004;13(3):355-66. Available from http://0-search.ebscohost.com.topcat.switchinc.org/login.aspx?direct=true&AuthType=cookie,ip,cpid&custid=s8470807&db=mnh&AN=15009338&site=ehost-live&scope=site
16. Parker CN, Finlayson KJ, Shuter P, Edwards HE. Risk factors for delayed healing in venous leg ulcers: A review of the literature. Int J Clin Pract. 2015;69(9):967-77.
17. Milic DJ, Zivic SS, Bogdanovic DC, Karanovic ND, Golubovic Z V. Risk factors related to the failure of venous leg ulcers to heal with compression treatment. J Vasc Surg [Internet]. 2009;49(5):1242-7. Available from http://dx.doi.org/10.1016/j.jvs.2008.11.069
18. Gohel MS, Taylor M, Earnshaw JJ, Heather BP, Poskitt KR, Whyman MR. Risk factors for delayed healing and recurrence of chronic venous leg ulcers - An analysis of 1324 legs. Eur J Vasc Endovasc Surg. 2005;29(1):74-7.BIREME)
19. Robertson L, Lee AJ, Gallagher K, Carmichael SJ, Evans CJ, McKinstry BH, et al. Risk factors for chronic ulceration in patients with varicose veins: A case control study. J Vasc Surg [Internet]. 2009;49(6):1490-8. Available from http://dx.doi.org/10.1016/j.jvs.2009.02.237
20. O’Brien J, Finlayson K, Kerr G, Edwards H. Evaluating the effectiveness of a self-management exercise intervention on wound healing, functional ability and health-related quality of life outcomes in adults with venous leg ulcers: A randomisedcontrolled trial. Int Wound J. 2017;14(1):130-7.
21. Klonizakis M, Tew GA, Gumber A, Crank H, Middleton G, Michaels JA. Supervised exercise training as an adjunct therapy for venous leg ulcers: a randomised controlled feasibility trial. Br J Dermatol. 2017;12(10):3218-21.
22. Heinen M, Borm G, Van der Vleuten C, Evers A, Oostendorp R, Van Achterberg T. The Lively Legs self-management programme increased physical activity and reduced wound days in leg ulcer patients: Results from a randomized controlledtrial. Int J Nurs Stud [Internet]. 2012;49(2):151-61. Available from http://dx.doi.org/10.1016/j.ijnurstu.2011.09.005
23. Domingues EAR, Cavalcanti MC e SL, Costa PCP da, Lopes MHB de M, Monteiro I, Alexandre NMC. Pain prevalence, socio-demographic and clinical features in patients with chronic ulcers. J Tissue Viability. 2016;25(3):180-4.
24. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):1-7.
25. Arksey H, O’Malley L. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32.
26. Jull A, Slark J, Parsons J. Prescribed exercise with compression vs compression alone in treating patients with venous leg ulcers a systematic review and meta-analysis. JAMA Dermatology. 2018;154(11):1304-11.
27. Smith D, Lane R, McGinnes R, O’Brien J, Johnston R, Bugeja L, et al. What is the effect of exercise on wound healing in patients with venous leg ulcers? A systematic review. Int Wound J. 2018;15(3):441-53.
28. The Joanna Briggs Institute. New JBI Levels of Evidence [Internet]. New JBI Levels of Evidence. 2013. p. 1-8. Available from http://joannabriggs.org/assets/docs/approach/JBI-Levels-of-evidence_2014.pdf
29. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 2018;169(7):467-73.
30. Kapp S, Miller C, Sayers V, Donohue L. The Leg Ulcer Prevention Program: effectiveness of a multimedia client education package for people with venous leg ulcers. Wound Pract Res [Internet]. 2010;18(2):80. Available from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=c8h&AN=2010698205&site=ehostlive&custid=s4121186
31. Van Hecke A, Grypdonck M, Beele H, Vanderwee K, Defloor T. Adherence to leg ulcer lifestyle advice: Qualitative and quantitative outcomes associated with a nurse-led intervention. J Clin Nurs. 2011;20(3-4):429-43.
32. Domingues E, Oliveira U, Lima MHM. Effectiveness of the strategies of an orientation programme for the lifestyle and wound-healing process in patients with venous ulcer: A randomised controlled trial. Int Wound J. 2018;15(5):798-806.
33. González A. Education Project to Improve Venous Stasis Self-management Knowledge. J Wound Ostomy Cont Nurs. 2014;41(6):556-9.
34. Gonzalez A. The Effect of a Patient Education Intervention on Knowledge and Venous Ulcer Recurrence: Results of a Prospective Intervention and Retrospective Analysis. Ostomy Wound Manag. 2017;63(6):16-28.
35. Jull A, Parag V, Walker N, Maddison R, Kerse N, Johns T. The PREPARE pilot RCT of home-based progressive resistance exercises for venous leg ulcers. J Wound Care. 2009;18(2):497-503.
36. Kelechi TJ, Green A, Dumas B, Brotherton SS. Online coaching for a lower limb physical activity program for individuals at home with a history of venous ulcers. Home Healthc Nurse [Internet]. 2010;28(10):596-605. Available from http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=21057229&site=ehost-live
37. Kelechi TJ, Mueller M, Spencer C, Rinard B, Loftis G. The effect of a nurse-directed intervention to reduce pain and improve behavioral and physical outcomes in patients with critically colonized/infected chronic leg ulcers. J Wound,Ostomy Cont Nurs. 2014;41(2):111-21.
38. Szewczyk MT, Jawień A, Cwajda-białasik J, Cierzniakowska K, Mościcka P, Hancke E. Randomized study assessing the influence of supervised exercises on ankle joint mobility in patients with venous leg ulcerations. Arch Med Sci. 2010;6(6):956-63.
39. Meagher H, Ryan D, Clarke-Moloney M, O’Laighin G, Grace PA. An experimental study of prescribed walking in the management of venous leg ulcers. J Wound Care [Internet]. 2012;21(9):421-430 10p. Available from http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=104067384&site=ehost-live&scope=site
40. O’Brien J, Edwards H, Stewart I, Gibbs H. A home-based progressive resistance exercise programme for patients with venous leg ulcers: A feasibility study. Int Wound J. 2012;10(4):389-96.
41. Klonizakis MD, Tew GA, Gumber A, Crank H, King B, Middleton G, et al. Supervised exercise training as an adjunct therapy for venous leg ulcers : a randomized controlled feasibility trial. Br J Dermatol. 2018;178:1072-82.
42. Mutlak O, Aslam M, Standfield NJ. An investigation of skin perfusion in venous leg ulcer after exercise. Perfus (United Kingdom). 2018;33(1):25-9.
43. Mutlak O, Aslam M, Standfield N. The influence of exercise on ulcer healing in patients with chronic venous insufficiency. Int Angiol. 2018;37(2):160-8.
44. Burkiewicz CJ, Guadagnin FA, Skare TL, do Nascimento M, Servin SC, de Souza GD. Vitamin D and skin repair: a prospective, double-blind and placebo controlled study in the healing of leg ulcers. Rev do Col Bras cirugioes.2012;39(5):401-7.
45. Franciscis S De, Sarro G De, Longo P, Buffone G, Molinari V, Stillitano DM, et al. Hyperhomocysteinaemia and chronic venous ulcers. Int Wound J. 2013;12:22-6.
46. Soriano JV, Gómez TS, Bermejo M, López P, Arboledas J, Carrasco J, et al. Efecto de un suplemento nutricional específico (Balnimax®) en la cicatrización de úlceras de la extremidad inferior de etiología venosa y úlceras por presión.Gerokomos [Internet]. 2015;27(1):27-32. Disponible en http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-928X2016000100007&lng=es.
47. Serra R, Grande R, Butrico L, Buffone G, Caliò FG, Squillace A, et al. Effects of a new nutraceutical substance on clinical and molecular parameters in patients with chronic venous ulceration. Int Wound J. 2016;13:88-96.
48. Barwell JR, Taylor M, Deacon J, Davies C, Whyman MR, Poskitt KR. Ankle motility is a risk factor for healing of chronic venous leg ulcers. Phlebology. 2001;16(1):38-40.
49. Fox J, Baquerizo-Nole K, Freedman J, Liu S, Van Driessche F, Yim E, et al. Ankle Range of Motion, Leg Pain, and Leg Edema Improvement in Patients With Venous Leg Ulcers. JAMA Dermatology. 2016;152(4):472-4.
50. 50. Younas A, Quennell S. Usefulness of nursing theory-guided practice: an integrative review. Scand J Caring Sci. 2019;2(7).
51. Kelly M, Gethin G. Prevalence of Chronic Illness and Risk Factors for Chronic Illness Among Patients With Venous Leg Ulceration: A Cross-Sectional Study. Int J Low Extrem Wounds. 2019.
52. Yang GK, Cao S, Kayssi A, Dueck AD, Alavi A. Critical Evaluation of Delayed Healing of Venous Leg Ulcers: A Retrospective Analysis in Canadian Patients. Am J Clin Dermatol. 2016;17(5):539-44.
53. Walburn J, Weinman J, Norton S, Hankins M, Dawe K, Banjoko B, et al. Stress, Illness Perceptions, Behaviours and Healing in Venous Leg Ulcers: Findings From a Prospective Observational Study. Psychosom Med [Internet]. 2017;79(June):585-92. Available from https://www.ncbi.nlm.nih.gov/pubmed/27941577 54. Prochaska JJ, Prochaska JO. A Review of Multiple Health Behavior Change Interventions for Primary Prevention. AmJpournal Lifestyle Med. 2011;5(3):1-21.
55. Williams KJ, Ayekoloye O, Moore HM, Davies AH. The calf muscle pump revisited. J Vasc Surg [Internet]. 2014;2(3):1-6. Available from http://dx.doi.org/10.1016/j.jvsv.2013.10.053
56. Yim E, Richmond NA, Baquerizo K, Van Driessche F, Slade HB, Pieper B, et al. The effect of ankle range of motion on venous ulcer healing rates. Wound Repair Regen. 2014;22(4):492-6.
2. Marinel.lo Roura J, Verdú-Soriano J. Conferencia Nacional de Consenso sobre las Úlceras de la Extremidad Inferior (CONUEI) Documento de consenso 2018 [Internet]. 2nd ed. Ergon, editor. C.O.N.U.E.I. Madrid, España; 2018. 146 p.Disponible en https://www.aeev.net/guias/CONUEI2018AEEVH.pdf
3. Weller CD, Buchbinder R, Johnston RV. Interventions for helping people adhere to compression treatments for venous leg ulceration. Cochrane Database Syst Rev. 2016;2016(3).
4. Green J, Jester R, McKinley R, Pooler A. The impact of chronic venous leg ulcers: a systematic review. J Wound Care [Internet]. 2014;23(12):601-12. Available from http://www.ncbi.nlm.nih.gov/pubmed/25492276
5. Phillips P, Lumley E, Duncan R, Aber A, Woods H, Jones G, et al. A Systematic Review of Qualitative Research into people´s experiences of living with venous leg ulcers. J Adv Nurs. 2018;74(3):550-63.
6. Onida S, Davies AH. Predicted burden of venous disease. Phlebology. 2016;31:74-9.
7. O’Donnell TF, Passman MA, Marston WA, Ennis WJ, Dalsing M, Kistner RL, et al. Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg.2014;60(2):3S-59S.
8. Evans R, Kuhnke JL, Burrows C, Kayssi A, Labrecque C, O’Sullivan-Drombolis D, et al. Best Practice Recommendations for the Prevention and Management of Venous Leg Ulcers. 2019. Report No.: A supplement of Wound Care Canada.
9. Asociación Española de Enfermería Vascular y Heridas. Guía de Práctica Clínica. Consenso sobre úlceras vasculares y pie diabético de la Asociación Española de Enfermería Vascular y Heridas (AEEVH). Tercera. Madrid, España; 2017 p. 140.
10. Harding K, Dowsett C, Fias L, Jelnes R, Mosti G, Oien R, et al. Simplifying Venous Leg Ulcer Management [Internet]. 2015. Available from www.woundsinternational.com
11. Nelson EA, Bell-Syer SEM. Compression for preventing recurrence of venous ulcers. Cochrane database Syst Rev. 2014;9(22):CD002303.
12. Jindal R, Dekiwadia DB, Krishna PR, Khanna AK, Patel MD, Padaria S. Evidence-Based Clinical Practice Points for the Management of Venous Ulcers. Indian J Surg. 2018;80(2):171-82.
13. Wounds UK. Best Practice Statement: Addressing complexities in the management of venous leg ulcers. [Internet]. London; 2019 p. 5-30. Available from www.wounds-uk.com
14. Nettel F, Rodríguez N, Nigro J, González M, Conde A, Muñoa A, et al. Primer consenso latinoamericano de úlceras venosas. Rev Mex Angiol [Internet]. 2013;41(1):95-126. Disponible en http://www.medigraphic.com/pdfs/revmexang/an-2013/an133b.pdf
15. Heinen MM, van Achterberg T, op Reimer WS, van de Kerkhof PCM, de Laat E. Venous leg ulcer patients: a review of the literature on lifestyle and pain-related interventions. J Clin Nurs [Internet]. 2004;13(3):355-66. Available from http://0-search.ebscohost.com.topcat.switchinc.org/login.aspx?direct=true&AuthType=cookie,ip,cpid&custid=s8470807&db=mnh&AN=15009338&site=ehost-live&scope=site
16. Parker CN, Finlayson KJ, Shuter P, Edwards HE. Risk factors for delayed healing in venous leg ulcers: A review of the literature. Int J Clin Pract. 2015;69(9):967-77.
17. Milic DJ, Zivic SS, Bogdanovic DC, Karanovic ND, Golubovic Z V. Risk factors related to the failure of venous leg ulcers to heal with compression treatment. J Vasc Surg [Internet]. 2009;49(5):1242-7. Available from http://dx.doi.org/10.1016/j.jvs.2008.11.069
18. Gohel MS, Taylor M, Earnshaw JJ, Heather BP, Poskitt KR, Whyman MR. Risk factors for delayed healing and recurrence of chronic venous leg ulcers - An analysis of 1324 legs. Eur J Vasc Endovasc Surg. 2005;29(1):74-7.BIREME)
19. Robertson L, Lee AJ, Gallagher K, Carmichael SJ, Evans CJ, McKinstry BH, et al. Risk factors for chronic ulceration in patients with varicose veins: A case control study. J Vasc Surg [Internet]. 2009;49(6):1490-8. Available from http://dx.doi.org/10.1016/j.jvs.2009.02.237
20. O’Brien J, Finlayson K, Kerr G, Edwards H. Evaluating the effectiveness of a self-management exercise intervention on wound healing, functional ability and health-related quality of life outcomes in adults with venous leg ulcers: A randomisedcontrolled trial. Int Wound J. 2017;14(1):130-7.
21. Klonizakis M, Tew GA, Gumber A, Crank H, Middleton G, Michaels JA. Supervised exercise training as an adjunct therapy for venous leg ulcers: a randomised controlled feasibility trial. Br J Dermatol. 2017;12(10):3218-21.
22. Heinen M, Borm G, Van der Vleuten C, Evers A, Oostendorp R, Van Achterberg T. The Lively Legs self-management programme increased physical activity and reduced wound days in leg ulcer patients: Results from a randomized controlledtrial. Int J Nurs Stud [Internet]. 2012;49(2):151-61. Available from http://dx.doi.org/10.1016/j.ijnurstu.2011.09.005
23. Domingues EAR, Cavalcanti MC e SL, Costa PCP da, Lopes MHB de M, Monteiro I, Alexandre NMC. Pain prevalence, socio-demographic and clinical features in patients with chronic ulcers. J Tissue Viability. 2016;25(3):180-4.
24. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):1-7.
25. Arksey H, O’Malley L. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32.
26. Jull A, Slark J, Parsons J. Prescribed exercise with compression vs compression alone in treating patients with venous leg ulcers a systematic review and meta-analysis. JAMA Dermatology. 2018;154(11):1304-11.
27. Smith D, Lane R, McGinnes R, O’Brien J, Johnston R, Bugeja L, et al. What is the effect of exercise on wound healing in patients with venous leg ulcers? A systematic review. Int Wound J. 2018;15(3):441-53.
28. The Joanna Briggs Institute. New JBI Levels of Evidence [Internet]. New JBI Levels of Evidence. 2013. p. 1-8. Available from http://joannabriggs.org/assets/docs/approach/JBI-Levels-of-evidence_2014.pdf
29. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 2018;169(7):467-73.
30. Kapp S, Miller C, Sayers V, Donohue L. The Leg Ulcer Prevention Program: effectiveness of a multimedia client education package for people with venous leg ulcers. Wound Pract Res [Internet]. 2010;18(2):80. Available from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=c8h&AN=2010698205&site=ehostlive&custid=s4121186
31. Van Hecke A, Grypdonck M, Beele H, Vanderwee K, Defloor T. Adherence to leg ulcer lifestyle advice: Qualitative and quantitative outcomes associated with a nurse-led intervention. J Clin Nurs. 2011;20(3-4):429-43.
32. Domingues E, Oliveira U, Lima MHM. Effectiveness of the strategies of an orientation programme for the lifestyle and wound-healing process in patients with venous ulcer: A randomised controlled trial. Int Wound J. 2018;15(5):798-806.
33. González A. Education Project to Improve Venous Stasis Self-management Knowledge. J Wound Ostomy Cont Nurs. 2014;41(6):556-9.
34. Gonzalez A. The Effect of a Patient Education Intervention on Knowledge and Venous Ulcer Recurrence: Results of a Prospective Intervention and Retrospective Analysis. Ostomy Wound Manag. 2017;63(6):16-28.
35. Jull A, Parag V, Walker N, Maddison R, Kerse N, Johns T. The PREPARE pilot RCT of home-based progressive resistance exercises for venous leg ulcers. J Wound Care. 2009;18(2):497-503.
36. Kelechi TJ, Green A, Dumas B, Brotherton SS. Online coaching for a lower limb physical activity program for individuals at home with a history of venous ulcers. Home Healthc Nurse [Internet]. 2010;28(10):596-605. Available from http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=21057229&site=ehost-live
37. Kelechi TJ, Mueller M, Spencer C, Rinard B, Loftis G. The effect of a nurse-directed intervention to reduce pain and improve behavioral and physical outcomes in patients with critically colonized/infected chronic leg ulcers. J Wound,Ostomy Cont Nurs. 2014;41(2):111-21.
38. Szewczyk MT, Jawień A, Cwajda-białasik J, Cierzniakowska K, Mościcka P, Hancke E. Randomized study assessing the influence of supervised exercises on ankle joint mobility in patients with venous leg ulcerations. Arch Med Sci. 2010;6(6):956-63.
39. Meagher H, Ryan D, Clarke-Moloney M, O’Laighin G, Grace PA. An experimental study of prescribed walking in the management of venous leg ulcers. J Wound Care [Internet]. 2012;21(9):421-430 10p. Available from http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=104067384&site=ehost-live&scope=site
40. O’Brien J, Edwards H, Stewart I, Gibbs H. A home-based progressive resistance exercise programme for patients with venous leg ulcers: A feasibility study. Int Wound J. 2012;10(4):389-96.
41. Klonizakis MD, Tew GA, Gumber A, Crank H, King B, Middleton G, et al. Supervised exercise training as an adjunct therapy for venous leg ulcers : a randomized controlled feasibility trial. Br J Dermatol. 2018;178:1072-82.
42. Mutlak O, Aslam M, Standfield NJ. An investigation of skin perfusion in venous leg ulcer after exercise. Perfus (United Kingdom). 2018;33(1):25-9.
43. Mutlak O, Aslam M, Standfield N. The influence of exercise on ulcer healing in patients with chronic venous insufficiency. Int Angiol. 2018;37(2):160-8.
44. Burkiewicz CJ, Guadagnin FA, Skare TL, do Nascimento M, Servin SC, de Souza GD. Vitamin D and skin repair: a prospective, double-blind and placebo controlled study in the healing of leg ulcers. Rev do Col Bras cirugioes.2012;39(5):401-7.
45. Franciscis S De, Sarro G De, Longo P, Buffone G, Molinari V, Stillitano DM, et al. Hyperhomocysteinaemia and chronic venous ulcers. Int Wound J. 2013;12:22-6.
46. Soriano JV, Gómez TS, Bermejo M, López P, Arboledas J, Carrasco J, et al. Efecto de un suplemento nutricional específico (Balnimax®) en la cicatrización de úlceras de la extremidad inferior de etiología venosa y úlceras por presión.Gerokomos [Internet]. 2015;27(1):27-32. Disponible en http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-928X2016000100007&lng=es.
47. Serra R, Grande R, Butrico L, Buffone G, Caliò FG, Squillace A, et al. Effects of a new nutraceutical substance on clinical and molecular parameters in patients with chronic venous ulceration. Int Wound J. 2016;13:88-96.
48. Barwell JR, Taylor M, Deacon J, Davies C, Whyman MR, Poskitt KR. Ankle motility is a risk factor for healing of chronic venous leg ulcers. Phlebology. 2001;16(1):38-40.
49. Fox J, Baquerizo-Nole K, Freedman J, Liu S, Van Driessche F, Yim E, et al. Ankle Range of Motion, Leg Pain, and Leg Edema Improvement in Patients With Venous Leg Ulcers. JAMA Dermatology. 2016;152(4):472-4.
50. 50. Younas A, Quennell S. Usefulness of nursing theory-guided practice: an integrative review. Scand J Caring Sci. 2019;2(7).
51. Kelly M, Gethin G. Prevalence of Chronic Illness and Risk Factors for Chronic Illness Among Patients With Venous Leg Ulceration: A Cross-Sectional Study. Int J Low Extrem Wounds. 2019.
52. Yang GK, Cao S, Kayssi A, Dueck AD, Alavi A. Critical Evaluation of Delayed Healing of Venous Leg Ulcers: A Retrospective Analysis in Canadian Patients. Am J Clin Dermatol. 2016;17(5):539-44.
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