Health systems are slow to embrace the long-term chronic disease management and health promotion approach needed for effective management of older adults with peripheral vascular disease, who experience years of leg ulceration and recurrence cycles. Leg ulcers are costly and slow to heal, frequently leading to prolonged ill-health and loss of independence for around 1% of adults, with incidence increasing with age (O'Meara, Cullum, Nelson, & Dumville, 2012). The average ulcer duration is over six months and up to 70% recur after healing (Edwards et al., 2013). The highest rates of recurrence are within three months of healing (Finlayson, Wu, & Edwards, 2015), suggesting that comprehensive assessment and tailored interventions around the time of healing is vital. In addition, the high rates of recurrence can result in significant health care expenditure to treat, prevent, or decelerate the progression of the disease (Kolluri, 2014; Spentzouris & Labropoulos, 2009; Weller, Buchbinder, & Johnston, 2013). The purpose of this study was to evaluate the outcomes from a ‘Best Foot Forward’ (BFF) program which aimed to increase client self-care knowledge of their underlying peripheral vascular disease, improve adherence to preventive activities, and prevent leg ulcer recurrence.
Methods
A longitudinal study was undertaken with clients who attended a community based wound clinic for care of a lower leg ulcer. All clients whose leg ulcer was healed between Oct 2012–Dec 2013 were invited to participate in the Best Foot Forward program and return to the follow-up clinic every three months. The Best Foot Forward program consisted of three aspects: regular ‘well-leg’ clinical assessments after healing; monthly workshops for clients and family for education and peer support; and provision of practical resources to prevent ulcer recurrence. Data were collected on demographic factors, medical history, health, lower limb clinical assessment, psychosocial variables, and client knowledge, self-management and satisfaction with the service. Kaplan-Meier survival curves and Cox proportional hazards regression were used to examine the time to ulcer recurrence and the influence of the BFF program, health service use, preventive treatments and psychosocial factors on recurrence.
Results
Of 93 eligible clients, 39 (42%) agreed to participate in the BFF program. There were no significant differences found in socio-demographic factors or ulcer duration in clients who attended the BFF program, compared to those who did not participate. However, being the primary caregiver for another family member was significantly associated with attending. Mean time to ulcer recurrence was 18.8 weeks (95% CI 9.2–28.4) for clients who did not attend the BFF program, compared to 63.2 weeks (95% CI 59.6–66.7) for those who attended the program (Log-rank test =38.58, p<0.001). Cox regression analysis found both the ulcer aetiology (p=0.006) and the BFF program (p<0.001) significantly influenced time to recurrence. Positive feedback and adherence to self-management activities were recorded at high rates (76%–91%).
Conclusions
This early work suggests that the triad of interventions have potential in reducing ulcer recurrence rates and promoting effective long term management of peripheral vascular disease.
See more of: Research Sessions: Oral Paper & Posters