Prescribed Exercise With Compression vs Compression Alone in Treating Patients With Venous Leg Ulcers: A Systematic Review and Meta-analysis.

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dc.contributor.author Jull, Andrew en
dc.contributor.author Slark, Julia en
dc.contributor.author Parsons, John en
dc.date.accessioned 2019-11-25T02:22:49Z en
dc.date.issued 2018-11 en
dc.identifier.citation JAMA dermatology 154(11):1304-1311 Nov 2018 en
dc.identifier.issn 2168-6068 en
dc.identifier.uri http://hdl.handle.net/2292/49164 en
dc.description.abstract Importance:Exercise is recommended as an adjuvant treatment for venous leg ulceration (VLU) to improve calf muscle pump function. However, the association of exercise with VLU healing has not been properly aggregated, and the effectiveness of different exercise interventions has not been characterized. Objective:To summarize the association of different exercise interventions with VLU healing when used as an adjuvant to any form of compression. Data Sources:The Cochrane Controlled Trials Register, MEDLINE, Embase, CINAHL, PsycInfo, and SCOPUS databases were searched through October 9, 2017. Study Selection:Randomized clinical trials (RCTs) of any exercise compared with no exercise in participants with VLU were included, where compression was used as standard therapy and a healing outcome was reported. Independent title screening and full text review by 2 authors (A.J., J.S.) with appeal to a third author (J.P.) if disagreement was unresolved. Of the 519 articles screened, a total of 6 (1.2%) studies met the inclusion criteria for systematic review, including 5 for meta-analysis. Data Extraction and Synthesis:Independent quality assessment for Cochrane risk of bias and data extraction by 2 authors with appeal to third author if disagreement unresolved (PRISMA). Data pooled using fixed effects model. Main Outcomes and Measures:The a priori primary outcome was any healing outcome (proportion healed, time to healing, or change in ulcer area). Secondary outcomes (adverse events, costs, and health-related quality of life) were only collected if a primary outcome was reported. Results:Six RCTs were identified and 5 (190 participants) met inclusion criteria for meta-analysis. The exercise interventions were progressive resistance exercise alone (2 RCTs, 53 participants) or combined with prescribed physical activity (2 RCTs, 102 participants), walking only (1 RCT, 35 participants), or ankle exercises (1 RCT, 40 participants). Overall, exercise was associated with increased VLU healing at 12 weeks although the effect was imprecise (additional 14 cases healed per 100 patients; 95% CI, 1-27 cases per 100; P = .04). The combination of progressive resistance exercise plus prescribed physical activity appeared to be most effective, again with imprecision (additional 27 cases healed per 100 patients; 95% CI, 9-45 cases per 100; P = .004). Conclusions and Relevance:The evidence base may now be sufficiently suggestive for clinicians to consider recommending simple progressive resistance and aerobic activity to suitable patients with VLU while further research is produced. en
dc.format.medium Print en
dc.language eng en
dc.relation.ispartofseries JAMA dermatology en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.subject Humans en
dc.subject Varicose Ulcer en
dc.subject Exercise Therapy en
dc.subject Quality of Life en
dc.subject Prescriptions en
dc.subject Compression Bandages en
dc.title Prescribed Exercise With Compression vs Compression Alone in Treating Patients With Venous Leg Ulcers: A Systematic Review and Meta-analysis. en
dc.type Journal Article en
dc.identifier.doi 10.1001/jamadermatol.2018.3281 en
pubs.issue 11 en
pubs.begin-page 1304 en
pubs.volume 154 en
dc.rights.holder Copyright: 2018 American Medical Association en
pubs.end-page 1311 en
pubs.publication-status Published en
dc.rights.accessrights http://purl.org/eprint/accessRights/RestrictedAccess en
pubs.subtype Meta-Analysis en
pubs.subtype research-article en
pubs.subtype Systematic Review en
pubs.subtype Journal Article en
pubs.elements-id 754929 en
pubs.org-id Medical and Health Sciences en
pubs.org-id Nursing en
dc.identifier.eissn 2168-6084 en
pubs.record-created-at-source-date 2018-10-05 en
pubs.dimensions-id 30285080 en


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