title: Nurse-led education sets out to improve patient concordance and prevent recurrence of leg ulcers.
abstract: OBJECTIVE
  This study evaluated the effects of a structured nurse-led education programme that aimed to improve patient concordance and prevent venous leg ulcer recurrence.
  
  
  METHODS
  The design was quasi-experimental. Subjects (average age: 80) had venous leg ulceration that had healed within the previous two years, and were cared for at home by a district nurse. Data were available on 49 patients with 97 legs, 72 of which had had venous leg ulcers. Patients were divided into two groups: a control group, which received 'usual' care, and experimental group, which was exposed to the education programme. Recurrence rates, the effects of the education on patient behaviour and the effect on recurrence of having both ankle movement and general mobility were measured over one year.
  
  
  RESULTS
  Patients in the experimental group experienced significantly less recurrence over the year (log rank test = 8.28, p = 0.004). To control for differences in mobility and ankle movement in the control and experimental groups at baseline, simultaneous logistic regression analysis was undertaken. This revealed a significant advantage for patients in the experimental group (p = 0.035; OR = 4.45, 95% CI = 1.11-17.74), who spent more time with their legs elevated each day. This difference was sustained throughout the 52 weeks (f = 2.88, p = 0.015). Those who had both full ankle movement (> 60 degrees) and full mobility (without aid) had significantly less recurrence (p = 0.042). Education had no significant effect on the amount of time patients wore compression hosiery (f = 2.1).
  
  
  CONCLUSIONS
  A structured nurse-led patient concordance programme is effective in preventing venous leg ulcer recurrence and increasing the time patients spend with their legs elevated at heart level. Having both full ankle movement and full mobility reduces the risk of recurrence.
authors.affiliation: Continuing Care Services, Oxfordshire Primary Care Trusts, UK. jill.brooks@sepcttr.nhs.uk
authors.forename: J
authors.initials: J
authors.lastname: Brooks
authors.forename: S J
authors.initials: SJ
authors.lastname: Ersser
authors.forename: A
authors.initials: A
authors.lastname: Lloyd
authors.forename: T J
authors.initials: TJ
authors.lastname: Ryan
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003479:Curriculum; D004509:Education, Nursing, Continuing / Q000458:organization & administration; D005260:Female; D015577:Geriatric Assessment; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D007871:Leg Ulcer / Q000517:prevention & control / Q000523:psychology; D016015:Logistic Models; D008297:Male; D015402:Nursing Education Research; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000458:organization & administration*; D015397:Program Evaluation; D011637:Public Health Nursing / Q000193:education / Q000458:organization & administration*; D016059:Range of Motion, Articular; D012008:Recurrence