title: Relationships between preventive activities, psychosocial factors and recurrence of venous leg ulcers: a prospective study.
abstract: OBJECTIVE
  The aim of this study was to identify relationships between preventive activities, psychosocial factors and leg ulcer recurrence in patients with chronic venous leg ulcers.
  
  
  BACKGROUND
  Chronic venous leg ulcers are slow to heal and frequently recur, resulting in years of suffering and intensive use of healthcare resources.
  
  
  METHODS
  A prospective longitudinal study was undertaken with a sample of 80 patients with a venous leg ulcer recruited when their ulcer healed. Data were collected from 2006 to 2009 from medical records on demographics, medical history and ulcer history; and from self-report questionnaires on physical activity, nutrition, preventive activities and psychosocial measures. Follow-up data were collected via questionnaires every 3 months for 12 months after healing. Median time to recurrence was calculated using the Kaplan-Meier method. A Cox proportional-hazards regression model was used to adjust for potential confounders and determine effects of preventive strategies and psychosocial factors on recurrence.
  
  
  RESULTS
  There were 35 recurrences in a sample of 80 participants. Median time to recurrence was 27 weeks. After adjustment for potential confounders, a Cox proportional hazards regression model found that at least an hour/day of leg elevation, 6 or more days/week in Class 2 (20-25 mmHg) or 3 (30-40 mmHg) compression hosiery, higher social support scale scores and higher General Self-Efficacy scores remained significantly associated (P < 0·05) with a lower risk of recurrence, while male gender and a history of deep vein thrombosis remained statistically significant risk factors for recurrence.
  
  
  CONCLUSIONS
  Results indicate that leg elevation, compression hosiery, high levels of self-efficacy and strong social support will help prevent recurrence.
authors.affiliation: Research Fellow Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia. k.finlayson@qut.edu.au
authors.forename: Kathleen
authors.initials: K
authors.lastname: Finlayson
authors.forename: Helen
authors.initials: H
authors.lastname: Edwards
authors.forename: Mary
authors.initials: M
authors.lastname: Courtney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015444:Exercise / Q000502:physiology / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D007866:Leg / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011584:Psychology; D012307:Risk Factors; D055502:Secondary Prevention; D012648:Self Care / Q000379:methods* / Q000523:psychology; D020377:Self Efficacy; D012944:Social Support; D053828:Stockings, Compression / Q000706:statistics & numerical data; D013997:Time Factors; D014647:Varicose Ulcer / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D014689:Venous Insufficiency / Q000150:complications / Q000453:epidemiology; D014945:Wound Healing / Q000502:physiology