title: Effect of physical therapy on wound healing and quality of life in patients with venous leg ulcers: a systematic review.
abstract: OBJECTIVE
  Patients with venous leg ulcers (VLUs) have calf muscle pump dysfunction, which is associated with reduced ankle range of motion (ROM). Physical therapy or exercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. However, little is known regarding the effect of physical therapy or exercise on healing and quality of life (QOL), which is impaired in patients with VLUs.
  
  
  OBJECTIVE
  To systematically review the current literature on the effect of physical therapy on healing and QOL outcomes in patients with VLUs and to identify research gaps that warrant further investigation.
  
  
  METHODS
  PubMed (MEDLINE), CINAHL, and Cochrane databases were searched in April 2014.
  
  
  RESULTS
  We found 10 articles, consisting of randomized clinical trials and single-arm cohort studies with small sample sizes, that used physical therapy or exercise for patients with open or healed VLUs. Although there is evidence that exercise strengthens the calf muscle pump and improves ankle ROM, few studies have investigated the effect of these interventions on QOL and healing, and few involved the supervision of a physical therapist.
  
  
  CONCLUSIONS
  The lack of evidence and randomized clinical trials suggests the need for further investigation on physical therapy-oriented exercise on wound healing and QOL. In addition, more studies are needed to investigate sustainability of the increased ankle ROM after physical therapy has ended or if VLU reoccurrences are prevented.
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Yim
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kirsner
authors.affiliation: Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Gailey
authors.affiliation: Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: David W
authors.initials: DW
authors.lastname: Mandel
authors.affiliation: Division of Dermatology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia4Department of Dermatology, Emory University, Atlanta, Georgia.
authors.forename: Suephy C
authors.initials: SC
authors.lastname: Chen
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Marjana
authors.initials: M
authors.lastname: Tomic-Canic
mesh_terms: D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D026741:Physical Therapy Modalities; D011788:Quality of Life; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000473:pathology / Q000628:therapy*; D014945:Wound Healing / Q000502:physiology