title: Identifying risk factors and protective factors for venous leg ulcer recurrence using a theoretical approach: A longitudinal study.
abstract: BACKGROUND
  The high recurrence rate of chronic venous leg ulcers has a significant impact on an individual's quality of life and healthcare costs.
  
  
  OBJECTIVE
  This study aimed to identify risk and protective factors for recurrence of venous leg ulcers using a theoretical approach by applying a framework of self and family management of chronic conditions to underpin the study.
  
  
  METHODS
  Secondary analysis of combined data collected from three previous prospective longitudinal studies.
  
  
  METHODS
  The contributing studies' participants were recruited from two metropolitan hospital outpatient wound clinics and three community-based wound clinics.
  
  
  METHODS
  Data were available on a sample of 250 adults, with a leg ulcer of primarily venous aetiology, who were followed after ulcer healing for a median follow-up time of 17 months after healing (range: 3-36 months).
  
  
  METHODS
  Data from the three studies were combined. The original participant data were collected through medical records and self-reported questionnaires upon healing and every 3 months thereafter. A Cox proportion-hazards regression analysis was undertaken to determine the influential factors on leg ulcer recurrence based on the proposed conceptual framework.
  
  
  RESULTS
  The median time to recurrence was 42 weeks (95% CI 31.9-52.0), with an incidence of 22% (54 of 250 participants) recurrence within three months of healing, 39% (91 of 235 participants) for those who were followed for six months, 57% (111 of 193) by 12 months, 73% (53 of 72) by two years and 78% (41 of 52) of those who were followed up for three years. A Cox proportional-hazards regression model revealed that the risk factors for recurrence included a history of deep vein thrombosis (HR 1.7, 95% CI 1.07-2.67, p=0.024), history of multiple previous leg ulcers (HR 4.4, 95% CI 1.84-10.5, p=0.001), and longer duration (in weeks) of previous ulcer (HR 1.01, 95% CI 1.003-1.01, p<0.001); while the protective factors were elevating legs for at least 30min per day (HR 0.33, 95% CI 0.19-0.56, p<0.001), higher levels of self-efficacy (HR 0.95, 95% CI 0.92-0.99, p=0.016), and walking around for at least 3h/day (HR 0.66, 95% CI 0.44-0.98, p=0.040).
  
  
  CONCLUSIONS
  Results from this study provide a comprehensive examination of risk and protective factors associated with leg ulcer recurrence based on the chronic disease self and family management framework. These results in turn provide essential steps towards developing and testing interventions to promote optimal prevention strategies for venous leg ulcer recurrence.
authors: School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. Electronic address: k.finlayson@qut.edu.au.
authors: Kathleen
authors: K
authors: Finlayson
authors: School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia.
authors: Min-Lin
authors: ML
authors: Wu
authors: Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
authors: Helen E
authors: HE
authors: Edwards
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D014647:Varicose Ulcer / Q000503:physiopathology*
keywords: Chronic disease; Protective factor; Recurrence; Risk factor; Venous leg ulcer