Project

Back to overview

The impact of a pluridisciplinary education program on venous leg ulcer size reduction: a randomized controlled trial

English title The impact of a pluridisciplinary education program on venous leg ulcer size reduction: a randomized controlled trial
Applicant Probst Sebastian
Number 185332
Funding scheme Project funding (Div. I-III)
Research institution Haute Ecole de Santé de Genève (HEdS) HES-SO
Institution of higher education University of Applied Sciences and Arts Western Switzerland - HES-SO
Main discipline Health
Start/End 01.02.2020 - 31.01.2023
Approved amount 541'739.00
Show all

Keywords (5)

wound healing; therapy adherence; multidisciplinary; venous leg ulcer; education

Lay Summary (French)

Lead
Chez les patients souffrant d’ulcères veineux de jambes, on note fréquemment un manque de connaissance de ces derniers des causes de leur maladie, ainsi qu’un manque d’adhérence aux thérapies proposées. Cette situation est à l’origine d’un taux de réapparition (récurrence) élevé de ces ulcères ayant des répercussions importantes sur les coûts de la santé. Ce projet vise l’amélioration de la prise en charge de ces patients par une approche éducative pluridisciplinaire.
Lay summary

Résumé

Les ulcères veineux de jambe sont des plaies causées par l’insuffisance veineuse. Ces plaies, touchant principalement les personnes de plus de 65 ans, cicatrisent lentement et reviennent de manière récurrente dans 60 à 70% des cas. Les causes majeures de ce taux élevé de récurrence s’avèrent être liées non seulement à un manque de compréhension et d’adhérence aux traitements de la part des patients, mais aussi à une prise en charge inadéquate de ces patients (temps alloué, transmission d’information) au sein du système de santé actuel. Cette situation engendre des interventions répétées et des temps de cicatrisation prolongés qui ont un impact important sur les dépenses de la santé. La prise en charge des patients souffrant d’ulcères veineux de jambes soulève donc des questions socio-sanitaire et économique pour lesquelles il s’agit de trouver des solutions.   

 

But

Ce projet vise à améliorer la prévention des rechutes d’ulcères veineux des membres inférieurs et la qualité de la prise en charge des patient-e-s atteint-e-s grâce à la mise en place d’un programme d’éducation thérapeutique pluridisciplinaire faisant intervenir les expertises d’infirmiers, de physiothérapeutes et de diététiciens. Les objectifs de ce projet sont de mesurer l’impact d’une telle intervention éducative pluridisciplinaire sur la vitesse de cicatrisation de la plaie, sur la fréquence de récurrence, ainsi que sur l’état de connaissances des patients concernant leur maladie et sur leur adhérence aux thérapies, comme par exemple la thérapie compressive, la pratique d’exercices ou l’adaptation de l’alimentation.

 

Signification

Cette recherche propose de documenter la création d’un programme éducatif pluridisciplinaire destiné aux patient-e-s atteint-e-s d’ulcère veineux de jambe, son implémentation dans la pratique, ainsi que l’évaluation de son efficacité. De plus, dans une perspective de généraliser et de renforcer les résultats, cette analyse s’étendra à un niveau international. En effet, ce projet est le fruit d’une collaboration entre la Suisse et l’Australie. Les résultats de cette étude définiront les exigences nécessaires pour améliorer la prise en charge au niveau de la qualité de vie, la compréhension et l’adhérence aux traitements des patient-e-s atteint-e-s, mais également pour prévenir les récidives et réduire les dépenses de santé. La mise au jour de ces exigences permettra une sensibilisation des personnes actives au niveau décisionnel avec comme perspective d’aboutir à la mise en œuvre d’actions concrètes au sein des institutions dans chacun des pays étudiés.

Direct link to Lay Summary Last update: 22.01.2020

Responsible applicant and co-applicants

Employees

Project partner

Natural persons


Name Institute

Abstract

Background and rationale: Venous leg ulcers (VLU) are slow healing wounds with a recurrence rate of 70% and a 60% risk of becoming chronic. Signs and symptoms such as pain or exudate are not only a burden on those affected but also on the health care system and society in general. The estimated VLU prevalence in the general population is 3%. Treatment cost for VLU is estimated to be 3% of overall health expenditure. Current therapeutic approaches are multifaceted and focus on reducing wound size and improving wound healing as well as preventing ulcer recurrence. Such approaches include compression therapy, leg elevation, specific ankle-exercises and a protein rich diet. They require a pluridisciplinary team of health care professionals from the domains of nursing, medicine, physiotherapy and nutrition. Approximately 70% of VLU patients have a knowledge deficit in regards to therapeutic measures and have difficulties with adherence to treatment protocols. Therefore, it is of utmost importance that the treatment team provides effective patient education and support during the learning phase. However, there are no published studies describing and evaluating the impact of pluridisciplinary educational interventions on adherence to the treatment plan and wound size reduction in VLU patients. Overall objectives: The objectives of the projected study are to evaluate the effectiveness of nurse-led intervention for high-risk patients with VLU in terms of patient knowledge/therapy adherence and to measure the impact of this intervention on wound size reduction and its evolution over time.Specific aims: The effectiveness of the intervention will be defined in terms of changes in behavior (altered adherence to compression therapy, elevation therapy, physical activity therapy, ankle exercise therapy, and protein supplement therapy), and in terms of VLU basic awareness acquisition and wound status evaluation. In addition, occurrence of recurrence after healing and incidence of complications (re-hospitalizations) will be measured (frequency and cost). Methodology of the planned study: An international multicenter randomized controlled trial with 248 participants in three Swiss French (n= 124) and two Australian (n=124) wound clinics is proposed. The study participants will be consecutive patients of the participating clinics who fulfill the inclusion criteria. Wound care will be performed according to the hospital’s standard clinical practice guidelines. Allocation to the intervention group (IG) or the control group (CG) will be concealed. The intervention will consist of VLU patient education care bundle giving patients an opportunity to learn about the use of compression bandages, wearing and putting on compression stockings, and will include the importance of physical activity, ankle exercises, leg elevation and a high-protein diet to healing outcomes. An educational brochure summarizing these aspects will be given to the patients of the IG. This group will be supervised by a study nurse, who will not be identical with the nurse in charge of the control group. Due to the intervention being an educational program, the study cannot be blinded either for the participants or the staff performing the intervention. The sample size assumptions are based on a two-sided alpha level of 0.05, power of 0.8, and a medium effect size. Univariate and bivariate analysis will be conducted according to the data level and distribution.Expected results and impact: The findings of this study will generate new knowledge and the results will contribute to VLU clinical practice guidelines to enhance patient adherence to therapy. Our results will not only help improving patients’ quality of life, but also contribute to reducing health expenditure. Additionally, it is in alignment with the National Strategy on the Prevention of Non-Communicable Diseases 2017 - 2024 establishing prevention work for people with enhanced risks and chronic conditions reinforcing protective factors such as diet and exercise. This pluridisciplinary study (engaging experts in nursing, physiotherapy and nutrition) associates two research centres with high-level expertise in the field of wound care that both successfully conducted and published research results.
-