Venous leg ulcer patients: a review of the literature on lifestyle and pain‐related interventions

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Abstract
Background. Having a leg ulcer has a major impact on daily life. Lifestyle is mentioned in most leg ulcer guidelines but mostly without much emphasis on the subject. Aims and objectives. Evidence for the effect of nutrition, leg elevation and exercise on the healing of leg ulcers was reconsidered. Furthermore, the evidence for effective pain‐related interventions was investigated. Design. Systematic literature review. Methods. Medline, Cinahl, Psychinfo and Cochrane were searched for studies on pain related interventions, and the effectiveness of leg elevation, leg exercise and nutritional interventions in patients with venous leg ulceration. Results. Some evidence was found to support a positive effect of leg exercises on the endurance and power of the calf muscle and on the haemodynamic status of the limb. There is also evidence for a positive effect of leg elevation during bed rest without compression. No hard evidence was found concerning the effect of enriched or altered nutrition on wound healing. However, there is some evidence of nutritional deficits in this patient group. The use of eutectic mixture of local anaesthetic cream is effective for reducing pain in wound debridement, but pain relief in daily life is insufficiently treated. Conclusion. There is no real evidence of effectiveness of the investigated lifestyle interventions but there are indications that lifestyle interventions might contribute to healing or prevention of venous leg ulceration. Relevance to clinical practice. Although there is no hard evidence, it can be expected that interventions such as nutritional monitoring, guided exercise and leg elevation will have a substantial impact on wound healing in patients with venous leg ulceration. The use of eutectic mixture of local anaesthetic cream can be advised for pain relief with wound debridement. The current lack of effective pain treatment with venous leg ulceration emphasizes the need for effective pain treatment.