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Factors Affecting Patient Adherence to Recommended Measures for Prevention of Recurrent Venous Ulcers

Shannon, Mary M.; Hawk, Joyce; Navaroli, LaTroy; Serena, Thomas

Journal of Wound, Ostomy and Continence Nursing: May/June 2013 - Volume 40 - Issue 3 - p 268–274
doi: 10.1097/WON.0b013e318285081a

PURPOSE: The purpose of the study was to describe patients' adherence to clinical recommendations for preventing recurrent venous leg ulcers (VLUs).

DESIGN: A cross-sectional study design was used for data collection.

SUBJECTS AND SETTING: The target population comprised patients discharged from 7 wound clinics with a healed VLU within 1 to 24 months prior to treatment for a recurrent VLU. Six of the wound clinics used for data collection were based in hospital outpatient departments and 1 were community based. Seventy-one patients participated in the study; 59% were male. Participants' mean age was 67 6 14 years (mean 6 SD).

METHODS: Participants completed a confidential anonymous questionnaire administered by wound care clinicians at each site. The 27-item questionnaire was developed by the investigators. Items on the questionnaire addressed multiple issues relevant to VLU recurrence, including compliance with compression stockings, leg elevation, and changes in medical condition. Items on the questionnaire also addressed satisfaction with education about prevention of VLU recurrence and subject demographics.

RESULTS : The majority of the patients (73%) reported wearing their stockings every day and elevating their legs (87%) as instructed. Sixteen respondents (25%) reported a weight gain since their last visit to the clinic; 9 reported weight gain varying from 10 to 50 pounds. Most of the patients (90%) were satisfied that they received sufficient information at discharge to care for their legs.

CONCLUSION: Seventy-three percent of patients with recurrent VLUs stated that they were adhering to recommendations for regular use of compression stockings in order to prevent recurrence. However, significant weight gain was reported by 25% of respondents. These findings suggest that prevention of weight gain should be examined as a possible intervention to prevent VLU recurrence in future studies.

Supplemental Digital Content is Available in the Text.

Mary M. Shannon, DNP, CRNP, CWOCN, Shannon Wound Care Consultants LLC. Chicora, Pennsylvania.

Joyce Hawk, FNP-BC, CWCN, Hawk Wound Care Consulting LLC. Pittsburgh, Pennsylvania.

LaTroy Navaroli, DNP, CRNP, CWS, Navaroli Medical. Warren, Pennsylvania.

Thomas Serena, MD, CEO/Medical Director, SerenaGroup. Cambridge, Massachusetts.

Correspondence: Mary M. Shannon, DNP, CRNP, CWOCN, 318 Conerty Rd, Chicora, PA 16025 (

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

Copyright © 2013 by the Wound, Ostomy and Continence Nurses Society