If there is a single best way to dress and treat venous leg ulcers, it can't be confirmed through existing research. That's the conclusion reached by a research group from the federal Agency for Healthcare Research and Quality (AHRQ) after a systematic review that found "little evidence exists" for the effectiveness of one approach over another.
The AHRQ study (.pdf) conducted by the Johns Hopkins University Evidence-Based Practice Center (EPC) focused on advanced wound dressings, systemic antibiotics, and venous surgery to evaluate which approach best facilitated healing. The EPC reviewed more than 10,000 research articles and narrowed its analysis to 60 studies that met research criteria. Methods reviewed included simple wound dressings, advanced wound dressings, dressings that incorporated biological elements such as human skin cells, use of systemic antibiotics, and venous surgery.
In the end, researchers found research lacking and were unable to point to any approach as preferable. "We found a paucity of well-designed well-controlled studies, as well as a lack of standard case definitions or approaches to managing confounders and interactions," the report stated. "Most studies were not blinded, and the results are therefore subject to reporting and ascertainment bias."
Absent from the report is any mention of the role movement can play in the management of venous ulcers. No physical therapists (PTs) were included in the key informant, technical expert, or peer reviewer groups that participated in the creation of the report; however, APTA did provide comments on a draft version of the report just released as well as a separate draft report on future research. In those comments, APTA representatives pointed out that the report on future research needs contained no discussion of exercise and gait training to optimize venous pump as a treatment option, and suggested that exercise prescription or walking to manage venous ulcers be included.
The EPC group will release a "disposition of comments" document 3 months after the online publication of its initial report. APTA will review the current report, disposition information, and report on future research needs to determine the best way to communicate with AHRQ on the benefits of physical activity in treatment.
APTA's Section on Electrophysiology and Wound Management offers resources for PTs interested in the latest developments in this area.
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