Identifying risk factors and protective factors for venous leg ulcer recurrence using a theoretical approach : a longitudinal study

Finlayson, Kathleen, Wu, Min-Lin, & Edwards, Helen E. (2015) Identifying risk factors and protective factors for venous leg ulcer recurrence using a theoretical approach : a longitudinal study. International Journal of Nursing Studies, 52(6), pp. 1042-1051.

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The high recurrence rate of chronic venous leg ulcers has a significant impact on an individual’s quality of life and healthcare costs.


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.


Secondary analysis of combined data collected from three previous prospective longitudinal studies.


The contributing studies’ participants were recruited from two metropolitan hospital outpatient wound clinics and three community-based wound clinics.


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 to 36 months).


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.


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 30 minutes 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 three hours/day (HR 0.66, 95% CI 0.44–0.98, p=0.040).


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.

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ID Code: 82321
Item Type: Journal Article
Refereed: Yes
Keywords: chronic disease, risk factor, ulcer recurrence, venous leg ulcers
DOI: 10.1016/j.ijnurstu.2015.02.016
ISSN: 0020-7489
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Nursing
Copyright Owner: Copyright 2015 Published by Elsevier Ltd.
Copyright Statement: NOTICE: this is the author’s version of a work that was accepted for publication in International Journal of Nursing Studies. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in International Journal of Nursing Studies, [VOL#, ISSUE#, (DATE)] DOI: 10.1016/j.ijnurstu.2015.02.016
Deposited On: 08 Mar 2015 23:00
Last Modified: 05 Jun 2016 20:47

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