The Effect of a Nurse-Directed Intervention to Reduce Pain and Improve Behavioral and Physical Outcomes in Patients With Critically Colonized/Infected Chronic Leg Ulcers

Abstract

We compared a WOC nurse-directed, patient-centered intervention called MECALF (motivational enhancement and conditioning activity for leg function) compared to conditioning activities for lower leg function (CALF) alone. Outcomes were study feasibility, pain, motivation, self-efficacy, physical activity, leg strength, and range of motion. Comparative study. The sample was drawn from 2 wound centers in the Southeastern United States. Twenty-one patients (n = 12 MECALF site A and n = 9 CALF site B) with painful lower legs and critically colonized/infected wounds participated in the study. All patients received usual wound care per center protocol. The MECALF intervention was delivered by WOC nurses for 6 weeks at site A and a handout of CALF depicting the conditioning activities was provided by site staff (not WOC nurses) to patients at site B. We assessed study feasibility with postsurvey questionnaires given to WOC nurses (training usefulness, ease of use of ME with patients) and subjects (able to perform activities, use logs). Pre- and postintervention outcome data were collected by study staff using pain, motivation, and self-efficacy scales, functional measures of physical activity, and physical measures of strength and range of motion. The study was found to be somewhat feasible by the WOC nurses and patients. WOC nurses had time management problems using MECALF during usual patient care. Patients reported that they were able to perform CALF. Overall pain was statistically significantly reduced (P = .046) in both groups of patients with painful critically colonized/infected leg ulcers measured at week 8, 2 weeks after the study period. The CALF group experienced a slightly greater reduction in pain intensity than did the MECALF group. No statistically significant differences between the groups were observed in behavioral outcomes for motivation (P = .641) and self-efficacy (P = .643), or for physical outcomes including overall ankle strength (P = .609) and ankle range of motion (P = .498). Functional and physical activity scores revealed no statistically significant differences in 3 measures, including Timed Up and Go test (P = .624), Timed Chair Standing Test (P = .686), or the Community Health Activities Model for Seniors (P = .803). While somewhat feasible to implement in the wound care setting, no improvement in outcomes was observed with the addition of the WOC nurse-directed intervention. However, pain in the lower legs of patients with critically colonized/infected wounds in both groups improved after a 6-week behavioral/physical activity intervention. A larger trial is needed to further elucidate these findings.