Effect of Physical Therapy on Wound Healing and Quality of Life in Patients With Venous Leg Ulcers: A Systematic Review

IMPORTANCE: Patients with venous leg ulcers (VLUs) have calf muscle pump dysfunction, which is associated with reduced ankle range of motion (ROM). Physical therapy or exercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. However, little is known regarding the effect of physical therapy or exercise on healing and quality of life (QOL), which is impaired in patients with VLUs. OBJECTIVES: To systematically review the current literature on the effect of physical therapy on healing and QOL outcomes in patients with VLUs and to identify research gaps that warrant further investigation. EVIDENCE REVIEW: PubMed (MEDLINE), CINAHL, and Cochrane databases were searched in April 2014. FINDINGS: We found 10 articles, consisting of randomized clinical trials and single-arm cohort studies with small sample sizes, that used physical therapy or exercise for patients with open or healed VLUs. Although there is evidence that exercise strengthens the calf muscle pump and improves ankle ROM, few studies have investigated the effect of these interventions on QOL and healing, and few involved the supervision of a physical therapist. CONCLUSIONS AND RELEVANCE: The lack of evidence and randomized clinical trials suggests the need for further investigation on physical therapy–oriented exercise on wound healing and QOL. In addition, more studies are needed to investigate sustainability of the increased ankle ROM after physical therapy has ended or if VLU reoccurrences are prevented.