Authors (including presenting author) :
Tsang T (1), Chan O (1), Or C (1), Soo A (1), Fan HL (1), Chan N (1), Lo J (1), Ip B (1), Kwong S (1), Yu H (2), Ng M (2), Hui E (2)
Affiliation :
(1) Physiotherapy Department, (2) Department of Surgery, Ruttonjee and Tang Shiu Kin Hospitals
Introduction :
Calf muscle weakness and tightness are common in Chronic Venous Insufficiency (CVI) patients which predisposes to disease progression. Evidence confirmed exercises that facilitate venous return, muscle pump efficiency and ankle joint flexibility; modification of activities and comorbidity management are beneficial. Physiotherapists has been attending patients on operative day after admission to provide pre-operative education and prescribe graduated compression stockings for post-operative management all along. An enhanced physiotherapy session aiming to address disease modifiable factors was launched in December 2020 for patients planning for surgery.
Objectives :
1. To improve the strength and flexibility of calf muscle of CVI patients via specific exercise program
2. To empower patients on disease modifiable factors
3. To enhance PT service on operative management in CVI patients
Methodology :
CVI patients planning for varicose vein operation were referred for physiotherapy CVI prehabilitation exercise programme within 3 weeks after attending vascular clinic. Initial assessment including CEAP classification, calf circumference, ankle range of motion(ROM), lower limb and calf muscle strength were assessed. CVI-specific strengthening and stretching exercises were prescribed with education pamphlet. Graduated compression stocking with education on usage was prescribed for oedema control. On operation date after patient admission, reassessment was conducted. Preoperative and postoperative education, graduated compression stockings and exercises were given.
Result & Outcome :
72 patients underwent varicose veins surgery between December 2020 to December 2022, including 35 with unilateral disease (UD) and 37 with bilateral disease (BD). The calf circumference, ankle active ROM on dorsiflexion and plantarflexion, and lower limb muscle strength by 30-second sit-to-stand test (STST) and calf raise test in both groups showed significant improvement (p < 0.01) except ankle dorsiflexion in BD group (p=0.02) and ankle plantarflexion in UD group (p=0.17).
Conclusion
This pilot prehabilitation exercise program provided relevant exercise training and education for CVI patients who are waiting for surgery. Improvement in lower limb strength, flexibility, ankle AROM and leg edema were demonstrated, and hence symptom control with concepts of disease modifiable factors. Service coverage expanding to the non-operative CVI patient group could be further explored to prevent disease progression.
