Impact of home visits on the functional capacity of patients with venous ulcers

Joaquim, Fabiana Lopes; Camacho, Alessandra Conceição Leite Funchal; Sabóia, Vera Maria; Santos, Renata da Costa; Santos, Lívia da Silva Firmino dos; Nogueira, Glycia de Almeida

doi:10.1590/0034-7167.2016690308i

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RESEARCH • Rev. Bras. Enferm. 69 (03) • May-Jun 2016 • https://doi.org/10.1590/0034-7167.2016690308i copy

Impact of home visits on the functional capacity of patients with venous ulcers

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to assess the impact of protocol home visits on the functional capacity of adult and elderly patients with venous ulcers, before and after guidance received at home.

Method:

clinical experimental, randomized, nonblinded and controlled study, developed with 32 patients (case and control groups). Fields of research were the Wound Outpatient Care Unit of the Antônio Pedro University Hospital and households of patients treated in the outpatient unit. Data collection occurred from February to June 2014, by means of an assessment tool of the health care unit, the TINETTI index and a script for directions to be provided to study participants who received home visits.

Results:

participants in the case group showed significant and differentiated improvement post-intervention when compared to the control group, which remained stable.

Conclusion:

directions provided in the home context were beneficial to the members of the case group.

Descriptors:
Nursing Care; Varicose Ulcer; Home Visit; Adult; Aged

Characteristics	Categories	Case group (n = 16)		Control group (n = 16)		P value^a a = χ2 or Fisher’s exact;
Characteristics	Categories	n	%	n	%	P value^a a = χ2 or Fisher’s exact;
Sex	Female	10	62.5	8	50.0	0.48
	Male	6	37.5	8	50.0
Age (years)^* * = expressed by the mean ± SD and compared by Student’s t test for independent samples.		60.1 ± 9.7		66.9 ± 11.6		0.08
Level of education	Functional illiterate	1	6.3	1	6.3	0.99
	Elementary school	9	56.3	8	50.0
	High school	5	31.3	6	37.5
	Higher education	1	6.3	1	6.3
Marital status	Single	3	18.8	2	12.5	0.63
	Married	6	37.5	9	56.3
	Divorced	3	18.8	1	6.3
	Widowed	4	25.0	4	25.0
City	Niterói	8	50.0	7	43.8	0.78
	São Gonçalo	6	37.5	8	50.0
	Itaboraí	2	12.5	1	6.3
Treatment time	6 months to 1 year	4	25.0	6	37.5	0.85
	1 to 5 years	1	6.3	1	6.3
	> 5 years	11	68.8	9	56.3
Number of recurrences	Never	5	31.3	8	50.0	0.45
	1 to 4x	7	43.8	4	25.0
	5 or more	4	25.0	4	25.0

Domains of the Balance Assessment Scale	Response	Before		After		P value^a a = McNemar test;
Domains of the Balance Assessment Scale	Response	n	%	n	%	P value^a a = McNemar test;
D1. Sitting balance	Poor	3	18.8	0	0	0.25
D1. Sitting balance	Good	13	81.2	16	100	0.25
D2. Standing up	Poor	0	0.0	0	0.0	0.50
	Average	13	81.2	11	68.8
	Good	3	18.8	5	31.2
D3. Attempts to stand up	Poor	0	0.0	0	0.0	0.25
	Average	7	43.8	4	25.0
	Good	9	56.2	12	75.0
D4. As soon as standing up	Poor	9	56.3	3	18.8	0.05
	Average	2	12.5	4	25.0
	Good	5	31.3	9	56.2
D5. Standing balance	Poor	3	18.8	1	6.3	0.15
	Average	5	31.2	5	31.3
	Good	8	50.0	10	62.5
D6. Test of three times	Poor	3	18.8	3	18.8	0.31
	Average	3	18.8	2	12.5
	Good	10	62.5	11	68.8
D7. Eyes closed	Poor	5	31.2	2	12.5	0.25
D7. Eyes closed	Good	11	68.8	14	87.5	0.25
D8. Spinning 360° (steps)	Poor	3	18.8	2	12.5	1
D8. Spinning 360° (steps)	Good	13	81.2	14	87.5	1
D8. Spinning 360° (balance)	Poor	4	25.0	3	18.8	1
D8. Spinning 360° (balance)	Good	12	75.0	13	81.2	1
D9. Sitting	Poor	2	12.5	1	6.2	0.60
	Average	6	37.5	7	43.8
	Good	8	50.0	8	50.0
Balance score^* * = expressed by the median (minimum-maximum) and compared by testing the Wilcoxon signed-rank test.		11.5 (3 - 16)		13.5 (4 - 16)		0.004

Domains of the Gait Assessment Scale	Response	Before		After		P value^a a = McNemar test;
Domains of the Gait Assessment Scale	Response	n	%	n	%	P value^a a = McNemar test;
D10. Beginning of gait	Poor	10	62.5	3	18.8	0.016
D10. Beginning of gait	Good	6	37.5	13	81.2	0.016
D11a. Length of steps (right foot)	Poor	1	6.2	1	6.2	1
D11a. Length of steps (right foot)	Good	15	93.8	15	93.8	1
D11a. Height of steps (right foot)	Poor	2	12.5	2	12.5	1
D11a. Height of steps (right foot)	Good	14	87.5	14	87.5	1
D11b. Length of steps (left foot)	Poor	1	6.2	1	6.2	1
D11b. Length of steps (left foot)	Good	15	93.8	15	93.8	1
D11b. Height of steps (left foot)	Poor	2	12.5	2	12.5	1
D11b. Height of steps (left foot)	Good	14	87.5	14	87.5	1
D12. Symmetry of steps	Poor	4	25.0	3	18.8	1
D12. Symmetry of steps	Good	12	75.0	13	81.2	1
D13. Continuity of steps	Poor	6	37.5	4	25.0	0.50
D13. Continuity of steps	Good	10	62.5	12	75.0	0.50
D14. Direction	Poor	1	6.2	0	0	0.25
	Average	8	50.0	7	43.8
	Good	7	43.8	9	56.2
D15. Trunk	Poor	2	12.5	0	0.0	0.25
	Average	5	31.3	6	37.5
	Good	9	56.3	10	62.5
D16. Distance of the ankles	Poor	1	6.2	0	0	1
D16. Distance of the ankles	Good	15	93.8	16	100	1
Gait score^* * = expressed by the median (minimum-maximum) and compared by testing the Wilcoxon signed-rank test.		9 (2 - 11)		10 (4 - 11)		0.002
Total score - TINETTI Index^* * = expressed by the median (minimum-maximum) and compared by testing the Wilcoxon signed-rank test.		20 (5 - 27)		24 (9 - 27)		0.0005

Domains of the Balance Assessment Scale	Response	Before		After		P value^a a = McNemar test; NP: statistical test not processed.
Domains of the Balance Assessment Scale	Response	n	%	n	%
D1. Sitting balance	Poor	0	0	0	0	NP
	Good	16	100	16	100	NP
D2. Standing up	Poor	1	6.3	1	6.3	0.31
	Average	12	75.0	11	68.8
	Good	3	18.8	4	25.0
D3. Attempts to stand up	Poor	1	6.3	1	6.3	1
	Average	4	25.0	4	25.0
	Good	11	68.8	11	68.8
D4. As soon as standing up	Poor	5	31.3	5	31.3	1
	Average	2	12.5	2	12.5
	Good	9	56.3	9	56.3
D5. Standing balance	Poor	3	18.8	3	18.8	1
	Average	2	12.5	2	12.5
	Good	11	68.8	11	68.8
D6. Test of three times	Poor	3	18.8	3	18.8	1
	Average	3	18.8	3	18.8
	Good	10	62.5	10	62.5
D7. Eyes closed	Poor	4	25.0	4	25.0	1
	Good	12	75.0	12	75.0	1
D8. Turning around 360° (steps)	Poor	4	25.0	4	25.0	1
	Good	12	75.0	12	75.0	1
D8. Turning around 360° (balance)	Poor	4	25.0	4	25.0	1
	Good	12	75.0	12	75.0	1
D9. Sitting	Poor	0	0	0	0	1
	Average	5	31.2	5	31.2
	Good	11	68.8	11	68.8
Balance score ^* * = expressed by the median (minimum-maximum) and compared by testing the Wilcoxon signed-rank test.		13 (2 - 16)		13 (2 - 16)		1

Domains of the Gait Assessment Scale	Response	Before		After		P value^a a = McNemar test; NP: statistical test not processed;
Domains of the Gait Assessment Scale	Response	n	%	n	%
D10. Beginning of gait	Poor	5	31.2	5	31.2	1
	Good	11	68.8	11	68.8	1
P11a. Length of steps (right foot)	Poor	4	25.0	4	25.0	1
	Good	12	75.0	12	75.0	1
D11a. Height of steps (right foot)	Poor	5	31.2	5	31.2	1
	Good	11	68.8	11	68.8	1
D11b. Length of steps (left foot)	Poor	3	18.8	3	18.8	1
	Good	13	81.2	13	81.2	1
D11b. Height of steps (left foot)	Poor	9	56.2	9	56.2	1
	Good	7	43.8	7	43.8	1
D12. Symmetry of steps	Poor	7	43.8	7	43.8	1
	Good	9	56.2	9	56.2	1
D13. Continuity of steps	Poor	6	37.5	6	37.5	1
	Good	10	62.5	10	62.5	1
D14. Direction	Poor	2	12.5	2	12.5	1
	Average	6	37.5	6	37.5
	Good	8	50.0	8	50.0
D15. Trunk	Poor	1	6.3	1	6.3	1
	Average	5	31.3	5	31.3
	Good	10	62.5	10	62.5
D16. Distance of the ankles	Poor	0	0	0	0	NP
	Good	16	100	16	100	NP
Score of the gait ^* * = expressed by the median (minimum-maximum) and compared by testing the Wilcoxon signed-rank test.		7.5 (0 - 11)		7.5 (0 - 11)		1
Total score - TINETTI Index^* * = expressa pela mediana (mínimo - máximo) e comparada pelo teste dos postos sinalizados de Wilcoxon.		21.5 (2 - 27)		21.5 (2 - 27)		1

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[1] CORRESPONDING AUTHOR: Fabiana Lopes Joaquim. E-mail: fabykim_enf@yahoo.com.br