A systematic review of community Leg Clubs for patients with chronic leg ulcers

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Abstract

Aim: Appraise the evidence on the outcomes of Leg Clubs on ulcer healing, psychosocial outcomes, patient safety, cost and experiences of Leg Club members.
Background: The Leg Club is a community-based social model of care in 30 UK locations and nine overseas for treating patients with chronic leg wounds. However, its cumulative effectiveness has not been reviewed to date.
Methods: Systematic review of primary research relating to the impact and quality of care of Leg Clubs treating patients with leg ulcers. Six electronic databases were systematically searched using the MeSH term “leg ulcer”, including other representative terms, in combination with “Leg Club”. The quality of individual studies was assessed using appraisal tools. The confidence in the quantitative evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE); and the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) assessed the quality of qualitative findings.
Findings: Seventeen relevant publications were identified. Four out of the 17 articles represent findings from randomised controlled trial (RCT). Thus, evidence from 14 independent studies involving at least 532 participants were included in the synthesis of this review. The quality of the evidence varied across the different outcomes and were mostly low or very low quality. Findings from one underpowered RCT from Australia reporting on clinical, patient-reported outcomes and economic outcomes were evaluated as moderate quality. Studies indicate that the Leg Club model has a positive impact on ulcer healing and recurrence, mood, sleep, quality of life and pain. Moreover, only three studies assessed wound infections reporting no infections had occurred during treatment at the Leg Clubs. Economic evaluations find Leg Clubs to probably be more cost-effective than usual care. Both patients and nurses projected positive views about the Leg Club, with particular emphasis on improved social interactions and delivery of patient-centred care.
Original languageEnglish
Article numberMs. No. PHC-D-17-00073R2
Number of pages20
JournalPrimary Health Care Research and Development
Publication statusAccepted/In press - 22 Jul 2018

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