Abstract

Purpose: The purpose of this case study and evidence based literature analysis is to determine the effect of exercise on symptoms due to venous insufficiency in those with post-thrombotic syndrome (PTS). Background: Post-thrombotic syndrome (PTS) is the most common long-term complication from a deep vein thrombosis (DVT). PTS is a form of venous insufficiency that occurs in an area that has previously been diagnosed with a DVT. PTS can greatly affect an individual's quality of life and requires, sometimes frequent, medical attention. Common symptoms can range from minor to severe and include: leg swelling, limb pain, intractable edema, leg ulceration, and skin changes. Although there has been advancement in the medical field with prevention of DVT, it still affects 1 to 3 of 1,000 people in the general population annually, and studies have shown that 20% to 50% of those develop PTS. The use of compression stockings and/or pharmacotherapy is a popular subject in PTS research; however, research on exercise as an effective treatment is less available. Case Description: This study is based on a 61-year-old female presenting to the emergency room in November 2015 with complaints of severe abdominal pain. She was then admitted to the hospital under inpatient status to undergo a cholecystectomy. Following surgery, this patient was evaluated by a physical therapist and deemed inappropriate for discharge at that time due to nausea and high level of pain. This patient then complained of right popliteal pain with an insidious onset and had a positive Homan's sign on the right as assessed by a physical therapist. Shortly after onset of pain, this patient was positively diagnosed with a DVT and was placed on anticoagulants. This patient's course of treatment inspired the following PICO question: for those patients who have suffered a DVT and have been diagnosed with post-thrombotic syndrome, does a regular exercise program versus no exercise at all decrease frequency and severity of symptoms due to venous insufficiency? Outcomes: A review of current literature showed that there is limited research available on exercise and PTS. Analysis of literature was extended to include the effects exercise has on venous insufficiency and venous ulceration. Several studies were analyzed and all produced similar results: exercise is not harmful for those with venous insufficiency and/or PTS and can be a beneficial treatment that may improve patients' quality of life in a variety of ways. Discussion: Of all 9 articles analyzed, one crucial piece of information was clear: exercise is safe for those with venous insufficiency and/or PTS. Overall, these articles showed that exercise either has no effect or has a positive effect on those suffering from venous insufficiency and/or PTS. Favorable effects of exercise include improved calf muscle pump function, calf muscle strength, calf muscle endurance, ankle ROM, severity of symptoms, patient reported pain, ability to perform ADLs, and quality of life. In addition, studies addressing individuals with venous ulceration, due to venous insufficiency, exercise showed to promote increased healing of ulceration. Based on the preceding evidence, exercise should be considered as an adjunct to medical treatment for venous insufficiency, including those diagnosed with PTS. Exercise aimed at lower body strengthening and conditioning will prove to be beneficial for this patient and should be considered as an outpatient treatment following her DVT. Further research should be conducted to address specific exercise guidelines for those diagnosed with PTS.

Provenance

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Document Type

Capstone

First Advisor

Fred Carey

Keywords

Exercise Therapy; Post-Thrombotic Syndrome, Deep Vein Thrombosis

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