Emily Beaves

Does lymphatic drainage massage in patients suffering from chronic venous leg ulcers in conjunction with their current clinical treatment improve outcomes?

Background

My project aims to determine if lymphatic drainage massage therapy has tangible benefits to those suffering from chronic venous leg ulcers, but who do not have lymphedema. 

The way I intend to ascertain whether there are benefits of this type of therapy is by recruiting willing patients who have consented into a randomised trial of either receiving lymphatic drainage massage alongside their current treatment, or by continuing with current treatment only. The randomisation will exclude bias and the group not having massage therapy will act as the baseline. A series of quality of life questionnaires will also form part of this project.

I feel that if this project is realised to its full potential, great benefits to nursing care and patient outcomes will manifest.

 

[...] if this project is realised to its full potential, great benefits to nursing care and patient outcomes will manifest

 

The benefits of this could include the ulcers healing at a faster rate; less pain suffered by the patient leading to improved quality of life; one-to-one care by massage therapist which in turn could improve the mental wellbeing of the patient; less antibiotic use due to the shorter length of time the ulcer is present for; reduced hospital admissions; reduced strain on staffing; and as a result of all these elements, a reduced financial strain on the health service.

The absolute priority of this project is to improve the mental and physical wellbeing of those suffering from this painful and debilitating condition.

Aims and objectives

My aims and objectives at the beginning of the project were to develop a research trial, which explored whether lymphatic drainage massage therapy is beneficial to patients suffering from chronic leg ulcers. I felt that my understanding of clinical research was limited, so I wanted to develop a support network, including my Celebrating Nursing Practice mentor, to guide me through the process.

My initial intention was to liaise with staff from leg ulcer groups, massage therapists, patients and lymphedema nurses, and to gain feedback on potential challenges and to see if they would be willing to participate.

I then wanted to start the process of setting up a clinical research trial, but had little knowledge of how this is done, and so needed to learn how clinical research projects are developed. I knew from previous experience that a good starting point is to do literature searches but again, I needed to learn how to do an effective literature search, and so knew I would need assistance with this.

[...] the potential benefits could include length of time reduction of ulcers suffered for, size reduction of ulcers, and as a result a reduced need for medical interventions such as dressings and antibiotics [...]

Activity to date 

  • I contacted a national leg ulcer charity, and spoke to the president of the charity who was keen to learn more about my project, and provided me with names and contacts for local leg ulcer clubs
  • I developed a hand-out for colleagues and participants, explaining my intentions and expectations
  • I arranged meetings with a vascular nurse specialists and lymphatic massage drainage trained breast specialist nurses to gain their feedback
  • I attended a workshop called ‘Finding the evidence’ which provided me with the basic skills to be able to do effective literature searches
  • I gained the position of senior research nurse, and have been supported and advised by my colleagues within the Research and Innovation Department on this project  
  • I have attended many relevant courses such as ‘Good clinical practice’ and ‘Valid informed consent’, and have attended an ethics committee meeting

Outputs to date

  • I have made some useful contacts locally, and gained a positive initial response
  • I have received constructive feedback on my project and this has allowed me to develop my thinking
  • I have been able to conduct my own literature searches and have also had a literature search performed by library staff
  • I am seeking funding to attend a ‘Systematic review’ masterclass, and have also begun to write a research proposal
  • I have begun to think about the project in an increasingly holistic manner, not simply the mechanics of whether lymphatic drainage massage therapy aids in healing chronic leg ulcers, but what that therapy and interaction means to the patient with regards to their quality of life, and as a result I would now like to include quality of life questionnaires

Lessons learned 

I have learnt many lessons so far, the main one being of my own naivety of the processes involved in setting up a professional and ethical clinical research project; the lengthy process involved and the challenges I would face. 

As a result of taking up the role as research nurse, I have been able to learn the processes in detail and re-focus on what I need to do to progress my project.

I have learnt that there are a lot of challenges to face in breaking down barriers within the workplace, and that people are not always as enthusiastic as I am about change within health care. As a result, I have worked on my communication skills in order to ascertain people’s concerns, address them and to make clear my expectations of others and myself.

 

[...] there are a lot of challenges to face in breaking down barriers within the workplace, and that people are not always as enthusiastic as I am about change within health care
 

I now make a conscious effort to be more welcoming of constructive criticisms of aspects of the project, as to begin with I had a tendency to see these as negative. I am changing my way of thinking to utilise these observations as tools for improvement. By learning this at the early stages of the project, it is allowing me to avoid problems further down the line.

No individual activity that I set out to do was specifically unachievable. I feel I have the drive and flexibility to be able to adapt to the challenges that I have faced. Overall, I feel the project has been slower to develop than I would have liked it to have been, but I am satisfied that the project will be a higher quality and a more valid piece of work as a result of ensuring it meets the professional expectations and regulations of valid clinical research.

Reflections on impact

I feel that if this project is successful in the longer term, it will show valid and tangible evidence of improvements in leg ulcer healing and the quality of life of the patients participating.

If it is shown to be a worthwhile therapy within leg ulcers, the potential benefits could include length of time reduction of ulcers suffered for, size reduction of ulcers, and as a result a reduced need for medical interventions such as dressings and antibiotics which in turn could lead to increased patient comfort and mood as well as cost savings for the health care system.

I feel that currently the way in which this result would need to be measured would be by randomisation of massage treatment versus no massage treatment, and a comparison of outcomes over a period of time within the two groups.

massaging foot of elderly person


The way forward

 If this project proves to be successful, I would continue to work towards proving the financial benefit of implementing lymphatic drainage massage therapists into areas where chronic leg ulcers are commonly treated. This is something I will consider whilst designing the trial methodology. I will be looking to ascertain costs as well as wound healing aspects and the quality of life of the patient. If I can show solid evidence of the benefits of the project, then I feel that this could become an addition to standard care in the wider population.

Sustain momentum embed the project

I intend to sustain momentum by continually driving this project forward and by utilising all networking opportunities possible. I feel that awareness, ease of use and education are the main factors in maintaining a successful change within health care, and I would strive to provide these aspects if the project is proven to be successful going forward.

 

[…] awareness, ease of use and education are the main factors in maintaining a successful change within health care