Authors (including presenting author) :
Yau LYD(1), Yu HYH(2), Lau CMJ(3), Mak YM(1), Ng YS(1), Ng HY(1), Pun TW(1), Tsang HL(1), Yu KH(1), Wong MYA(1)
Affiliation :
(1)Occupational Therapy Department, Ruttonjee and Tang Shiu Kin Hospitals, (2)Department of Surgery, Ruttonjee and Tang Shiu Kin Hospitals, (3)Department of Rehabilitation Sciences, The Hong Kong Polytechnic University
Keyword 1: :
Compression therapy
Keyword 2: :
Varicose veins
Keyword 3: :
Protocol-drive intervention
Introduction :
Varicose veins affect up to 10% of the population, with higher risk among individuals requiring prolonged standing or walking (e.g., salespersons, bartenders, butchers, cleaners, chefs). Symptoms include disfiguration, cramping, swelling, fatigue, pigmentation, and ulcerations. Many patients seek treatment only when symptoms become severe (Chun et al., 2017). Severity is assessed using the CEAP classification (clinical stages 0–6). Patients with stage 3 or above typically experience symptoms that impair quality of life (Darvall et al., 2012). Compression therapy is an effective non-invasive treatment. In Hong Kong, patients are referred to occupational therapists for pressure garment prescription, but waiting times in public healthcare can reach up to 64 weeks, potentially worsening quality of life, disease progression, and increasing the need for surgery (Gohel et al., 2018). To address this, a protocol-driven occupational therapy intervention was implemented in January 2023, prioritizing complicated cases (CEAP ≥3), standardizing clinical pathways, introducing validated outcome measures, and refining discharge planning.
Objectives :
This retrospective study evaluates the efficacy of a protocol-driven occupational therapy intervention for complicated varicose veins (CEAP ≥3). The primary objective is to assess clinical outcomes and treatment effectiveness. Secondary objectives include comparing waiting time from referral to pressure garment prescription and evaluating treatment duration and follow-up sessions against the pre-protocol period.
Methodology :
This retrospective study included patients with complicated varicose veins (CEAP clinical classification ≥3) referred to the Occupational Therapy Department, Tang Shiu Kin Hospital, for pressure garments between April 2021 and March 2024. Exclusions were CEAP < 3, non-compliance (< 5 days/week), Lycra allergy, missing CMS data, or loss to follow-up (defaulted/death). Patients were divided into: Group 1 (pre-protocol: April 2021 – December 2022) — standard pressure garment provision without structured assessments. Group 2 (protocol: January 2023 – March 2024) — protocol-driven intervention with initial appointment at 2 weeks, VCSS and AVVQ at baseline/discharge, ≤6 sessions/year, and standardized education group. Primary outcomes assess patients’ clinical condition and quality of life by using VCSS and AVVQ scores; secondary outcomes included waiting time, treatment duration, and number of follow-up sessions. Data were analyzed using paired-sample t-tests in SPSS (p < 0.05 significant).
Result & Outcome :
The study included 51 patients in Group 1 (pre-protocol, mean age 69.5 years, 52.9% male) and 74 patients in Group 2 (protocol, mean age 68.1 years, 50% male). Both groups mainly comprised CEAP stage 3 & 4 cases. Waiting time for pressure garment prescription was reduced from 12 weeks (Group 1) to 6 weeks (Group 2). Average treatment duration decreased from 15.82 months to 11.64 months (p=0.0004), and average follow-up sessions dropped from 6.84 to 5.31 (p=0.00023). Surgical intervention rates were 74.5% in Group 1 and 48.6% in Group 2. Both groups showed significant improvement in Venous Clinical Severity Score (VCSS): Group 1: 4.72 → 4.17 (p=0.017) Group 2: 5.18 → 4.62 (p< 0.001) Aberdeen Varicose Veins Questionnaire (AVVQ) improved significantly in Group 1 (10.27 → 8.96, p=0.001), but remained stable in Group 2 (11.41 → 11.18, p=0.150). Pain and oedema were well controlled in both groups at discharge.
