Effect of Adding Warm Compression to Exercise Therapy on Severity and Functional Status among Patients with Chronic Limb-Threatening Ischemia
DOI:
https://doi.org/10.31674/mjn.2026.v18i01.008Abstract
Background: Chronic Limb-Threatening Ischemia (CLTI) is a serious form of peripheral artery disease. Significantly influencing their quality of life and functional abilities and causing increased risk for limb amputation. Objectives: To evaluate the effect of adding warm compression to exercise therapy on limb ischemia severity and physical functional health status among patients with CLTI. Methods: A quasi-experimental study design was used. One hundred patients from the Vascular Surgery Department of Assiut University Hospital, Assiut University, Egypt, were selected as a purposive sample (50 in the control group and 50 in the study group). A patient assessment form, a standardized classification system for CLTI severity assessment, and a physical functional health status assessment form were used to collect the data. Results: Statistically significant differences were found between both groups at 1 and 6 months postoperatively regarding the stage of CLTI severity (p<0.001 and p<0.001, respectively). Also, there are statistically significant differences between the two times (1st and 6th month postoperative) between both studied groups regarding the mean physical functional health status (P<0.001**). Conclusion: The study findings indicated that the implementation of exercise and warm compression positively influenced postoperative patient outcomes. The study suggests that exercise and warm compression should be regarded as an essential component of the standard hospital therapy for patients with CLTI.
Keywords:
Chronic Limb-Threatening Ischemia (CLTI), Exercises Therapy, Warm Compression TherapyDownloads
References
Azmy, N. H., Ghanem, H. M., Ata-allah, K. A., & Desouky, A. A. (2022). Educational needs for prevention of peripheral neuropathy deterioration in diabetic patients. Assiut Scientific Nursing Journal, 10(32), 11–20. https://doi.org/10.21608/ASNJ.2022.154132.1413
Bączyk, G., Kozłowska, K. A., Kubiak, K., & Formanowicz, D. (2025, March). Health problems and quality of life in patients with Chronic Lower Limb Ischemia–A polish population one-centre-based study. In Healthcare (Vol. 13, No. 6, p. 643). MDPI. https://doi.org/10.3390/healthcare13060643.
Banaś, W., Czerniak, B., & Budzyński, J. (2022). Physical and psychological functioning of patients with chronic limb ischemia during a 1-year period after endovascular revascularization. Journal of Vascular Surgery, 75(5), 1679-1686. https://doi.org/10.1016/j.jvs.2021.10.021
Berchiolli, R., Bertagna, G., Adami, D., Canovaro, F., Torri, L., & Troisi, N. (2023). Chronic limb-threatening ischemia and the need for revascularization. Journal of Clinical Medicine, 12(7), 2682. https://doi.org/10.3390/jcm12072682
Castelli, R., Gidaro, A., Casu, G., Merella, P., Profili, N. I., Donadoni, M., & Delitala, A. P. (2023). Aging of the arterial system. International Journal of Molecular Sciences, 24(8), 6910. https://doi.org/10.3390/ijms24086910
Cieri, I. F., Alvarez, A. A. R., Patel, S., Boya, M., Nurko, A., Teeple, W., & Dua, A. (2025). Association of chronic limb ischemia Rutherford classification with clinical outcomes following lower extremity revascularization. Annals of Vascular Surgery, 113, 227-234. https://doi.org/10.1016/j.avsg.2025.01.020
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates, New York. https://doi.org/10.4324/9780203771587
Conte, M. S., Bradbury, A. W., Kolh, P., White, J. V., Dick, F., Fitridge, R., Mills, J. L., Ricco, J. B., Suresh, K. R., & Murad, M. H. (2019). Global vascular guidelines on the management of chronic limb-threatening ischemia. European Journal of Vascular and Endovascular Surgery, 58(1), S1-S109. https://doi.org/10.1016/j.jvs.2019.02.016
El-Sayed, R. A. E., Abd Elsalam, S. N., & Elmetwaly, R. M. (2021). Effect of Buerger-Allen Exercise on lower extremities perfusion among patients with Type 2 Diabetes Mellitus. Egyptian Journal of Health Care, 12(2), 555-572. https://doi.org/10.21608/ejhc.2021.165205
Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. https://doi.org/10.3758/BF03193146
Ferreira, J., Roque, S., Longatto-Filho, A., Afonso, J., Carneiro, A., Vila, I., Silva, C., Cunha, C., Mesquita, A., Cotter, J., Correia-Neves, M., Mansilha, A., & Cunha, P. (2024). Higher levels of cytokines in patients with chronic limb-threatening ischemia. Annals of Vascular Surgery, 106, 255-263. https://doi.org/10.1016/j.avsg.2024.02.033
Gueifão, I., Quintas, A., Soares Ferreira, R., Pais, F., Ribeiro, T., Cardoso, J., Fidalgo, H., & Ferreira, M. E. (2025). Chronic limb-threatening ischemia under the age of 50 – a single-center 12-year retrospective study. Angiologia E Cirurgia Vascular, 20(3), 166–172. https://doi.org/10.48750/acv.621
Haga, M., Shindo, S., Nitta, J., Kimura, M., Motohashi, S., Inoue, H., & Akasaka, J. (2024). Anatomical and clinical factors associated with infrapopliteal arterial bypass outcomes in patients with chronic limb-threatening ischemia. Heart and Vessels, 39(11), 928–938. https://doi.org/10.1007/s00380-024-02421-6
Hassan, Z. M., EL-Din, S. A. B., ElRasek, A., & Mohammed, I. (2020). Impact of Buerger Allen Exercise on improving selected clinical features of peripheral vascular disease among diabetic patients. IOSR Journal of Nursing and Health Science (IOSR-JNHS), 9(2), 4-13. https://doi.org/10.9790/1959-0902070413
Hlatky, M. A., Boineau, R. E., Higginbotham, M. B., Lee, K. L., Mark, D. B., Califf, R. M., ... & Pryor, D. B. (1989). A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). The American Journal of Cardiology, 64(10), 651-654. https://doi.org/10.1016/0002-9149(89)90496-7
Jette, A. M., Davies, A. R., Cleary, P. D., Calkins, D. R., Rubenstein, L. V., Fink, A., ... & Delbanco, T. L. (1986). Functional status questionnaire: Reliability and validity when used in primary care. Journal of General Internal Medicine, 1(3), 143-149. https://doi.org/10.1007/bf02602324
Lee, R. E., Patel, A., Soon, S. X. Y., Chan, S. L., Yap, C. J. Q., Chandramohan, S., ... & Tang, T. Y. (2022). One year clinical outcomes of Rutherford 6 chronic limb threatening ischemia patients undergoing lower limb endovascular revascularisation from Singapore. CVIR Endovascular, 5(1), 32. https://doi.org/10.1186/s42155-022-00306-1
Mazzolai, L., Belch, J., Venermo, M., Aboyans, V., Brodmann, M., Bura-Rivière, A., ... & Visonà, A. (2024). Exercise therapy for chronic symptomatic peripheral artery disease: a clinical consensus document of the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases in collaboration with the European Society of Vascular Medicine and the European Society for Vascular Surgery. European Heart Journal, 45(15), 1303-1321. https://doi.org/10.1016/j.ejvs.2024.01.009
Mohamer, N. A., Abo El-Ata, A. B., & Aly, E. G. (2022). Health needs of patients with chronic lower limbs ischemia in general Port Said hospitals. Port Said Scientific Journal of Nursing, 9(1), 240–260. https://doi.org/10.21608/pssjn.2022.93112.1143
Mohammed, H. E., AbdelRazik AbdelHakim, E., Mohammed Zaki, S., H Mohamed, A., S Ahmed, S., & S., Abdelbaky, A. (2022). Comparison the effect of dynamic exercises and warm compresses on rheumatoid arthritis patients’ disabilities and self-efficacy. Egyptian Journal of Health Care, 13(4), 1861-1879. https://doi.org/10.21608/ejhc.2022.304370
Naveh, S., Thomas, S., Abumoawad, A., Canonico, M. E., Rogers, R. K., & Bonaca, M. P. (2025, April 2). Exercise therapy in symptomatic peripheral artery disease: Summary of current knowledge and future directions. American College of Cardiology. https://www.acc.org/Latest-in-Cardiology/Articles/2025/04/02/13/44/Exercise-Therapy-in-Symptomatic-Peripheral-Artery-Disease
Piechocki, M., Przewłocki, T., Pieniążek, P., Trystuła, M., Podolec, J., & Kabłak-Ziembicka, A. (2024). A non-coronary, peripheral arterial atherosclerotic disease (carotid, renal, lower limb) in elderly patients - A review: Part I - Epidemiology, risk factors, and atherosclerosis-related diversities in elderly patients. Journal of Clinical Medicine, 13(5), 1471. https://doi.org/10.3390/jcm13051471
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Lippincott Williams & Wilkins, Pennsylvania.
Rutherford, R. B., Baker, J. D., Ernst, C., Johnston, K. W., Porter, J. M., Ahn, S., & Jones, D. N. (1997). Recommended standards for reports dealing with lower extremity ischemia: revised version. Journal of Vascular Surgery, 26(3), 517-538. https://doi.org/10.1016/S0741-5214(97)70045-4
Saad, H. M. I., Elashry, M. G. G., & Hofny, H. M. F. (2025). Functional status and quality of life among elderly patients with chronic lower limb ischemia at Assiut University Hospital. Assiut Scientific Nursing Journal, 13(48), 43-57. https://doi.org/10.21608/asnj.2024.336327.1949
Shatnawi, N. J., Al-Zoubi, N. A., Al-Bakkar, L. A., Abu-Baker, A. M., Khader, Y. S., Al-Omari, M., & El-Heis, M. A. (2023). Chronic limb-threatening ischemia in patients with type 2 diabetes: Revascularization index as a predictor for primary endovascular intervention outcome. Vascular Health and Risk Management, 19, 495–504. https://doi.org/10.2147/VHRM.S394521
Xu, Z., Chuo, J., & Zhao, X. (2025). Effectiveness of home-based walking exercise for patients with peripheral artery disease and intermittent claudication: a systematic review and meta-analysis. BMJ open, 15(1), e086013. https://doi.org/10.1136/bmjopen-2024-086013
Ying, A. F., Tang, T. Y., Jin, A., Chong, T. T., Hausenloy, D. J., & Koh, W. P. (2022). Diabetes and other vascular risk factors in association with the risk of lower extremity amputation in chronic limb-threatening ischemia: a prospective cohort study. Cardiovascular Diabetology, 21(1), 7. https://doi.org/10.1186/s12933-021-01441-0
Zaki, E, W., Mostafa Ragheb, M., Saied Taha, A., & Sobhy Omran, E. (2023). Effect of Buerger Allen Exercise on lower extremity perfusion among patients with Type 2 Diabetes Mellitus. Journal of Nursing Science Benha University, 4(1), 1166-1182. https://doi.org/10.21608/jnsbu.2023.280725
Zanoli, G., Albarova-Corral, I., Ancona, M., Grattagliano, I., Hotfiel, T., Iolascon, G., ... & Rodríguez Maruri, G. (2024). Current indications and future direction in heat therapy for musculoskeletal pain: A narrative review. Muscles, 3(3), 212-223. https://doi.org/10.3390/muscles3030019
Zhou, J., & Zhou, L. (2024). Comprehensive nursing model for diabetic foot ulcers: A strategy to improve prognosis and quality of life. Medicine, 103(26), e38674. https://doi.org/10.1097/MD.0000000000038674
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