A Therapeutic Education Program for the Prevention of the Post-thrombotic Syndrome

Background: The postthrombotic syndrome account for approximately one half of advanced chronic insufficiency, and its incidence is related to the severity of the thrombotic event and the quality of the treatment in the acute phase, but also influenced by the behavior and lifestyle of the patient (physical activity, weight control and compliance to elastic stockings1⁄4). The aim of therapeutic education is to help the patient to achieve the required changes in lifestyle and health related behaviors by improving his knowledge, skills and motivation, which seem appropriate in patients with high risk of postthrombotic syndrome. We developed and performed a preliminary evaluation of a structured therapeutic education program dedicated to the patients with a recent episode of proximal deep vein thrombosis. Methods: The education program is organized as a six days course for small groups of 6 to 10 patients who benefit from, one individual educative consultation, four group education workshops and six sessions of active balneotherapy, also aiming at educational objectives. Three training courses were organized in three different spa resorts specifically dedicated to the care of patients with venous diseases (La Lechere, Rochefort et Bagnoles de l’Orne). Main inclusion criteria were a recent ( 2 years) proximal DVT of the lower limbs remaining symptomatic but with no skin changes (C0s-C3), availability for the course and written consent. An evaluation of CIVIQ2 quality of life scale (autoevaluation), and VCSS and Villalta score (by an independent observer) was performed at inclusion, and at 2 and 6 months follow-up. Results: Twelve women and nine (median age 58 years; 20-89) were enrolled. No dropout was observed during follow-up. Every participant declared a high level of satisfaction level. Two and six months follow-up showed a significant improvement of the CIVIQ2 quality of life scale (P .01), the VCSS (P .05) and the Villalta score (P .01). Conclusion: This promising results have to be confirmed in a larger scale randomized controlled study with longer follow-up, which has just started. Work supported by a grant of the Association Francaise pour la Recherche Thermale (#2009-02).