Venous leg ulcer clinical practice guidelines: what is AGREEd?
Open accessAbstract
Objective The aim was to evaluate the quality of current venous leg ulcer (VLU) clinical practice guidelines (CPGs) to assist healthcare professionals in choosing an accessible high quality CPG to advise their practice, and to identify areas for improvement in future versions of current CPGs. Methods A systematic review of PubMed, Embase, online CPG databases, and reference lists of included CPGs was carried out. Full text CPGs published no earlier than 1998 reporting evidence based recommendations on VLU diagnosis and management in English were included. CPGs that were only available if purchased were excluded. Two reviewers identified eligible CPGs, extracted data, and assessed the quality independently using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Significant scoring discrepancies were discussed with a third reviewer. Results Fourteen eligible CPGs were identified (1999-2016). The majority of CPGs originated from Europe or North America. Overall, there was good inter-reviewer reliability of scores with an intraclass correlation coefficient of 0.986 (95% confidence interval 0.979-0.991). No single CPG achieved the highest score in all six domains. Significant methodological heterogeneity was observed across VLU CPGs; however, consistently, poor performance was noted in domain 5, concerning CPG applicability. Conclusion Four CPGs were considered of adequate quality for clinical use. Consolidation of efforts to drive high quality, comprehensive VLU CPGs is necessary to reduce the number of and heterogeneity seen in currently published guidelines. Elements of methodological quality are lacking and a structured approach with use of checklists and CPG creation tools, such as AGREE II or others, may bolster rigour in future VLU CPGs.
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Guidelines recommend self-care treatments for venous leg ulcers, such as wearing compression therapy, practicing specific exercises, and following a particular diet.
“To prevent recurrences and manage and treat venous leg ulcers, various guidelines recommend self-care treatments, such as wearing compression therapy (Tan et al., 2019), practicing specific exercises, and following a particular diet (Probst et al., 2019).”
From Application and challenges of using a Constructivist Grounded Theory methodology to address an undertheorized clinical challenge: A discussion paper (2024) · cites this paper as Tan et al., 2019
Cites
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164 · see citing works
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2009.06.006 · Cited by 10,578 · see citing works
Scottish Intercollegiate Guidelines Network
Twaddle, S., & Qureshi, S. (2005) · Evidence-based Healthcare and Public Health · doi:10.1016/j.ehbc.2005.09.008 · Cited by 4,079 · see citing works
Gloviczki, P., Comerota, A. J., Dalsing, M. C., Eklöf, B., Gillespie, D. L., Gloviczki, M. L., Lohr, J. M., McLafferty, R. B., Meissner, M. H., Murad, M. H., et al. (2011) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2011.01.079 · Cited by 1,509 · see citing works
Guidelines International Network: Toward International Standards for Clinical Practice Guidelines
Qaseem, A., Forland, F., Macbeth, F., Ollenschläger, G., Phillips, S., van der Wees, P., & for the Board of Trustees of the Guidelines International Network* (2012) · Annals of Internal Medicine · doi:10.7326/0003-4819-156-7-201204030-00009 · Cited by 902 · see citing works
Editor's Choice – Management of Chronic Venous Disease
Wittens, C. H. A., Davies, A. H., Bækgaard, N., Broholm, R., Cavezzi, A., Chastanet, S., Wolf, M. A., Eggen, C. A. M., Giannoukas, A., Gohel, M., et al. (2015) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2015.02.007 · Cited by 845 · see citing works
Self-citationO’Donnell, T. F., Passman, M. A., Marston, W. A., Ennis, W. J., Dalsing, M. C., Kistner, R. L., Lurie, F., Henke, P. K., Gloviczki, M. L., Eklöf, B., et al. (2014) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2014.04.049 · Cited by 729 · see citing works
Schünemann, H. J., Wiercioch, W., Etxeandia, I., Falavigna, M., Santesso, N., Mustafa, R., Ventresca, M., Brignardello-Petersen, R., Laisaar, K.-T., Kowalski, S., et al. (2014) · Canadian Medical Association Journal · doi:10.1503/cmaj.131237 · Cited by 686 · see citing works
Brouwers, M. C., Kho, M. E., Browman, G. P., Burgers, J. S., Cluzeau, F., Feder, G. S., Fervers, B., Graham, I. D., Hanna, S., & Makarski, J. (2010) · Canadian Medical Association Journal · doi:10.1503/cmaj.091716 · Cited by 495 · see citing works
A systematic review of compression treatment for venous leg ulcers
Fletcher, A., Cullum, N. A., & Sheldon, T. (1997) · BMJ · doi:10.1136/bmj.315.7108.576 · Cited by 360 · see citing works
The GRADE system for rating clinical guidelines
Kavanagh, B. P. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000094 · Cited by 246 · see citing works
Guidelines for the treatment of venous ulcers
Robson, M. C., Cooper, D. M., Aslam, R. S., Gould, L. J., Harding, K. G., Margolis, D. J., Ochs, D. E., Serena, T. E., Snyder, R., Steed, D. L., et al. (2006) · Wound Repair and Regeneration · doi:10.1111/j.1524-475x.2006.00174.x · Cited by 196 · see citing works
Diagnosis and treatment of venous ulcers.
Collins, L. G., & Seraj, S. (2010) · PubMed · Cited by 162 · see citing works
Venous ulcers of the lower extremity: Definition, epidemiology, and economic and social burdens
Lal, B. K. (2015) · Seminars in Vascular Surgery · doi:10.1053/j.semvascsurg.2015.05.002 · Cited by 137 · see citing works
Societal costs of chronic venous disease in CEAP C4, C5, C6 disease
Rabe, E., & Pannier, F. (2010) · Phlebology The Journal of Venous Disease · doi:10.1258/phleb.2010.010s09 · Cited by 122 · see citing works
Vig, S., Dowsett, C., Berg, L. T., Caravaggi, C. M. F., Rome, P., Birke‐Sørensen, H., Bruhin, A., Chariker, M., Depoorter, M., Dunn, R., et al. (2011) · Journal of Tissue Viability · doi:10.1016/j.jtv.2011.07.002 · Cited by 116 · see citing works
Sabharwal, S., Patel, N. K., Gauher, S., Holloway, I., & Athansiou, T. (2014) · Clinical Orthopaedics and Related Research · doi:10.1007/s11999-014-3530-0 · Cited by 76 · see citing works
Best Practice Recommendations for the Prevention and Treatment of Pressure Ulcers
Keast, D. H., Parslow, N. E., Houghton, P. E., Norton, L., & Fraser, C. (2007) · Advances in Skin & Wound Care · doi:10.1097/01.asw.0000284922.69932.c5 · Cited by 70 · see citing works
Evidence‐based (S3) guidelines for diagnostics and treatment of venous leg ulcers
specialists., T. G. I. A. D. W. R. A. M. I. S. T. D. P. I. W. T. O. T. (. H. A. P. O. R. O. T. P. I. C. T. G. I. B. O. T. R. O. S. R. A. C. O. A. A. E. G. M. P. T. D. I. I. A. A. G. F. T. E. D. A. T. O. V. L. U. B. D. O. O. M. (2016) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.13848 · Cited by 63 · see citing works
Sabharwal, S., Patel, V., Nijjer, S. S., Kirresh, A. Z., Darzi, A. W., Chambers, J. C., Malik, I. S., Kooner, J. S., & Athanasiou, T. (2013) · Journal of the Royal Society of Medicine · doi:10.1177/0141076813486261 · Cited by 41 · see citing works
Evidence-based (S3) guidelines for diagnostics and treatment of venous leg ulcers
Neumann, H. A. M., CORNU-THÉNARD, A., Jünger, M., Mosti, G. B., Munte, K., Partsch, H., Rabe, E., Ramelet, A., & Streit, M. (2016) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.1_13848 · Cited by 38 · see citing works
Guidelines for the diagnosis and therapy of the vein and lymphatic disorders.
Gb, A., Allegra, C., Pl, A., Arpaia, G., Bianchini, G., Bonadeo, P., Botta, G., Castaldi, A., Gasbarro, V., Genovese, G., et al. (2005) · PubMed · Cited by 36 · see citing works
The Association for the Advancement of Wound Care (AAWC) venous and pressure ulcer guidelines.
Bolton, L. L., Girolami, S., Corbett, L. Q., & van Rijswijk, L. (2014) · PubMed · Cited by 34 · see citing works
Superficial venous insufficiency from the infernal to the endothermal
Carradice, D. (2014) · Annals of The Royal College of Surgeons of England · doi:10.1308/003588414x13824511650498 · Cited by 24 · see citing works
Best Practice Recommendations for the Prevention and Treatment of Venous Leg Ulcers
Burrows, C., Miller, R., Townsend, D., Bellefontaine, R., MacKean, G. L., Orsted, H. L., & Keast, D. H. (2007) · Advances in Skin & Wound Care · doi:10.1097/01.asw.0000284937.32707.c4 · Cited by 21 · see citing works
Werner, R. N., Marinović, B., Rosumeck, S., Strohal, R., Haering, N., Weberschock, T. B., Dreher, A., & Nast, A. (2015) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.13358 · Cited by 20 · see citing works
Guidelines for diagnosis and therapy of venous ulcers (version 8 2008)
Gallenkemper, G. (2008) · Phlebologie · doi:10.1055/s-0037-1622246 · Cited by 19 · see citing works
Couch, K. S., Corbett, L. Q., Gould, L. J., Girolami, S., & Bolton, L. L. (2017) · PubMed · Cited by 14 · see citing works
The management of patients with venous leg ulcers: new guidelines
Williams, C. (1999) · British Journal of Nursing · doi:10.12968/bjon.1999.8.8.6639 · Cited by 10 · see citing works
Prise en charge de l'ulcère de jambe à prédominance veineuse hors pansement - Juin 2006
(2007) · Journal des Maladies Vasculaires · doi:10.1016/j.jmv.2007.03.002 · Cited by 7 · see citing works
Guidelines on venous ulceration: A mess
Maccatrozzo, S., Onida, S., & Davies, A. H. (2016) · Phlebology The Journal of Venous Disease · doi:10.1177/0268355516657686 · Cited by 6 · see citing works
Self-citation
Flagged first, then by citations
1 of the 32 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Global guidelines trends and controversies in lower limb venous and lymphatic disease
Gianesini, S., Obi, A. T., Onida, S., Baccellieri, D., Bissacco, D., Борсук, Д. А., Campisi, C., Campisi, C. C., Cavezzi, A., Chi, Y., et al. (2019) · Phlebology The Journal of Venous Disease · doi:10.1177/0268355519870690 · Cited by 89 · see citing works
Self-citationVenous Leg Ulcers: A Review of Published Assessment and Treatment Algorithms
Bernatchez, S. F., Eysaman-Walker, J., & Weir, D. (2021) · Advances in Wound Care · doi:10.1089/wound.2020.1381 · Cited by 72 · see citing works
Quality of Rehabilitation Clinical Practice Guidelines: An Overview Study of AGREE II Appraisals
Dijkers, M. P. J. M., Ward, I., Annaswamy, T. M., Dedrick, D., Feldpausch, J., Moul, A., & Hoffecker, L. (2020) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2020.03.022 · Cited by 36 · see citing works
Butova, X., Shayakhmetov, S., Fedin, M., Zolotukhin, I. A., & Gianesini, S. (2021) · Journal of Personalized Medicine · doi:10.3390/jpm11121280 · Cited by 28 · see citing works
Medicine and Phlebolymphology: Time to Change?
Cavezzi, A. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9124091 · Cited by 28 · see citing works
Probst, S., Bobbink, P., Séchaud, L., & Buehrer Skinner, M. (2021) · Journal of Advanced Nursing · doi:10.1111/jan.14611 · Cited by 26 · see citing works
Experiences of patients living with venous leg ulcers: A qualitative meta-synthesis
Guo, X., Gao, Y., Ye, X., Zhang, Z., & Zhang, Z. (2023) · Journal of Tissue Viability · doi:10.1016/j.jtv.2023.11.012 · Cited by 20 · see citing works
Bobbink, P., Pugliese, M.-T., Larkin, P., & Probst, S. (2020) · Journal of Tissue Viability · doi:10.1016/j.jtv.2020.08.006 · Cited by 18 · see citing works
Bobbink, P., Larkin, P., & Probst, S. (2024) · International Journal of Nursing Studies Advances · doi:10.1016/j.ijnsa.2024.100199 · Cited by 15 · see citing works
“To prevent recurrences and manage and treat venous leg ulcers, various guidelines recommend self-care treatments, such as wearing compression therapy (Tan et al., 2019), practicing specific exercises, and following a particular diet (Probst et al., 2019).”
BackgroundHu, Z., Wang, S., Yang, H., Xv, H., Shan, B., Lin, L., & Han, X. (2024) · International Wound Journal · doi:10.1111/iwj.14736 · Cited by 15 · see citing works
Lin, B., Chen, C., Zhou, S.-K., Tseng, Y., Wang, S., & Huang, Y. (2020) · Phlebology The Journal of Venous Disease · doi:10.1177/0268355520935739 · Cited by 11 · see citing works
A Methodological Assessment of Diabetic Foot Syndrome Clinical Practice Guidelines
Tan, M. K. H., Goodall, R. J., Hughes, W., Langridge, B., Shalhoub, J., & Davies, A. H. (2020) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2020.04.028 · Cited by 11 · see citing works
Self-citationInfectious Disease and Primary Care Research—What English General Practitioners Say They Need
Lecky, D. M., Granier, S., Allison, R., Verlander, N. Q., Collin, S. M., & McNulty, C. A. M. (2020) · Antibiotics · doi:10.3390/antibiotics9050265 · Cited by 10 · see citing works
What Determines the Quality of Rehabilitation Clinical Practice Guidelines?
Dijkers, M. P. J. M., Ward, I., Annaswamy, T. M., Dedrick, D., Hoffecker, L., & Millis, S. R. (2020) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000001645 · Cited by 9 · see citing works
A methodologic assessment of lymphedema clinical practice guidelines
Tan, M. K. H., Salim, S., Beshr, M., Guni, A., Onida, S., Lane, T. R. A., & Davies, A. H. (2020) · Journal of Vascular Surgery Venous and Lymphatic Disorders · doi:10.1016/j.jvsv.2020.05.004 · Cited by 9 · see citing works
Self-citationBontinis, V., Ktenidis, K., Bontinis, A., Koutsoumpelis, A., Antonopoulos, C. N., Giannopoulos, A., Rafailidis, V. D., Chorti, A. G., & Bradbury, A. W. (2023) · Journal of Endovascular Therapy · doi:10.1177/15266028231193978 · Cited by 9 · see citing works
Jindal, R., Chaudhary, P., Gupta, B., Kaur, T., & Dhillon, S. (2021) · Indian Journal of Surgery · doi:10.1007/s12262-021-03064-x · Cited by 7 · see citing works
Slonková, V., Vašků, A., & Vašků, V. (2022) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.18770 · Cited by 6 · see citing works
Linn, D. D., Beckett, R. D., & Faust, A. C. (2022) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.13687 · Cited by 6 · see citing works
A systematic review assessing the quality of clinical practice guidelines in chronic venous disease
Salim, S., Tan, M. K. H., Geoghegan, L., Belramman, A., Onida, S., & Davies, A. H. (2020) · Journal of Vascular Surgery Venous and Lymphatic Disorders · doi:10.1016/j.jvsv.2020.09.014 · Cited by 6 · see citing works
Self-citationTan, M. K. H., Salim, S., Machin, M., Geroult, A., Onida, S., Lane, T. R. A., & Davies, A. H. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-056750 · Cited by 5 · see citing works
Self-citationBobbink, P., Gschwind, G., Larkin, P. J., & Probst, S. (2024) · Qualitative Health Research · doi:10.1177/10497323241285692 · Cited by 5 · see citing works
Eckert, K. A., & Carter, M. J. (2021) · Wound Repair and Regeneration · doi:10.1111/wrr.12897 · Cited by 4 · see citing works
Bobbink, P., Gschwind, G., & Probst, S. (2023) · British Journal of Nursing · doi:10.12968/bjon.2023.32.12.s28 · Cited by 5 · see citing works
Yan, R., Zhao, W., & Sun, Q. (2019) · Healthcare Technology Letters · doi:10.1049/htl.2019.0008 · Cited by 5 · see citing works
The global management of leg ulceration: Pre early venous reflux ablation trial
Heatley, F., Onida, S., & Davies, A. H. (2020) · Phlebology The Journal of Venous Disease · doi:10.1177/0268355520917847 · Cited by 4 · see citing works
Self-citationAnca, P. I. (2023) · FARMACIA · doi:10.31925/farmacia.2023.1.5 · Cited by 4 · see citing works
Martinato, M., Ranzato, C., Faggian, E., Foletto, M., Moreal, C., Guidone, N., Acar, A. Ş., Masiero, F., Beghin, F., Peruzzo, S., et al. (2023) · Wound Repair and Regeneration · doi:10.1111/wrr.13107 · Cited by 3 · see citing works
Satchithanantham, V., Gooneratne, T., Twine, C. P., & Hinchliffe, R. J. (2023) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2023.06.005 · Cited by 2 · see citing works
Chao, S., Kuan, C., Lin, Y., Tai, H., & Cheng, N. (2024) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000006064 · Cited by 1 · see citing works
Bobbink, P., Gschwind, G., Teixeira, C. M., Charbonneau, L., Guex, C., Chabal, L., & Probst, S. (2022) · Journal of Wound Management Official journal of the European Wound Management Association · doi:10.35279/jowm2022.23.01.02 · Cited by 1 · see citing works
Gavrilov, K. A., Markina, V. А., Sevostyanova, K. S., & Shevela, A. I. (2023) · Ambulatornaya khirurgiya = Ambulatory Surgery (Russia) · doi:10.21518/akh2023-020 · Cited by 1 · see citing works
Obstinate chronic venous ulcer treated with the homoeopathic medicine Silicea: A case report
Paliwal, S., & Nahar, L. (2024) · Indian Journal of Research in Homoeopathy · doi:10.53945/2320-7094.1881 · Cited by 1 · see citing works
Shan, H., Li, Q., Xu, X., Wang, X., Han, J., & Zhang, J. (2024) · Advances in Skin & Wound Care · doi:10.1097/asw.0000000000000142 · Cited by 1 · see citing works
Challenges in the reflux ablation in a patient with chronic venous leg ulcer – case report
Juśko, M., & Urbanek, T. (2021) · Phlebological Review · doi:10.5114/pr.2021.106881
Marinković, D. (2021) · Zdravstvena zastita · doi:10.5937/zdravzast50-33583
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Lozano, J. S., & Pizarro, S. M. (2023) · Enfermería Investiga · doi:10.31243/ei.uta.v8i3.2122.2023
Lee, A. H. H., Wright, A. P., Westcott, M. J., Shan, L. L., Choong, P., & Davies, A. H. (2023) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2023.10.025
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Rezende, L. D. A., Catabriga, D. D. S., Pacheco, A. D. O., Ramalho, A. D. O., & Freitas, P. D. S. S. (2024) · Jornal Vascular Brasileiro · doi:10.1590/1677-5449.202301592
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Yin, Y., Wang, J., & Gao, L. (2025) · Experts' Perspectives on Medical Advances. · doi:10.1007/978-981-96-2067-8_16
Altenburg, A., Burg, G., & Zouboulis, C. C. (2025) · Springer eBooks · doi:10.1007/978-3-031-78491-0_18
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- Authors
- Tan, M. K. H., Luo, R., Onida, S., Maccatrozzo, S., & Davies, A. H.
- Affiliations
- Charing Cross Hospital (GB)
- Italian Institute of Telemedicine (IT)
- Corresponding author
- Davies, Alun H.
- Venue
- European Journal of Vascular and Endovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2019-01
- Volume
- 57
- Issue
- 1
- Pages
- 121-129
- ISSN
- 1078-5884 (ISSN-L)
- OpenAlex
- W2895715396
- Cited by
- 43
- References
- 32
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 8 · 2023: 9 · 2022: 4 · 2021: 6 · 2020: 11 · 2019: 2
- FWCI
- 0.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- European Journal of Vascular and Endovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (CL-2017-21-007)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Surgery › Diagnosis and Treatment of Venous Diseases
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- venous leg ulcers, guideline quality, AGREE II, guideline evaluation, guideline applicability, guideline development, methodological heterogeneity
- MeSH terms
- Humans, Leg, Research Design, Varicose Ulcer, Practice Guidelines as Topic
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