Assessment of the Effect of Spa Therapy on the Quality of Life of Patients With Chronic Venous Insufficiency (NEYRAC)

Study Overview
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Brief Summary
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Evaluation of the effectiveness of a phlebology-oriented spa therapy at 6 months on the quality of life of patients suffering from chronic venous insufficiency of the lower limbs

Detailed Description
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NEYRAC is a: prospective, before/after, cohort follow-up study with repeated measurements monocentric study with the dispensation of a 3-week phlebology-oriented spa therapy in Neyrac-les-Bains

Official Title
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Evaluation of the Effectiveness of a Phlebology-oriented Spa Treatment on the Quality of Life of Patients Suffering From Chronic Venous Insufficiency of the Lower Limbs, 6-month After the Spa Treatment

Conditions
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Chronic Venous Insufficiency

Intervention / Treatment
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* Other: Spa therapy


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Age greater than 18 years Patient with chronic venous insufficiency of the lower limbs (CEAP category C4a, C4b and C4c) Patient presenting an indication for a phlebology-oriented spa treatment as the primary orientation. Patients with a dermatological or rheumatological pathology can benefit from a dual orientation spa treatment with a main phlebology orientation Patient affiliated to the social security system or such a system Available for an 18-day spa treatment and a 6-month follow-up For women of childbearing age: effective contraception Patient close to a study investigator (excluding teleconsultation) If not patient with access to the necessary equipment to perform a teleconsultation (smartphone, tablet or computer with an internet connection + taking and sending photos of the lower limbs) Non inclusion criteria: Venous surgery or venous interventional therapy within 3 months prior to inclusion or scheduled within the next 3 months History of venous ulcer Contraindication to spa therapy (immune deficiency, evolving cardiopathy neoplasia, infection, pulmonary tuberculosis, severe renal insufficiency, alcoholic cirrhosis, advanced senility and severe mental disorders) Predictable intolerance to thermal treatments (intolerance to heat, baths, etc.) Persons suffering from venous insufficiency of the varicose vein type (category CEAP C2) or edema alone (category CEAP C3) or open or healed ulcers (CEAP category C5 and C6) Patient who has already undergone a phlebology-oriented spa treatment within the current thermal season Subject already included in an interventional clinical research protocol Persons referred to in articles L1121-5 to L1121-8 of the Code de la Santé Publique (pregnant women, women in labour and parturient and nursing mothers, persons deprived of liberty by judicial or administrative decision, persons subject to a legal protection measure or not being able to verbally communicate their agreement, minor)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: before / after study
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: patient treated with a phlebology-oriented spa therapy<br>Thermal treatments among the following: pool, Kneipp pool, high pressure shower under immersion in a swimming pool, general jet shower, cataplasm in multiple local application, compress, massage under water or with thermal derivatives, walking corridor | Other: Spa therapy<br>* Thermal treatments among the following: pool, Kneipp pool, high pressure shower under immersion in a swimming pool, general jet shower, cataplasm in multiple local application, compress, massage under water or with thermal derivatives, walking corridor<br>* Other names: spa care;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To evaluate the effectiveness of a complete phlebology-oriented spa therapy on the quality of life of patients suffering from chronic venous insufficiency of the lower limbs | Comparison of the mean scores of the Chronic Venous Insufficiency specific Quality of life questionnaire (CIVIQ20) at baseline and at 6 months. The 20-item questionnaire, which provides a global index and an outline of 4 quality-of-life dimensions-pain (4 items), physical (4 items), psychological (9 items), and social (3 items). Items on the CIVIQ-20 scale were scored from 1 to 5 which means a total score from 20 to 100. A higher score means a worse outcome. | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison of Visual Analog Scales (VAS) for pain at enrolment and 1.5, 3, 4.5 and 6 months after enrolment (post-cure) to quantitatively assess the improvement of patients' pain before/after treatment | Comparison of the means of Visual Analog Scales (VAS) at enrolment an 1.5, 3, 4.5 and 6 months after enrolment. Score from 0 to 100. A higher score means a worse outcome. | 1.5, 3, 4.5 and 6 months | 
| Assessment of the global quality of life by the EuroQol 5 Dimensions 5 Levels questionnaire (EQ5D-5L). | Improvement in global quality of life (EQ5D-5L questionnaire) between enrolment and at 3 and 6 months after enrolment The EQ5D-5L essentially consists of the EQ-5D descriptive system and the EQ visual analogue scale (EQ VAS). There are five dimensions assessed in the descriptive system: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. Score from -0.53 to 1. A higher score means better outcome. The EQ VAS records the patient's self-rated health on a vertical visual analogue scale, where the endpoints are labelled 'The best health you can imagine' and 'The worst health you can imagine'. The VAS can be used as a quantitative measure of health outcome that reflect the patient's own judgement. Score from 0 to 100. A higher score means better outcome. | 3 and 6 months | 
| Physician/Patient perception | The perception of the physician and the patient will be asked to evaluate the benefit of the spa therapy, 3 and 6 months after enrolment using a 5-point Likert scale. There are no numerical scores, only results in % of patients improved or worsened. | 3 and 6 months | 
| Medication consumption | Collection of medication consumption to evaluate the benefit of the spa therapy (comparison of consumption before and after treatment) To avoid any risk of confusion, medication consumption will be set to the daily consumption. Medication use for 72 hours (D-2, D-1, D0) Medication consumption day before yesterday/yesterday/today: Anticoagulant Veinotonic In the 3 months prior to the visit: Medication use will be assessed by the investigating physician who will have to specify if this one is consumed because of the venous insufficiency or of another pathology | 6 months | 
| Assessment of compression compliance | Comparison of the self-reported compression compliance (percentage of wearing time in the last week), between baseline and 3 and 6 months after enrolment | 3 and 6 months | 
| Evolution of the CEAP (Clinical Etiology Anatomical distribution Pathophysiology) category | Comparison of CEAP category assessed by the investigating physician between enrolment and 3 and 6 months after enrolment The basic principles of the CEAP classification include a description of the clinical class (C) based on objective signs, the etiology (E), the anatomical distribution (A) of reflux and obstructions in superficial, deep and perforating veins and the underlying pathophysiology (P), whether related to reflux or obstructions. Only the clinical class (C) and the etiology (E) will be assessed. | 3 and 6 months | 
| Evolution of the general clinical criteria : Body Mass Index (BMI) | Comparison of the Body Mass Index between enrolment, and 3 months and 6 months after enrolment | 3 and 6 months | 
| Evolution of the general clinical criteria : systolic blood pressure | Comparison of the systolic blood pressure between enrolment, and 3 months and 6 months after enrolment | 3 and 6 months | 
| Evolution of the general clinical criteria : diastolic blood pressure | Comparison of the diastolic blood pressure between enrolment, and 3 months and 6 months after enrolment | 3 and 6 months | 
| Evolution of the general clinical criteria : heart rate | Comparison of the heart rate between enrolment, and 3 months and 6 months after enrolment | 3 and 6 months | 
| Evaluation of the Rutherford score at enrolment and at 3 months and at 6 months after enrolment to estimate the clinical severity of venous insufficiency | Comparison of mean scores between enrolment and 3 months and 6 months after enrolment. The Rutherford questionnaire is the Venous Clinical Severity Score (VCSS) questionnaire without the compression part. The Rutherford questionnaire includes 9 hallmarks of venous disease, each scored on a severity scale from 0 to 3. In order to generate a dynamic score, the categories are scored individually, which adds emphasis to the most severe sequelae of venous disease that are likely to show the greatest response to therapy. These include skin changes and pigmentation, inflammation and induration, and ulcers (including number, size, and duration). Score from 0 to 27. A higher score means a worse outcome. | 3 and 6 months | 
| Evaluation of the use of care related or not to venous insufficiency 6 months post enrolment | Collection of medical events related or not to venous insufficiency (number of SAE, number of hospitalizations, number of medical and paramedical procedures) | 6 months | 
| Evaluation of compliance with the spa therapy | Comparison of the thermal treatments received by the patient during the spa therapy with the thermal treatments prescribed by the thermal doctor at the start of the spa therapy, collected in the spa treatment booklet | 3 weeks | 
| Evaluation of the specific quality of life by the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) questionnaire | Quantitative improvement of the health status of all patients by comparison of the mean of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, 3 months and 6 months for all patients, and then only for patients with osteoarthritis The WOMAC is the validated index for the assessment of lower limb osteoarthritis according to a Likert scale with 5 possible answers (none = 0; minimal = 1; moderate = 2; severe = 3; extreme = 4) Scores from 0 to 100. A higher score means a worse outcome. | 3 and 6 months | 
| Comparison of the effictiveness of the treatment according to the limitation of the patient's walking (subgroup analysis according to patient mobility) | Comparison of the primary endpoint Chronic Venous Insufficiency specific Quality of life questionnaire (CIVIQ20) according to the limitation of the patient's walking (limitation of the walking is self reported by the patient) The 20-item questionnaire, which provides a global index and an outline of 4 quality-of-life dimensions-pain (4 items), physical (4 items), psychological (9 items), and social (3 items). Items on the CIVIQ-20 scale were scored from 1 to 5 which means a total score from 20 to 100. A higher score means a worse outcome. | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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spa therapy, phlebology, chronic venous insufficiency