Medical Hydrology and Balneology: Environmental Aspects

Therapeutic education programs for the
patients with chronic venous disease in the
setting of spa resorts
Carpentier P (1)
(1) Recherche Universitaire de La Léchère, Université Joseph Fourier,
Grenoble, France
PCarpentier@chu-grenoble.fr
Background
Severe chronic venous disease (CVD), with a high risk of leg ulcer, is found in
more than 5% of the adult population of industrialized countries. Each year, in
France, such 30 000 to 40 000 patients benefit from a spa treatment in one of the 13
resorts accredited for this disease, and we wanted to take this opportunity to develop
therapeutic education programs dedicated to these patients, aiming at improving
their knowledge, skills and motivation for their treatment,and to improve their
health related behaviors and lifestyle (physical activity, weight control, compliance
to elastic stockings, etc…). Two programs were developed: the first one to be
organized in a regular 3 weeks spa treatment for CVD, and the second one with a
specifically designed intensive spa treatment of six days for patients with severe
deep vein thrombosis.
Methods
The first program was developed by a pluri-professional working group of 15
health professionals developed for patients with advanced CVI, with the help of a
group of patients. This program includes for each patient: an individual educational
diagnosis, three interactive groups workshops, and an educational personalized
follow up by phone interview. The second program was developed in the same way,
and organized as a six days training 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.
These two programs were experimented in five different venous spa resorts.
Results
During experimentation, one hundred forty eight patients with advanced venous
insufficiency (CEAP classes C4 to C6) were enrolled in the first program. After a 3
months follow-up, the evaluation by phone interview (1% drop-out) showed that
61% of the health behavior objectives were fully achieved, 21% partially obtained
and 18% unreached; 83% of the patients fully achieved at least one objective. In the
mean time, the CIVIQ score decreased in 69% of the patients (p