***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Quality of life may be considerably reduced in patients who are suffering from chronic lower limb venous insufficiency , although existing generic quality of life instruments ( NHP , SF-36 or SIP ) can not completely identify their specific complaints . The Chronic Venous Insufficiency Question naire ( CIVIQ ) has been developed by iterative process . First , a pilot group of 20 patients was used to identify a number of important features of quality of life affected by venous insufficiency , other than physical symptoms of discomfort . A second study involving 2,001 subjects was used to reduce the number of items . Subjects were asked to score both the severity of their problems and the importance they attributed to each problem on a 5-point Likert scale . The importance items found in patients with venous insufficiency were subjected to factorial analyses ( PCA , PAF ) . The final version is a 20-item self-administered question naire which explores four dimensions : psychological , physical and social functioning and pain . Internal consistency of the question naire was vali date d for each dimension ( Cronbach 's alpha > 0.820 for three out of four factors ) . Reproducibility was confirmed in a 60 patient test-retest study . Pearson 's correlation coefficients for both the four dimension subscales and for the global score at 2-week intervals were greater than 0.940 . Finally , the question naire was tested in a r and omized clinical trial of 934 patients in order to assess responsiveness and the convergent validity of the instrument , together with the patient 's own quality of life . This study demonstrated that convergence was valid : Pearson 's correlation coefficients between clinical score differences and quality of life score differences were small ( from 0.199–0.564 ) but were statistically different from 0 ( p<0.001 ) . St and ardized response mean ( SRM ) and effect size ( ES ) were calculated to assess sensitivity to change . SRM and ES both demonstrated considerble responsiveness to change ( > 0.80 ) . Reliability , face , content , construct validity and responsiveness were also determined for this specific quality of life question naire relating to venous insufficiency . Results suggest that this question naire may be used with confidence to assess quality of life in clinical trials on chronic venous insufficiency OBJECTIVE To compare interface pressure ( IP ) and static stiffness index ( SSI ) of four different compression systems currently in use for the treatment of patients with venous leg ulcer . METHOD Fifty-two ambulatory adults with healthy legs were recruited at r and om at a study centre after they had consented . The evaluated systems were : short-stretch system ( SSB ) , Rosidal sys ( Lohmann & Rauscher ) , multilayer b and aging ( LSB ) Profore ( Smith & Nephew ) , Vari-stretch ( VSB ) ProGuide ( Smith & Nephew ) and tubular compression ( CS ) Rosidal Mobil ( Lohmann & Rauscher ) . Interface pressure was measured using Kikuhime ( Harada Corp. ) , placing a 3 cm-diameter probe at the B1 point . IP recording took place in the supine and st and ing positions , while sitting and during walking , on application of the compression systems and every 15 minutes thereafter for 4 hours . RESULTS The IPs of SSB , LSB and VSB  , measured immediately after b and age application , were significantly higher than that of CS ( all p < 0.05 ) . During the 4-hour study period , the IP for both VSB and LSB measured in the supine position initially increased to > 60 mmHg . Their overall mean IPs in the supine position were 48.96 ± 3.99 mmHg and 48.12 ± 4.57 mmHg , respectively . SSB and CS demonstrated more tolerable IP levels in this position of < 40 mmHg , which was similar to those when sitting . All systems maintained at least 40 mmHg in walking . SSB had a high SSI of 20 throughout the study . LSB followed with an SSI of 18 at the start , which reduced to 13 , while the SSI for VSB decreased from 17 to 12 and CS , with an SSI of 6 , lagged behind . CONCLUSION These results may contribute to the underst and ing of IP and SSI of the four different compression systems evaluated . The IP and SSI data presented give clinicians an indication of the appropriate frequency of re-application of compression , and preliminary data on choosing a safe and effective compression treatment for their patients . DECLARATION OF INTEREST The investigators received an educational grant from Lohmann & Rauscher GmbH & Co KG for this study OBJECTIVE Deterioration of calf muscle pump function is associated with progression of chronic venous insufficiency ( CVI ) . We postulated that a supervised exercise program would improve calf muscle strength and venous hemodynamics in patients with CVI . METHODS We recruited 31 patients for this r and omized , prospect i ve trial . Inclusion criteria required the presence of skin changes or ulceration ( CEAP 4 , 5 , 6 ) , and duplex ultrasound scanning ( reflux or scarring ) and air plethysmographic ( APG ) evidence of CVI . Subjects were r and omized into control ( n = 13 ) and therapy ( n = 18 ) groups . Class II ( 30 - 40 mm Hg )  compression hosiery was given to all . The experimental group received physical therapy design ed specifically to strengthen calf musculature . Dynamic strength and power were measured with a Biodex II dynamometer ( Biodex Medical Systems , Shirley , NY ) at slow and fast speeds . Reflux ( venous filling index ) and calf pump function ( ejection fraction , residual volume fraction ) were measured with APG . Quality -of-life question naires and venous severity scores were also administered . Outcomes were compared 6 months after initiation of exercise . Probability of treatment effect was tested with univariate analysis of variance , with control for baseline values . RESULTS Demographic variables and medical comorbidities were not different between groups . After 6 months of intervention , indicators of calf pump function returned to a normal range in the therapy ( experimental ) group . Mean residual volume fraction was improved in the exercise group ( -8.75 + /- 4.6 vs 3.4 + /- 2.9 in the control group ; P < .029 ) . Mean ejection fraction was increased in the exercise group ( 3.48 + /- 2.7 vs -1.4 + /- 2.1 in the control group ; P < .026 ) . Reflux , while substantially greater than the normal value of 2.0 mL/s in both groups , was unchanged . The exercise regimen improved isokinetic peak torque/body weight at both slow speed ( 3.1 + /- 1.4 in the therapy group vs -1.0 + /- 1.1 in the control group ; P < .05 ) and fast speed ( 2.8 + /- 0.9 in the therapy group vs - 0.3 + /- 0.6 in the control group ; P < .03 ) . No changes were observed in quality -of-life or severity scores . CONCLUSIONS Calf muscle pump function and dynamic calf muscle strength were improved after a 6-month program of structured exercise . Directed physical conditioning of the calf musculature may prove beneficial for patients with or without alternative management options for severe CVI . Further research on exercise for patients with CVI is warranted BACKGROUND Physical therapy has not been evaluated much for the treatment of chronic venous insufficiency before . The question is whether balneohydrotherapy and usual care combined is superior to usual care alone . PATIENTS AND METHODS In a r and omized trial comparing spa therapy versus waiting list patients were treated on an out-patient basis in a private spa center . Patients had to be between 18 and 80 years old , with chronic venous insufficiency ( stage 3 or 4 according to the CEAP classification ) . The balneohydrotherapy group received 18 days of treatment in Aix-Les-Bains spa center continuing their usual care . The control group continued their usual care as well during the study . The balneohydrotherapy program consisted of Kneipp therapy ( 10 minutes ) , walking 10 minutes in a special mineral water pool with underwater jets at 23 ° C , massage and bathing in a mineral water tub at 34 ° C . The main outcome criterion was the number of patients with 20 % self assessed improvement on the Chronic Venous Insufficiency Question naire at three months after therapy . RESULTS 192 patients were assessed for eligibility , 99 were r and omized 5 retired drew back their consent and were not included in the intention to treat analysis . None were lost to follow up . After three months 32 ( 66 % ) patients improved in the balneohydrotherapy group and 13 ( 28 % ) in the control group . The difference between groups was significant ( odd ratio 5.08 [ 1.94 - 13.55 ] , relative risk reduction 2.33 [ 1.42 - 3.84]).There were no serious side effects .  CONCLUSIONS Balneohydrotherapy seems to improve quality of life of patients with chronic venous insufficiency BACKGROUND Purpose of this study was to assess the effects of thermal hydrotherapy ( balneokinesis ) with a sulphurous water on clinical symptoms , quality of life and some functional parameters in patients with varicose veins . PATIENTS AND METHODS 70 patients with primary or secondary symptomatic varicosis were enrolled and su bmi tted to elastic compression therapy . Patients were then r and omized to receive ( 50 pts , group A ) or not receive ( 20 pts , group B ) balneokinetic treatment for 12 days " on top " of elastic compression . Clinical symptoms , quality of life and functional parameters obtained with light reflex plethysmography ( PPG ) and laser Doppler fluxmetry ( LDF ) were assessed after 3 and 6 months . RESULTS Scores for subjective symptoms as pain , edema , and venous claudication were decreased after 6 months in both groups , but more evidently in group A su bmi tted to balneokinesis . Some parameters related to quality of life evaluation as " bodily pain " and " emotional role " were improved only in patients undergoing balneokinesis . Regarding functional parameters , with PPG venous refilling time after foot exercise moderately increased in both groups . With LDF a significant improvement in the veno-arteriolar reflex was seen in the group treated with balneokinesis . CONCLUSIONS These results show additional benefits of balneokinetic treatment in patients with symptomatic varices su bmi tted to elastic compression . In fact , clinical and quality of life improvements were observed . The associated amelioration in the veno-arteriolar reflex may support these subjective benefits BACKGROUND Apart from compression therapy , physical therapy has scarcely been evaluated in the treatment of  chronic venous disorders ( CVDs ) .  Spa treatment is a popular way to administer physical therapy for CVDs in France , but its efficacy has not yet been assessed in a large trial . The objective was to assess the efficacy of spa therapy for patients with advanced CVD ( CEAP clinical classes C4-C5 ) . METHODS This was a single-blind ( treatment concealed to the investigators ) r and omized , multicenter , controlled trial ( French spa resorts ) . Inclusion criteria were primary or post-thrombotic CVD with skin changes but no active ulcer ( C4a , C4b , or C5 ) . The treated group had the usual 3-week spa treatment course soon after r and omization ; the control group had spa treatment after the 1-year comparison period . All patients continued their usual medical care including wearing compression stockings . Treatment consisted of four balneotherapy sessions per day for 6 days a week . Follow-up was performed at 6 , 12 and 18 months by independent blinded investigators . The main outcome criterion was the incidence of leg ulcers at 12 months . Secondary criteria were a modified version of the Venous Clinical Severity Score , a visual analog scale for leg symptoms , and the Chronic Venous Insufficiency Question naire 2 and EuroQol 5D quality -of-life auto question naires . RESULTS Four hundred twenty-five subjects were enrolled : 214 in the treatment group ( Spa ) and 211 in the control group ( Ctr ) ; they were similar at baseline regarding their demographic characteristics , the severity of the CVD , and the outcome variables . At 1 year , the incidence of leg ulcers was not statistically different ( Spa : + 9.3 % ; 95 % confidence interval [ CI ] , + 5.6 - + 14.3 ; Ctr : + 6.1 % ; 95 % CI , + 3.2 - + 10.4 ) , whereas the Venous Clinical Severity Score improved significantly in the treatment group ( Spa : -1.2 ; 95 % CI , -1.6 - -0.8 ; Ctr : -0.6 ; 95 % CI , -1.0 - -0.2 ; P = .04 ) . A significant difference favoring spa treatment was found regarding symptoms after 1 year ( Spa : -0.03 ; 95 % CI , -0.57 - + 0.51 ; Ctr : + 0.87 ; 95 % CI,+0.46 - + 1.26 ; P = .009 ) . EuroQol 5D improved in the treatment group ( Spa : + 0.01 ; 95 % CI , -0.02 - + 0.04 ) while it worsened ( Ctr : -0.07 ; 95 % CI , -0.10 - -0.04 ) in the control group ( P < .001 ) . A similar pattern was found for the Chronic Venous Insufficiency Question naire 2 scale ( Spa : -2.0 ; 95 % CI , -4.4 - + 0.4 ; Ctr : + 2.4 ; 95 % 
    Output:
    
We identified moderate- to low-certainty evidence that suggests that balneotherapy may result in a moderate improvement in pain , quality of life and skin pigmentation changes and has no clear effect on disease severity signs and symptoms score , adverse effects , leg ulcers and oedema when compared with no treatment .