[Compression devices for decongestion therapy : A cross-sectional observational survey of handling, pressure, and comfort]

Performance of an adjustable compression wrap in occupational leg swelling

BACKGROUND

Edema in some subjects worsens over time and wraps help to reduce the leg volume.

MATERIAL AND METHODS

An adjustable compression wrap was tried on volunteers for 5 h and volumes measured in each limb before and after wrapping using a 3D surface scanner (HandySCAN 3D®) to estimate the volume of the leg. The contralateral leg was used as control.

RESULTS

We observed a significant decrease in volume in the wrap legs and an increase in the control legs (p < .001), both in the lower part of leg (p = .001) and in the upper part (p = .001).

CONCLUSIONS

Using the Readywrap® for 5 hours significantly reduces the leg volume. This study enables Readywrap to be studied in a population that is easy to observe in the context of a research program. The Handyscan3D® was shown accurate and reproducible to assess leg volume in future studies.

Ökonomische und ökologische Effekte von Bandagehilfen in der KPE Phase I des Lymphödems – eine explorative Analyse des Materialverbrauchs in einer Sekundäranalyse einer Studie zu Schaumstoffbandagehilfen

Hintergrund Bezogen auf klinische Wirksamkeit und Therapieeffekte von Schaumstoff-Bandagehilfen in der KPE Phase I des Armlymphödems führten die Autoren eine RCT durch, die die Nichtunterlegenheit der Bandagehilfen im Vergleich zu Standarduntermaterial zeigte. Die parallele Erfassung des Polstermaterialverbrauchs und der Applikationsdauer hat die Frage nach ökonomischen und ökologischen Effekten anschließen lassen.

Methoden Explorative Analyse des Materialverbrauches und der Applikationszeit von Bandagehilfen im Vergleich mit Standardunterpolsterung in der KPE Phase I bei Patient*innen mit sekundärem Armlymphödem Stadium II bis III. Ergebnisse: 1. Materialverbrauch: Insgesamt wurden im Beobachtungszeitraum in der Kontrollgruppe 50,7 m Schlauchverband und 207 m Polsterwatte bei n=15 Probanden verbraucht. Demgegenüber standen insgesamt 92 m wiederverwendbare Schaumstoffbandagen bei n=15 Proband*innen in der Interventionsgruppe. 2. Applikationszeit: In der Kontrollgruppe belief sich die Applikationszeit im Mittel auf 13,4±3,4 min., in der Inventionsgruppe auf 10,3±2,2 min. Die Analyse zeigt einen signifikanten Gruppenunterschied (p=0.007).

Diskussion In der KPE Phase I zeigen sich bei Patient*innen mit Armlymphödem Einsparungen in puncto Materialverbrauch und Applikationsdauer unter Verwendung von Schaumstoffbandagen. Beide Parameter sind für Physiotherapeut*innen und Einrichtungen auch von ökonomischer Relevanz. Die Schaumstoffbandagen haben durch Waschbarkeit und damit Wiederverwendbarkeit überdies ökologische Effekte. Bislang übliche Polstermaterialien werden überwiegend nach der Anwendung verworfen.

[Classification and nomenclature of current materials for compression therapy]

Compression therapy has been an essential part of conservative therapy for people with chronic wounds and edema of the lower extremities for hundreds of years. The initiated therapy can be divided into the decongestion phase, maintenance phase, and prevention. The choice of the respective compression materials is based, among other factors, on these phases, the clinical stage and symptoms, the needs of the affected person and their physical abilities. Today, a wide range of different materials and methods are available for compression therapy. Thus, it is increasingly difficult to keep an overview of these treatment options, especially since the nomenclature used by the manufacturers is often inconsistent. Thus, the materials and methods for compression therapy currently available in German-speaking countries and their clinical indications are described in this review article. In addition, a uniform nomenclature is proposed, on the basis of which an appropriate exchange between all those involved in the care of people with compression therapy is guaranteed.

Increasing competence in compression therapy for venous leg ulcers through training and exercise measured by a newly developed score-Results of a randomised controlled intervention study

Compression therapy with short-stretch bandages is the most common treating option for patients with venous leg ulcers in the decongestion phase in Germany. This randomised controlled intervention study examined whether a training is suitable to sustainably improve the skills of health care professionals. Altogether 55 nurses from hospitals and outpatient care participated. They were randomly assigned to case and control groups. Participants' abilities to properly apply a compression bandaging were assessed before and after a training session as well as after 1 and 3 months using a newly developed score (CCB score) based on six control parameters (CPs): padding, starting point, heel inclusion, heart direction, pressure at forefoot (A) and calf base (B1). After training, a significant increase in competence was observed, which only decreased non-significantly over the observation period: The average CCB score was 2.796 at V0, 4.89 at V1, 4.88 at V2, and 4.66 at V3. The CPs for pressure at A and B1 were met by a maximum of 42.6 and 43.6%, respectively, at all timepoints. The CP starting point was fulfilled by at least 61.7% after training, the CPs heart direction, heel and underpadding by at least 89.4, 96.4, and 97.9%, respectively. As a result of our study, it can be concluded that training improves the ability of users to apply compression bandagings, but one-off training does not appear to be suitable to improve the ability to apply compression bandagings with a therapy-relevant pressure. Therefor more training especially with pressure measuring devices would be necessary.

[Standard of patient-centred care before admission to a university wound centre]

Hintergrund und Fragestellung

Die Versorgungswege von Patienten mit chronischen Wunden sind häufig sehr langwierig. Dies kann zu einer verminderten Versorgungsqualität und zu einer verspäteten Diagnose der eigentlichen Ursache führen. Gleichzeitig existieren zertifizierte Einrichtungen für diese Patientengruppe. Die vorliegende Arbeit untersucht mögliche Gründe für eine verzögerte Zuweisung an diese Zentren und ob eine spezifische Patientenauswahl an universitäre Zentren gelangt.

Patienten und Methoden

Durch eine retrospektive Auswertung der Patientendatensätze zum Zeitpunkt der Erstvorstellung im zertifizierten Wundzentrum wurden Variablen zum Versorgungszustand vor der universitären Vorstellung analysiert.

Ergebnisse

Es konnten Datensätze von 177 Patienten ausgewertet werden (53 % weiblich, 47 % männlich). Die Altersspanne lag zwischen 27 und 95 Jahren. Die mittlere Bestandsdauer der Wunde betrug 22 Monate. Eine Gefäßdiagnostik war im Vorfeld in 32 % (arterielle Diagnostik) bzw. 36 % (phlebologische Diagnostik) durchgeführt worden. Eine Gewebeprobe war in 9 % der Fälle entnommen worden, v. a. bei Patienten mit > 24 Monaten bestehender Wunde. In nur 45 % der Fälle stimmte die externe Diagnose mit der im Wundzentrum abschließend gestellten Diagnose überein.

Diskussion

Die Versorgungssituation von Patienten mit chronischen Wunden außerhalb spezialisierter Versorgungsstrukturen ist als unzureichend anzusehen. Eine frühzeitige Versorgung nach etablierten Standards in Diagnostik und Therapie sowie zeitnahe Überweisung bei stagnierendem Verlauf an eine Spezialsprechstunde sind anzustreben.

iWRAP: A Theranostic Wearable Device With Real-Time Vital Monitoring and Auto-Adjustable Compression Level for Venous Thromboembolism

OBJECTIVE

Venous Thromboembolism (VTE) is a commonly underdiagnosed disease with severe consequences and an exceedingly high mortality rate. Conventional compression wraps are devised for therapeutic purpose but lack diagnostic capacity. Recent advances in flexible electronics and wearable technologies offer many possibilities for chronic disease management. In particular, vital signs have been studied to show a strong correlation with the risk of VTE patients. In this study, we aim to develop an intelligent theranostic compression device, referred to as iWRAP, with the built-in capacity of real-time vital sign monitoring together with auto-adjustable compression level.

METHODS

An instantaneous pneumatic feedback control with a high-resolution pressure sensor is integrated to provide a highly stabilized compression level at the prescribed interface pressure for an improved therapeutic outcome. Meanwhile, arterial pulse waveforms extracted from the pressure readings from the smart compression device can be utilized to derive the body vital signs, including heart rate (HR), respiratory rate (RR) and blood pressure (BP).

RESULTS

A reliable delivery of the targeted compression level within ±5% accuracy in the range of 20-60 mmHg has been achieved through the feedback of the interface pressure. Both HR and RR have been measured within clinical-grade accuracies. Moreover, BP estimated using an ALA model has been achieved at low compression levels, which is also within a clinical-acceptable accuracy. The acquired vital information has been instantaneously fit into the clinically acceptable criteria for life-threatening PE risk with timely assessments.

CONCLUSION

The iWRAP has shown the potential to become the first theranostic wearable device with both continuous delivery of accurate and effective compression therapy and real-time monitoring of life-threatening conditions for VTE patients.

[Evidence of compression therapy with special consideration of medical adaptive compression systems]

For several decades, compression therapy, which is associated with few side effects, has been a basis for the conservative treatment of patients with phlebological and lymphological diseases. For the practical implementation of compression therapy, many different materials are available, some with system-specific advantages and disadvantages. Medical adaptive compression systems (MAK) are still a relatively new treatment option in Germany. Apart from the very good practical experience in clinical everyday life, the compilation of the scientific evidence of compression therapy also shows that the scientific data situation is significantly better than for many other medical areas, especially for the treatment of patients with venous diseases. It is important to note that compression therapy must reliably guarantee adequate compression pressure. If these conditions are met, it can be assumed on the basis of the currently available data that the clinical effectiveness of the different compression systems is comparably good. These aspects have now also been well tested for MAK, so that these analogies can be drawn. Therapists today can therefore choose between different, very effective therapy options and take individual factors, patient wishes and economic aspects into account when making their selection.

[Compression bandages with and without padding : Observational controlled survey of pressure and comfort]

BACKGROUND

In the context of compression therapy, padded bandages are designed to prevent skin damage, increase adherence and support the success of therapy. Routine use is discussed, because comparative studies are lacking.

OBJECTIVES

This study examines effectiveness, comfort, and impact of short-stretch bandages without padding compared to underpadded bandages.

PARTICIPANTS AND METHODS

In all, 61 healthy participants wore padded bandages foam or synthetic cotton wool on one leg and nonpadded bandages on the other. On both sides, a resting pressure of 50 mm Hg was generated. After 60 min resting pressure, skin condition, comfort, pain, and fitting of the bandages were assessed.

RESULTS

All bandages showed pressure losses after 1 h; 82.0% of nonpadded bandages had a pressure drop of 9 mm Hg or more. The following were observed in unpadded bandages: constrictions (100.0%), severe redness (77.0%) and bruises (42.6%). Comfort was rated as pleasant by 3.3% without padding, by 83.9% with foam padding, and by 73.3% with synthetic cotton wool padding. Nonpadded compression bandages caused in 62.3% pain from 1-3 (numerical rating scale 0-10).

CONCLUSIONS

Padded compression bandages maintain the therapy-relevant pressure better, provide more comfort, and cause less pain and skin problems than nonpadded compression bandages. These aspects are crucial for adherence, and therapeutic success. After 1 h of use on the healthy leg, there were obvious differences. Significantly more side effects may appear after several hours of use on previously damaged skin. Therefore, compression bandages should always be padded.