Compression therapy: scientific background and practical applications

Compression therapy in dermatology

Compression therapy is a conservative therapy that can be used in many patients with dermatological conditions, especially those associated with edema. In addition to its well-established use in venous and lymphatic disorders, there is increasing evidence that compression therapy supports the healing of inflammatory dermatoses. The presence of edema, regardless of its etiology, is an indication for the use of compression therapy. Nowadays, a variety of materials and treatment options are available for compression therapy, each with their own advantages and disadvantages. Often, compression therapy with low resting pressures is sufficient for effective therapy and is better tolerated by patients. The main contraindications to compression therapy are advanced peripheral arterial disease and decompensated heart failure. Individual factors and economic considerations should be taken into account when deciding on compression therapy with the patient. Patient self-management should be encouraged whenever possible. This requires education and support tools.

Kompressionstherapie in der Dermatologie

Die Kompressionstherapie ist eine konservative Therapie, die bei vielen Patienten mit dermatologischen Krankheiten durchgeführt werden kann, insbesondere wenn diese mit Ödemen assoziiert sind. Neben den wissenschaftlich sehr gut belegten Indikationen bei venösen und lymphatischen Erkrankungen, gibt es auch zunehmend wissenschaftliche Hinweise, dass durch die Kompressionstherapie die Abheilung entzündlicher Dermatosen unterstützt wird. Wenn Ödeme vorliegen, handelt es sich, unabhängig von deren Genese, um einen Einsatz im Rahmen der Zulassung der Kompressionstherapie.

Für die Kompressionstherapie stehen heute verschiedene Materialien und Versorgungsoptionen mit systemspezifischen Vor‐ und Nachteilen zur Verfügung. Oft ist eine Kompressionstherapie mit niedrigen Ruhedruckwerten für einen Therapieerfolg ausreichend und wird von den Patienten besser toleriert. Als wichtigste Kontraindikationen der Kompressionstherapie sind die fortgeschrittene periphere arterielle Verschlusskrankheit und die dekompensierte Herzinsuffizienz zu beachten.

Bei der gemeinsam mit dem Patienten getroffenen Entscheidung für eine Kompressionstherapie, sollten individuelle Faktoren und wirtschaftliche Aspekte berücksichtigt werden. Wann immer möglich, ist ein Selbstmanagement des Patienten zu unterstützen. Hierfür sind Edukation und Hilfsmittel erforderlich.

Pressure-Measuring Devices for Compression Therapy in Venous Leg Ulcers: A Comprehensive Review

OBJECTIVE

To investigate the evolution of pressure-measuring devices used in compression treatment for venous leg ulcers and assess the most practical and effective devices to determine optimal pressure in compression therapy.

DATA SOURCES

Relevant information was retrieved from databases including Google Scholar, PubMed, Wiley Online, and ScienceDirect without publication date restrictions. The keywords included venous leg ulcer, compression therapy, pressure measuring device, pressure sensor, and wireless system.

STUDY SELECTION

Studies included in the review had to be published in English and discuss or compare pressure-measuring devices/sensors for compression therapy, the development of alternative sensors, and the applications of wireless technologies. Veterinary studies, conference proceedings, and unpublished articles were excluded. Applicable studies and articles were critically evaluated and synthesized.

DATA EXTRACTION

After abstract review, 39 studies were identified. During full-text review, study details were collected using a data extraction form and organized into tables. Device attributes, accuracy, price, and limitations were categorized and analyzed.

DATA SYNTHESIS

Studies disagree on the effectiveness and user-friendliness of existing pressure-measuring devices. These devices often impact user comfort and convenience, which are crucial factors in the adoption and use of wearable devices. Potential solutions for pressure-measuring devices with promising technologies were proposed: four feasible alternative sensors are described that could improve comfort and facilitate prolonged use under bandages. Advanced communication technologies may provide more convenience for users and practitioners.

CONCLUSIONS

Conventional pressure-measuring devices used in compression therapy are not designed for the user's comfort and convenience. The use of flexible and stretchy pressure sensors (e-skin) provides good biocompatibility, conformability, and comfort and when integrated with near-field communication technology could address the drawbacks of current pressure-measuring devices.

Maggot Therapy as a Part of a Holistic Approach in the Treatment of Multimorbid Patients with Chronic Ulcer

Patients with chronic wounds (leg ulcers, decubitus, and diabetic foot ulcers) suffer from marked restrictions in their quality of life and can often no longer adequately carry out their everyday tasks. The need for nursing and medical care increases when other illnesses and complaints are present at the same time. Qualified wound care and the treatment of comorbidities are therefore of particular importance. The treatment of this disease, which is increasing in number, requires a holistic, multimodal treatment approach which, in addition to professional wound care, also includes comorbidities in the treatment. This case study describes an old treatment method for refractory wounds, the so-called "maggot therapy", and shows how this is integrated into a holistic, multimodal therapeutic approach.

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.

[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.

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

BACKGROUND

If compression bandaging is not performed in a professional manner, the objectives of the therapy may not be achieved and side effects or complications may result.

OBJECTIVES

This cross-sectional observational survey examines the handling of the treatment options: short-stretch bandages with padding, multicomponent compression systems, and adaptive compression bandages.

PARTICIPANTS AND METHODS

During several training sessions on the topic of compression therapy, 137 participants performed compression bandagings on each other. In this regard, they were asked to achieve a predetermined pressure range (short-stretch bandages: 50-60 mm Hg, multicomponent compression systems: 40-50 mm Hg, adaptive compression bandage: 35-45 mm Hg). To evaluate the efficiency, the time used for application, the achieved pressure value, and the comfort were determined.

RESULTS

Of the 302 bandagings (n = 137 participants), 28.4% lay within the given target pressure value range. This included 11.2% of performed short-stretch bandages, 35.2% of multicomponent compression systems, and 85.0% of adaptive compression bandages. Significant differences in the mean deviations are found between the treatment options. The bandage was described as being comfortable by 37.7% of users of short-stretch bandages with padding, by 65.0% of those wearing a multicomponent compression system, and by 94.6% of participants with an adaptive compression bandage.

CONCLUSIONS

In practice, short-stretch bandages are still the most frequently used care option for the creation of a phlebological compression bandage. In this survey, they proved to be unsafe, time-consuming, and uncomfortable in relation to other treatment options. Multicomponent compression systems and adaptive compression bandages are treatment options that may be a contemporary alternative which also bares more comfort for the patient.

Comparison of the effectiveness of complex decongestive therapy and compression bandaging as a method of treatment of lymphedema in the elderly

Background

Lymphedema is a chronic condition which significantly lowers the quality of patient life, particularly among elderly populations, whose mobility and physical function are often reduced.

Objectives

The aim of the study was to compare the effectiveness of multi-layer compression bandaging (MCB) and complex decongestive therapy (CDT), and to show that MCB is a cheaper, more accessible and less labor intensive method of treating lymphedema in elderly patients.

Patients and methods

The study included 103 patients (85 women and 18 men) aged ≥60 years, with unilateral lower limb lymphedema. The subjects were divided into two groups: 50 treated with CDT and 53 with MCB. Pre- and post-treatment BMI, and average and maximum circumference of the edematous extremities were analyzed.

Results

Reduction in swelling in both groups was achieved after 15 interventions. Both therapies demonstrated similar efficacy in reducing limb volume and circumference, but MCB showed greater efficacy in reducing the maximum circumference.

Conclusion

Compression bandaging is a vital component of CDT. Maximum lymphedema reduction during therapy and maintaining its effect cannot be achieved without it. It also demonstrates its effectiveness as an independent method, which can reduce therapy cost and accessibility.

Compression therapy in patients with venous leg ulcers

Wund-D.A.CH. is the umbrella organization of the various wound care societies in German-speaking countries. The present consensus paper on practical aspects pertinent to compression therapy in patients with venous leg ulcers was developed by experts from Germany, Austria, and Switzerland. In Europe, venous leg ulcers rank among the most common causes of chronic wounds. Apart from conservative and interventional wound and vein treatment, compression therapy represents the basis of all other therapeutic strategies. To that end, there are currently a wide variety of materials and systems available. While especially short-stretch bandages or multicomponent systems should be used in the initial decongestion phase, ulcer stocking systems are recommended for the subsequent maintenance phase. Another - to date, far less common - alternative are adaptive Velcro bandage systems. Medical compression stockings have proven particularly beneficial in the prevention of ulcer recurrence. The large number of treatment options currently available enables therapists to develop therapeutic concepts geared towards their patients' individual needs and abilities, thus resulting in good acceptance and adherence. Compression therapy plays a crucial role in the treatment of patients with venous leg ulcers. In recent years, a number of different treatment options have become available, their use and application differing among German-speaking countries. The present expert consensus is therefore meant to outline concrete recommendations for routine implementation of compression therapy in patients with venous leg ulcers.

[Quality of self-applied compression bandages in patients with chronic venous ulcers : Results of a prospective clinical study]

BACKGROUND

For effective compression therapy in patients with venous leg ulcers, sufficient pressure is essential. In everyday life, it is often the patients themselves who apply the compression bandages. Many of these patients have restriction in their movement and had been rarely trained adequately. Hence, there was the question of how efficient are the autonomously applied compression bandages of those patients.

PATIENTS AND METHODS

In all, 100 consecutive patients with venous leg ulcer were asked to apply compression bandages on their own leg. We documented both the achieved compression and formal criteria of correct performance.

RESULTS

A total of 59 women and 41 men with an average age of 70.3 years were included in the study. Overall 43 patients were not able to apply a compression bandage because of physical limitations. The measured pressure values in the remaining 57 patients ranged between 6 and 93 mm Hg (mean 28.3 mm Hg). Eleven patients reached the prescribed effective compression pressure. Of these, formal errors were found in 6 patients, so that only 5 patients had correctly applied the compression bandages.

CONCLUSION

Our data show that most patients with venous leg ulcers are not able to apply effective compression therapy with short-stretch bandages to themselves. Multilayer systems, adaptive compression bandages, and ulcer stocking systems today are possibly easier and more effective therapy options. Alternatively short-stretch bandages could be applied by trained persons but only under the control with pressure measuring probes.

[Indications and contraindications for modern compression therapy]

Compression therapy is a physical therapy with few side effects, which is used especially in patients with edema of the lower extremities. The indication for compression therapy is given here for edema of very different origins such as, for example, venous or lymphatic disease symptoms as well as renal insufficiency, obesity or inflammation. However, different contraindications must be considered in these patients. Of particular importance are the advanced peripheral arterial occlusive disease and the polyneuropathy, which need special attention.Due to the large number of different compression materials and systems available today, in spite of these contraindications, compression therapy can be carried out with a large proportion of patients with edema of the lower extremities. The therapy should be adapted to the comorbidities and individual needs as well as personal abilities in the context of a patient-oriented care.

Compression therapy - cross-sectional observational survey about knowledge and practical treatment of specialised and non-specialised nurses and therapists

Knowledge about methods and materials and their correct usage is the basis for compression therapy. This study compares knowledge and practical skills of participants with further training with those who had no training. This comparison provides information on whether further qualifications have an impact on knowledge and practical skills. In seminars for compression therapy, data on specific and non-specific expertise were acquired. A practical test determined the participants' skills for creating a compression bandage in a pressure value range of 50-60 mmHg. In total, 1338 participants with specific expertise and 138 participants with non-specific expertise took part. Knowledge evaluation showed that 7·9% of the specific expertise group had knowledge regarding padding, 10% regarding multi-component systems and 13·6% regarding ulcer stocking systems. In the practical test, 12·3% of all participants achieved the target range. The majority of users in both groups is not familiar with the different compression materials or their appropriate usage. In the non-specific expertise group, knowledge concerning up-to-date materials and methods is one-third lower. The practical test showed major deficits on both sides. Appropriate exercises, for example, with pressure-measuring devices, should be mandatory for all professional groups who perform compression bandaging.

[A standard data set for the evaluation of venous leg ulcers in selective contracts : National consensus]

BACKGROUND

Selective agreements are becoming increasingly important in health care management. To date, no standard recommendations for the evaluation of selective contracts are available.

OBJECTIVES

Against this background, a recommendation on the evaluation of selective contracts in patients with leg ulcers (LU) was developed and approved by the nationwide consensus conference.

MATERIALS AND METHODS

Based on a systematic literature review and followed by a manual search through other possible evaluation indicators in the care of patients with LU, a Delphi-based consensus process was performed by various scientific societies, professional associations, insurances and supply networks.

RESULTS

For the evaluation of efficiency and quality of care, a recommendation on the evaluation of selective agreements with patients with LU was consented in six meetings and in five multistage online surveys. In total, 44 evaluation indicators were identified in the quality subareas structure, process, and outcome. The outcome indicators are divided into clinical, patient-related, and cost-related indicators.

CONCLUSIONS

The developed evaluation indicators represent the quality of care in patients with LU. The indicators can be applied individually, depending on the agreed contract-specific supply target. After implementation of this national standard, the comparability of selective agreements in the management of patients with LU can be ensured and consolidated.

Epidemiology and use of compression treatment in venous leg ulcers: nationwide claims data analysis in Germany

Chronic venous diseases are the most common causes of leg ulcers. Compression treatment (CT) is a central component of venous leg ulcer (VLU) therapy along with prevention based on guidelines and clinical evidence. However, large-scale data on the use of CT are rare. In particular, there have not yet been published nationwide data for Germany. We analysed data from a large German statutory health insurance (SHI) on incident VLU between 2010 and 2012. VLUs were identified by ICD-10 diagnoses. The status of active disease was defined by wound-specific treatments. Compression stockings and bandages were identified by SHI medical device codes. The overall estimated incident rate of active VLU of all insured persons was 0·34% from 2010 to 2012. Adapted to the overall German population, n = 229 369 persons nationwide had an incident VLU in 2010-2012. Among all VLU patients, only 40·6% received CT within 1 year, including 83·3% stockings, 31·8% bandages and 3·1% multi-component compression systems. Compression rates showed significant differences by gender and age. Large regional variations were observed. Validity of data is suggested by high concordance with a primary cohort study. Although recommended by guidelines, there is still a marked under-provision of care, with CT in incident VLUs in Germany requiring active measures.

[Compression therapy of venous leg ulcers in the decongestion phase]

Compression therapy is the basis for successful treatment in most patients with venous leg ulcers. Concerning compression therapy, the initial phase of decongestion and the following phase of maintenance should be differentiated. While in the maintenance phase (ulcer) stocking systems are now frequently recommended, in the decongestion phase compression bandages are mostly still used, which however are often inappropriately applied. In German-speaking countries, compression therapy with short-stretch bandages has a long tradition. However, their correct application requires good training and monitoring, which is often lacking in daily practice. Less error-prone treatment alternatives are multicomponent systems, some of which have an optical marker for the control of the correct subbandage pressure. In another new type of compression system, which is called adaptive or wrap bandages, the compression pressure can be adjusted using a Velcro fastener. Accompanying intermittent pneumatic compression therapy can also be used in the decongestion phase. Thus, there are now several different treatment options that can be used for the decongestion phase in patients with venous leg ulcers. Often bandages with short-stretch materials are very prone to errors and should in most cases be replaced by other compression systems today. The patient's preference, need, and capability should be considered when selecting the appropriate system for the individual patient.

[Compression therapy in leg ulcers]

Compression therapy is well-tried treatment with only few side effects for most patients with leg ulcers and/or edema. Despite the very long tradition in German-speaking countries and good evidence for compression therapy in different indications, recent scientific findings indicate that the current situation in Germany is unsatisfactory. Today, compression therapy can be performed with very different materials and systems. In addition to the traditional bandaging with Unna Boot, short-stretch, long-stretch, or multicomponent bandage systems, medical compression ulcer stockings are available. Other very effective but far less common alternatives are velcro wrap systems. When planning compression therapy, it is also important to consider donning devices with the patient. In addition to compression therapy, intermittent pneumatic compression therapy can be used. Through these various treatment options, it is now possible to develop an individually accepted, geared to the needs of the patients, and functional therapy strategy for nearly all patients with leg ulcers.