Systematic review of patient preference and adherence to the correct use of graduated compression stockings to prevent deep vein thrombosis in surgical patients

A randomized controlled trial of standard vs customized graduated elastic compression stockings in patients with chronic venous disease

OBJECTIVE

This study aimed to compare the efficacy of customized graduated elastic compression stockings (c-GECSs) based on lower leg parameter models with standard GECSs (s-GECSs) in patients with chronic venous disease (CVD).

METHODS

In this randomized, single-blind, controlled trial, 79 patients with stage C2 or C3 CVD were assigned to one of two groups: c-GECSs or s-GECSs. The primary outcome was change to Venous Insufficiency Epidemiological and Economic Study Quality of Life (VEINES-QOL) scores at months 1, 3, and 6 as compared with baseline. Secondary outcomes included compliance with wearing ECSs, interface pressure at the smallest circumference of the ankle (point B) and the largest circumference of the calf (point C), and calf volume (CV).

RESULTS

There were 13 pairs of s-GECS and 2 pairs of c-GECS that showed pressure values higher than the standard at either point B or C. The c-GECSs were significantly superior to s-GECSs in terms of score improvement at all three time points (month 1, 8.47 [95% confidence interval (CI), 7.47-9.45] vs 5.89 [95% CI, 5.00-6.78]; month 3, 9.60 [95% CI, 8.47-10.72] vs 6.72 [95% CI, 5.62-7.83]; month 6, 7.09 [95% CI, 5.93-8.24] vs 3.92 [95% CI, 2.67-5.18]; P < .0001). Besides, at month 1, the mean daily use time of the c-GECS and s-GECS groups was 10.7 and 9.5 hours, respectively (P < .05). Correlation analysis indicated a negative relationship between local high pressure and daily duration in the s-GECS group (rpb = -0.388; n = 38; P < .05). Variances in pressure were greater in the s-GECSs group. The c-GECSs showed advantage in maintaining pressure. Both c-GECSs and s-GECSs effectively reduced CV (mL), with no significant differences between groups (month 1, 90.0 [95% CI, 71.4-108.5] vs 85.0 [95% CI, 65.6-104.2]; month 3, 93.8 [95% CI, 69.7-117.8] vs 85.9 [95% CI, 65.5-106.2]; month 6, 70.8 [95% CI, 46.5-95.2]) vs 60.8 [95% CI, 44.1-77.5]).

CONCLUSIONS

The c-GECSs based on individual leg parameter models significantly improved VEINES-QOL scores and provided stable and enduring pressure as compared with s-GECSs for patients with stage C2 or C3 CVD. Although both c-GECSs and s-GECSs effectively reduced CV, the superior fit and comfort of c-GECSs improved patient compliance. Hence, c-GECSs are a viable alternative for patients who have difficulty tolerating s-GECSs.

Biomedical therapeutic compression textiles: Physical-mechanical property analysis to precise pressure management

Biomedical therapeutic compression textiles (TCTs) have been extensively applied in the prevention and treatment of chronic venous insufficiency of lower extremities. An efficiency and operable development strategy to achieve the morphologic control and pressure fitness of TCTs needs to be proposed to improve the medical precision and patient adherence. Therefore, the present study qualitatively explored the influencing mechanisms of each knitting variable on physical-mechanical properties and pressure behaviors of TCTs. Then constructed the quantitative models to digitalize the knitting variables for determination of yarn-machinery setting design values. The results revealed that the feeding velocity of elastic inlay yarn materials and loop size settings impacted the pressure values owing to the diversities of fabric dimensions and mechanical tensile properties, respectively. Simultaneously, the derivation ratios of proposed circumferential and pressure models evaluated by experimental validated trials were approximately 1.1% and 10.8%, respectively. This study provided the fundamental references for the design, manufacturing, and property controlling of compression textiles to improve the biomedical therapeutic effectiveness for targeted users.

Patient Preferences and Their Influence on Chronic Hepatitis B-A Review

Chronic hepatitis B (CHB) is a common chronic viral infectious disease that requires long-term treatment to control the condition and prevent complications. To standardize treatment regimens for CHB, professional associations have established relevant guidelines, but they have often overlooked patient preferences. Historically, in the treatment process, medical decisions were predominantly made by physicians or health care administrators, with limited patient involvement, leading to the neglect of patient preferences. Patient attitudes, expectations, and needs are all influenced by their preferences, and patient preferences have a direct impact on treatment adherence. Understanding and respecting patient preferences are crucial to ensuring treatment effectiveness. This article will explore patient preferences in the treatment of CHB and elucidate the influence of patient preferences on treatment adherence, aiming to provide insights for the development of a more personalized and effective health care process.

Development and validation of a graduated compression stockings adherence scale

OBJECTIVE

Compression therapy with the use of graduated compression stockings (GCSs) is a common treatment strategy for chronic venous disease (CVD). However, there is no uniform and objective standard to assess adherence to the use of GCSs. The aim of this study is to develop and validate a GCS Compliance Scale (GCSAS) to fill gaps in internationally recognized comprehensive scales and provide a useful tool for future research.

METHODS

The items included in the GCSAS were based on a review of the literature and open-ended interviews with experts, who screened the initial items using an item-level content validity index. Then, pilot tests were conducted three times with 50 participants. After exclusion of redundant and cross-loading items by exploratory factor analysis, 290 subjects were recruited to evaluate the reliability and validity of the proposed GCSAS. Analyses included internal consistency, test-retest reliability, split-half reliability, construct validity, criterion validity, convergent validity, and discriminant validity.

RESULTS

The final GCSAS consisted of 17 items and 5 dimensions. The results of the exploratory factor analysis indicated that the variances of each factor explained were 22.03%, 14.85%, 14.74%, 14.16%, and 13.35%, and all 5 factors explained 79.13% of the variance among the 17 items. The factor loadings of all items were >0.7. Confirmatory factor analysis indicated that the indices were adequate. A significant positive correlation was found between the GCSAS and the Venous Insufficiency Epidemiological and Economic Study - Quality of Life questionnaire scores (r = 0.76, p < 0.001). The Cronbach's alpha coefficient was 0.90, test-retest reliability was 0.81, and split-half reliability was 0.92.

CONCLUSIONS

The GCSAS showed good validity and reliability to assess compliance with the use of GCSs among patients with CVD.

[Medical compression stockings for chronic venous diseases and lymphedema : Scientific evidence and results of a patient survey on quality of care]

Hintergrund und Ziele

Medizinische Kompressionsstrümpfe (MKS) sind bei chronischer venöser Insuffizienz (CVI) aller Stadien indiziert und beim Lymphödem eine unverzichtbare Therapiekomponente; 8 % der deutschen Bevölkerung tragen vom Arzt verordnete MKS, Frauen häufiger als Männer (12 % vs. 5 %) und insbesondere Personen ab 60 Jahren (17 %). Die Adhärenz der Patienten ist relevant für eine erfolgreiche Behandlung mit MKS. Untersucht wurde die Versorgung mit MKS aus Patientensicht.

Patienten und Methodik

Die vorliegende Studie untersuchte 2019 die Versorgungsqualität durch strukturierte Interviews mit 414 repräsentativ ausgewählten Nutzern. Die Erkenntnisse werden vor dem Hintergrund wissenschaftlicher Evidenz zur Wirkung der MKS diskutiert.

Ergebnisse

Venenprobleme sind der häufigste Verordnungsgrund (44 %), gefolgt von Lymphödemen (22 %) bzw. Mehrfachindikationen (27 %). Patienten tragen MKS zumeist täglich und durchschnittlich 11 h/Tag; 89 % der Patienten waren zufrieden bzw. sehr zufrieden mit den MKS und berichteten je nach Indikation ein differenziertes Wirkprofil. Dieses reflektiert die umfangreiche wissenschaftliche Evidenz zur klinischen Wirksamkeit der MKS. Ein wichtiger Faktor für die Patientenadhärenz ist die ärztliche Schulung und Aufklärung.

Schlussfolgerungen

MKS werden von Patienten sehr gut akzeptiert. Bei der Verordnung sollen praktischen Aspekte wie An- und Ausziehen, empfohlene Tragedauer und -häufigkeit sowie der Wirkmechanismus der MKS vermittelt werden.

Graphic abstract

Guideline No. 417: Prevention of Venous Thromboembolic Disease in Gynaecological Surgery

OBJECTIVE

The primary objective of this clinical practice guideline is to provide gynaecologists with an algorithm and evidence to guide the use of thromboprophylaxis in gynaecological surgery.

TARGET POPULATION

All patients undergoing gynaecological surgery for benign or malignant indications.

BENEFITS, HARMS, AND COSTS

The implementation of this guideline will benefit patients undergoing gynaecological surgery and provide physicians with a standard algorithm for the use of perioperative thromboprophylaxis.

EVIDENCE

The following search terms were entered into MEDLINE, Google Scholar, and Cochrane in 2017 and 2018: VTE, PE, DVT, thromboprophylaxis, gynaecological surgery, heparin, graduated compression stocking, intermittent pneumatic stocking, obesity, pediatrics, minimally invasive surgery, heparin induced thrombocytopenia, regional anesthesia). Articles included were randomized controlled trials, meta-analyses, systematic reviews, and observational studies. Additional publications were identified from the reference lists of these articles. There were no date limits, but search results were limited to English language articles only. Searches were updated and incorporated into the guideline up to September 2018.

VALIDATION METHODS

The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations).

INTENDED USERS

Gynaecologists and other members of the surgical team. RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).

Sensitivity of the properties of the graduated compression stocking and soft tissues on the lower limb-stocking interfacial pressure using the orthogonal simulation test

Graduated compression stocking (GCS) plays an important role in the treatment of venous disease in the lower limb. However, the effect of the variation in the mechanical properties of the GCS and the soft tissues on the treatment of the venous disease in the lower limb remains unclear. The aim of the present study was to investigate the influence of the material properties of the GCS and soft tissues on the lower limb-stocking interfacial pressure using the orthogonal simulation test. A three-dimensional finite element (FE) model of the lower limb was established using the MRI dataset of a 40-year-old volunteer. The bones, the skin, the veins and the skeletal muscles were reconstructed in the FE model. The FE model of the GCS was generated using the information provided by the manufacturer. Then the parameter sensitivity analysis was performed using a two-step orthogonal simulation test. The first-step orthogonal test showed that the variation in the Young's modulus in the wale direction of the GCS induced a change of 0.37 mmHg in the lower limb-stocking interfacial pressure in the ankle section. The second-step orthogonal test showed that the variations in the Young's modulus in the wale direction of the GCS in the knee section induced the changes of 0.05 mmHg, 0.15 mmHg and 0.60 mmHg in the interfacial pressure in the ankle, the calf and the knee, respectively. In conclusion, the Young's modulus in the wale direction of the GCS and the Poisson's ratio of the GCS are the parameters significantly influencing the lower limb-stocking interfacial pressure. The interfacial pressure in the ankle is not sensitive to the Young's modulus in the wale direction of the GCS in the knee section. However, the interfacial pressures in the calf and knee are sensitive to the Young's modulus in the wale direction of the GCS in the knee section. These data provide important information for the design of GCS.

Reducing Venous Thromboembolism Risk Through a Collaborative Team Approach

PURPOSE

Venous thromboembolism (VTE) is a preventable cause of death following surgical procedures and is associated with increased cost and patient complications. The purpose of this article is to outline a collaborative team approach to reducing VTE rates within an organization in an effort to increase the quality and safety of care provided.

DESIGN

An interdisciplinary team collaborated on an approach to reduce VTE rates within the organization following a literature review of best practices related to risk assessment, nurse driven protocols, interdisciplinary collaboration, and autonomy.

METHODS

Through an interdisciplinary collaborative effort, improvements were made toward decreasing rates of the patient safety indicator-12: perioperative pulmonary embolism/deep vein thrombosis.

FINDINGS

Following implementation of several initiatives, the VTE rate within the organization steadily decreased and has remained below benchmark for over 18 months.

CONCLUSION

The successful improvements led by the interdisciplinary VTE Committee demonstrate the impact of best practices implemented through shared decision-making and autonomy.

Chinese orthopaedic nurses' knowledge, attitude and venous thromboembolic prophylactic practices: A multicentric cross-sectional survey

BACKGROUND

Venous thromboembolism is a severe preventable complication among orthopaedic surgical patients. Integrating therapeutic guidelines into clinical practice can help improve patient safety and reduce the burden of this pathology. Improving the quality of patient care is important for bridging the gap between the prophylaxis for venous thromboembolism and therapeutic guidelines.

OBJECTIVES

This study aimed at evaluating the knowledge, attitude, and venous thromboembolism and prophylaxis practices of Chinese orthopaedic nurses to guide quality care improvements.

METHODS

The data used in this study are secondary data obtained from a multicentric survey. An anonymous questionnaire was used to measure the attitude and knowledge of venous thromboembolic prophylaxis among orthopaedic nurses. VTE prophylactic practices were extracted from medical records within the electronic case report form immediately after the nurses' investigations. The STROBE statement for observational studies was applied.

RESULTS

Results indicated that although 94.0% of the responding nurses had attended training courses in their wards, a majority of them (68.9%) achieved a median knowledge score of 7 points or below (range 0-9). Knowledge regarding the proper use of prophylaxis, identification of risk factors, signs and symptoms for pulmonary embolism was limited. Self-reported attitudes underestimate the relationships between venous thromboembolism and low-quality nursing care. Pharmacological prophylaxis was highly used (90.9%), while the utilisation of mechanical prophylaxis and its proper use was relatively low.

CONCLUSIONS

Chinese orthopaedic nurses demonstrated enthusiasm for venous thromboembolism and prophylaxis. Their knowledge needs to be improved, including the proper use of prophylaxis, identification of risk factors, signs and symptoms. Mechanical prophylaxis practice for VTE prevention after THA and TKA surgical procedures is not optimistic. Further studies should analyse the causes from multiple perspectives, including the availability of resources, the knowledge and attitude of doctors, nurses and patients.

RELEVANCE TO CLINICAL PRACTICE

The findings from this study can be used to develop and implement interventions for venous thromboembolism after orthopaedic surgery.

Parametric modeling the human calves for evaluation and design of medical compression stockings

BACKGROUND AND OBJECTIVE

Accurate dose of compression imposed by functional compression garments, such as medical compression stockings, is critical for medical treatment or rehabilitation. To evaluate or provide fitted compression stockings for individuals, the real curved calf shapes other than just anthropometric parameters are required.

METHODS

This paper proposes and verifies a simple 3D parametric model of human calf that can fast and efficiently construct representative calves for evaluation or size-design purposes. Instead of selecting feature points, shape parameters were used to characterize the real calves.

RESULTS

Based on principal component analysis and a database of 220 scanned Chinese subjects, the proposed parametric model was found as capable of largely reducing the data complexity to only the 1st order principal component with a major variance percentage of as high as 96%. A methodological framework of parametric modeling was then proposed. Results show that the proposed parametric model and method can fast produce valid representative shapes of patients' calves, with which commercial stockings can be evaluated and customized stockings can be designed.

CONCLUSIONS

It can be concluded that the proposed parametric model and method can highly boost evaluation/size customization of MCSs, and will also inspire the research on customization of other compression garments.

Intermittent pneumatic compression for venous thromboembolism prevention: a systematic review on factors affecting adherence

OBJECTIVE

Venous thromboembolism (VTE) is a potentially fatal complication of hospitalisation. Intermittent pneumatic compression (IPC) is one approach to reducing the likelihood of a VTE. Adherence to IPC is known to be inadequate though the reasons for this remain unclear. This systematic review explores factors that affect adherence to IPC in the inpatient context.

METHODS

Information sources-EMBASE, MEDLINE and PsycINFO were searched for literature between January 1960 and May 2019. Eligibility criteria-studies were included if they focused on inpatient care and examined factors affecting adherence to IPC devices.

RESULTS

Included studies-a total of 20 out of 1476 studies were included. Synthesis of results-eight factors were identified that affected adherence: patient discomfort (n=8), healthcare professionals' knowledge and behaviours (n=6), mobilisation (n=6), equipment supply and demand (n=3), the use of guidelines (n=3), intensive care context (n=2), computer-assisted prescribing (n=2) and patients' knowledge of IPC (n=1).

CONCLUSION

Overall while the evidence base is quite limited, a number of factors were shown to affect adherence to IPC. These findings could be used to inform future research and quality improvement efforts to increase adherence in this very important, but currently under-researched area.

Reasons for patient non-compliance with compression stockings as a treatment for varicose veins in the lower limbs: A qualitative study

The study aims to explore the comprehensive reasons for patients’ non-compliance with graded elastic compression stockings (GECS) as the treatment for lower limb varicose veins. Phenomenological analysis was applied in this qualitative study. The patients diagnosed with lower limb varicose veins and undergoing elective surgery who showed non-compliance with GECS as the treatment were invited to have semi-structured, in-depth, face-to-face interviews. Colaizzi method was employed to analyze the data for emerging themes associated with the reasons for patients’ non-compliance. Four main themes and nine subthemes related to the reasons for non-compliance with GECS for lower limb varicose veins were summarized. The main themes that emerged were (1) gaps in the knowledge of GECS therapy as a treatment for lower limb varicose veins, (2) few recommendations from the doctors and nurses, (3) disadvantages of GECS, and (4) sociopsychological factors. These themes provide data for policy and planning to improve patients’ compliance with GECS in China. Patients, healthcare professionals, and policy makers should share the responsibility to improve patients’ compliance with GECS therapy.

Intermittent Calf Compression Delays the Onset of Presyncope in Young Healthy Individuals

Orthostatic fluid shifts reduce the effective circulating volume and thus contribute to syncope susceptibility. Recurrent syncope has a devastating impact on quality of life and is challenging to manage effectively. To blunt orthostatic fluid shifts, static calf compression garments are often prescribed to patients with syncope, but have questionable efficacy. Intermittent calf compression, which mimics the skeletal muscle pump to minimize pooling and filtration, holds promise for the management of syncope. We aimed to evaluate the effectiveness of intermittent calf compression for increasing orthostatic tolerance (OT; time to presyncope). We conducted a randomized single-blind crossover study, in which participants (n = 21) underwent three graded 60° head-up-tilt tests to presyncope with combined lower body negative pressure on separate days. Low frequency intermittent calf compression (ICLF; 4 s on and 11 s off) at 0-30 and 0-60 mmHg was applied during two tests and compared to a placebo condition where the garment was fitted, but no compression applied. We measured continuous leg circumference changes (strain gauge plethysmography), cardiovascular responses (finger plethysmography; Finometer Pro), end tidal gases (nasal cannula), and cerebral blood flow velocity (CBFv, transcranial Doppler). The 0-60 mmHg ICLF increased OT (33 ± 2.2 min) compared to both placebo (26 ± 2.4 min; p < 0.001) and 0-30 mmHg ICLF (25 ± 2.7 min; p < 0.001). Throughout testing 0-60 mmHg ICLF reduced orthostatic fluid shifts compared to both placebo and 0-30 mmHg ICLF (p < 0.001), with an associated improvement in stroke volume (p < 0.001), allowing blood pressure to be maintained at a reduced heart rate (p < 0.001). In addition, CBFv was higher with 0-60 mmHg ICLF than 0-30 mmHg ICLF and placebo (p < 0.001). Intermittent calf compression is a promising novel intervention for the management of orthostatic intolerance, which may provide affected individuals renewed independence and improved quality of life.

Prevention of venous thromboembolism in postoperative abdominal patients: a best practice implementation project

OBJECTIVES

This project's aim was to ensure that venous thromboembolism assessment was performed accurately, and that adequate prophylaxis was followed-up, resulting in a decrease in the incidence of venous thromboembolism postoperatively and enhancing recovery after surgery.

INTRODUCTION

Venous thromboembolism (VTE), which includes deep venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients. Evidence suggests that the majority of hospital patients are at risk for VTE, but the prophylaxis recommended for their risk factors are not adequately utilized. Venous thromboembolism prevention is primarily based on an adequate risk stratification.

METHODS

A baseline audit on VTE prevention utilizing the Joanna Briggs Institute Practical Application of Clinical Evidence System program was undertaken and involved 21 nurses and 30 patients. An intervention including VTE education, clinical practice and prophylaxis was conducted, following which a post-implementation re-audit was undertaken.

RESULTS

The baseline audit results showed that four audit criteria results were found to under 30%, which indicated poor compliance with the current evidence. After implementing the strategies, including education, VTE video, etc., there was a huge improvement, with most of the audit criteria achieving 100% compliance.

CONCLUSIONS

Overall the project achieved a significant improvement in evidence-based practice in the prevention of VTE, implemented in two wards. Sustaining best practice should be planned for the future.

Research quality in the study of mechanical methods of deep vein thrombosis prophylaxis

There is a lack of good-quality recent clinical data to support the use of mechanical methods to prevent deep vein thrombosis. Recommendations and meta-analyses have to rely on old data from evaluations of devices that are no longer available, with diagnostic methods that are obsolete. The aim of this narrative review is to examine the reasons why better recent evidence is not available, and how this will affect innovation in mechanical deep vein thrombosis prophylaxis. Analysis of recent published trials shows great variability in techniques and technologies, which complicates evaluation of the effectiveness of properties of intermittent pneumatic compression, graduated compression stockings, and electrical stimulation devices. Negative controlled trials have become difficult to conduct, and low rates of deep vein thrombosis have left many comparative trials of devices underpowered. There is a risk that if new approaches to enable clinical research are not developed that technological advancement of mechanical prophylaxis will be inhibited.

Active compression garment prevents tilt-induced orthostatic tachycardia in humans

Compression garments are used by patients with lower extremity edema to help regulate fluid distribution and to prevent orthostatic symptoms. Current compression stockings are often reported as uncomfortable and adherence is poor. The current study was conducted to assess the efficacy of a novel active compression garment on healthy individuals undergoing 60‐degree head‐up tilts for 10 min to induce venous pooling and subsequent physiological responses. During tilts while garments were on, participants’ absolute change in heart rate relative to baseline was lower (16.7 ± 8.7 BPM) compared to control (20.9 ± 11.47 BPM, P = 0.002). There were no differences in changes in mean arterial blood pressure between conditions (P = 0.303). One participant had a pre‐syncopal event which occurred during a tilt without garments. This participant did not experience pre‐syncopal symptoms with the garments on. All together, these data suggest that a novel active compression garment is capable of blunting increases in heart rate during head‐up tilt. While untested thus far in patient populations, these garments may prove efficacious in preventing orthostatic intolerance.

Semiautomatic intermittent pneumatic compression device applied to deep vein thrombosis in major orthopedic surgery

Objective

To investigate the effect of additional semiautomatic intermittent pneumatic compression device (IPCD) in the prevention of deep vein thrombosis (DVT) of lower extremity in these patients undergoing major orthopedic surgery, when compared with the conventional graduated compression stockings alone.

Methods

The data of 112 patients undergoing major orthopedic surgery were retrospectively analyzed. 51 patients who ever received IPCD and graduated compression stockings during major orthopedic surgery were taken as the experimental group, and 61 patients who only received the conventional graduated compression stockings during surgery were taken as the observation group. The Doppler sonography was utilized to detect the presence of DVT and pulmonary embolism pre- and postoperatively. Besides, the mean and peak velocity of blood flow in femoral vein were recorded before and after surgery. And then, the comparisons between the two groups were made, respectively.

Results

When compared with the conventional graduated compression stockings alone, the intraoperative application of IPCD and stockings contributed the significant reduction of DVT (3.92%, 2/51 versus 9.84%, 6/61, X² = 5.632, P = 0.034). In terms of the mean and peak velocity of blood flow in femoral vein, the postoperative difference was higher in the observation group than those in the control group (149.56 ± 26.35 versus 130.15 ± 22.56 mm/s, P < 0.05). With respect to perioperative blood loss, the difference between the two groups was statistically significant (800.5 ± 320.7 versus 950.1 ± 305.9 ml, P = 0.031).

Conclusions

Intraoperative application of IPCD could promote blood circulation of lower limbs, and significantly decrease the incidence of potentially fatal DVT in patients undergoing major orthopedic surgery, when compared with the conventional graduated compression stockings.