Comparison of stiffness and interface pressure during rest and exercise among various arm sleeves

Adjustable Compression Wraps (ACW) vs. Compression Bandaging (CB) in the Acute Phase of Breast Cancer-Related Arm Lymphedema Management—A Prospective Randomized Study

The objective of this study is to compare the effectiveness, comfort and possibilities of the self-application of adjustable compression wraps (ACW) with compression bandaging (CB) in the acute phase of treatment in advanced upper-limb lymphedema. In total, 36 patients who fulfilled the admission criteria were randomly assigned into ACW-Group (18 patients), or CB-Group (18 patients). Treatment in both groups lasted for two weeks. In the first, all patients were educated in applying adjustable compression wraps (ACW-Group) or self-bandaging (CB-Group) and treated by experienced physiotherapists. In the second week, the use of ACW and CB was continued by the patients themselves at home. In both groups, a clinically significant reduction in the affected limb volume was found after the first week (p < 0.001). A further decrease in the affected limb volume within the second week was noted only in the CB-Group (p = 0.02). A parallel trend was found in the percentage reduction in the excess volume after one and two weeks of compression therapy. Within two weeks, both groups achieved a significant improvement in decreasing lymphedema-related symptoms, but women from the ACW-Group reported complications related to carrying out compression more frequently (p = 0.002). ACW can reduce lymphedema and disease-related symptoms, but based on the results it is difficult to recommend this method as an alternative option in the acute phase of CPT among women with advanced arm lymphedema.

S.T.R.I.D.E. Professional Guide to Compression Garment Selection for the Lower Extremity

The following supplement is a rare example of a paper that combines clinical experience and theoretical knowledge on textiles used in compression therapy. The authors' intention is to propose a decision support system for choosing specific compression devices, which can be adjusted to counteract the individual signs and symptoms in an optimally adopted way. The document concentrates on compression devices which can be self-applied by the patients—compression stockings and adjustable wraps. The acronym ‘S.T.R.I.D.E.’, incorporating both textile characteristics and clinical presentation, stands for: Shape, Texture, Refill, Issues, Dosage and Etiology. The intent of the mnemotechnical value is to highlight that successful compression includes more than dosage alone. In addition to dosage, etiology and patient presentation need to be incorporated, including a patient's physical ability to use compression effectively as part of the daily routine, thereby promoting adherence.

The suggested algorithms provide a valuable guide to stride across the important, but still underestimated field of medical compression therapy and will help to put the prescription of a specific product on a more rational basis. Enjoy reading!

Hugo Partsch Emeritus Professor Medical University of Vienna, Austria

Preventing Early Postoperative Arm Swelling and Lymphedema Manifestation by Compression Sleeves After Axillary Lymph Node Interventions in Breast Cancer Patients: A Randomized Controlled Trial

CONTEXT

Breast cancer-related lymphedema (LE) remains one of the major long-term complications after surgery. Many reports showed the effectiveness of compression in breast cancer-related LE treatment, but randomized controlled trials evaluating compression garments for postoperative prevention are lacking.

OBJECTIVES

The aim of the study was to evaluate the potential role of light arm compression sleeves for reducing the incidence of early postoperative swelling and of breast cancer-related arm LE.

METHODS

A total of 45 women were pre-operatively randomly assigned to a group with compression of circular-knit sleeves in compression class I (15-21 mm Hg) for daily wearing (compression group [CG]; n = 23) or to a control group without compression (no CG, n = 22). Both groups underwent a standardized physical exercise program. Arm volumes were measured before surgery and one, three, six, nine, and 12 months thereafter.

RESULTS

At one month, postoperative swelling was reduced only in CG. After 12 months, the average change of excess volumes (edema) reached -67.6 mL in the CG vs. +114.5 mL in the no CG (P < 0.001). Significantly less edema was seen in the CG after three, six, nine, and 12 months. No significant difference between groups in health-related quality of life (measured by EORTC QLQ-C30) was observed.

CONCLUSION

Fifteen to 21 mm Hg compression sleeves in combination with physical activity may be a safe and efficient option to prevent postsurgical arm swelling and development of LE.

Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphoedema: a feasibility study

Exercise is considered to be a key aspect of lymphoedema treatment, although there is little evidence for the therapeutic effect of exercise in managing breast cancer-related lymphoedema (BCRL). This small randomised controlled trial (RCT) was designed to determine the feasibility, prior to undertaking a larger RCT, of researching a daily home-based exercise programme to treat stable BCRL. An experimental design compared the exercise intervention combined with standard lymphoedema self-care to self-care alone over a 6-month period. Twenty-three women with stable unilateral BCRL of ≥10 % excess limb volume (ELV) were randomly allocated to a daily home-based exercise programme and self-care (n = 11) or self-care measures alone (n = 12). The primary objective was to determine difference in limb volume reduction for the two groups. Secondary objectives were to monitor change in other areas that impact BCRL: quality of life, arm function and range of shoulder movement. All 23 women completed the trial, providing full data for each time point. The intervention group showed a clinically and statistically significant improvement in relative ELV at week 26 (95 % confidence interval (CI) -26.57 to -5.12), whereas the control group improvement crossed the line of no effect (95 %CI -17.71 to 1.1). This study demonstrated the feasibility of conducting a RCT of exercise as a therapeutic intervention in the management of BCRL. Although the sample was small, the results support the findings of other exercise studies which have shown trends towards improvement.

Edema: a silent but important factor

Edema is a normal response to injury. Even the smallest injury is associated with some inflammation, and initial edema is part of the normal inflammatory process. However, edema becomes a concern when it persists beyond the inflammatory phase. Once we have progressed into the rebuilding, or fibroplastic phase of healing, edema will delay healing and contribute to complications such as pain and stiffness. Early prevention and management to prevent this progression are therefore critical. This article discusses edema in relation to stages of healing and presents the research behind techniques available to the clinician to manage localized extracellular upper extremity edema in the patient with an intact lymphatic system.

Development of separated elastic stockings

Objectives

To investigate the acceptability of newly developed separated elastic stockings, which are divided into two portions at the ankle.

Methods

The difficulty in putting on and taking off stockings was compared between the original or modified separated stockings with various techniques in order to reduce the shift of the stockings and current non-separated stockings in healthy volunteers and patients with lymphoedema by applying both stockings alternately. In the modified model, the shift during daily activities was measured in healthy volunteers and patients with lymphoedema.

Results

The two items, ‘easier compared with non-separated stockings’ and ‘much easier’, were chosen at rates of 75% and 81% for putting on and taking off stockings for the original separated stockings and 75% and 75% for the modified separated stockings, respectively. Complaints during daily activities with the modified type to the stockings decreased as compared with the original type. The shift of stockings after an average 11-hour application was 1.6 ± 3.0 SD mm (range: 0–10 mm).

Conclusions

Modified separated elastic stockings are easier to put on and take off compared with current non-separated stockings, and they can be used safely because of their low-level shift during daily activities.

Interface pressure and stiffness in different combinations of compression material

Objectives

To compare the interface pressure and stiffness between various combinations of compression material.

Methods

Using a stiffness-determining device, the interface pressure and stiffness were determined in several combinations of five elastic stockings and two elastic bandages.

Results

In the double stockings system, the interface pressure increased significantly and the highest stiffness was observed in double short-stretch stockings. When short-stretch bandages were applied over either short- or long-stretch stockings, a significant increase in stiffness was observed at any initial pressure compared with the single use of short-stretch stockings. In double bandage systems, when short-stretch bandages were applied over either short- or long-stretch bandages, the stiffness increased significantly. When long-stretch bandages were used over short-stretch bandages, the stiffness decreased significantly.

Conclusions

The stiffness is changeable according to the combinations of material, such as double stockings, double bandages and the wearing of bandages over stockings. The use of short-stretch bandages as the outside layer produces the highest stiffness at a high initial pressure.