Comparative systematic review and meta-analysis of compression modalities for the promotion of venous ulcer healing and reducing ulcer recurrence (original) (raw)
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Is it time to re-appraise the role of compression in non-healing venous leg ulcers?
Journal of wound care, 2013
To evaluate the role of compression in non-healing venous leg ulcers (VLUs) of > 3 months' duration. Patients' records from three independent data sets of non-healing VLUs of > 3 months'duration were re-analysed.Two data sets were separate audits of clinical practice and the third comprised patients' records from a randomised controlled trial. Some patients in each data set were never treated with compression. The effect of compression on healing at 6 months was tested with logistic regression. In each data set, patients in the compression and no-compression groups were matched according to ulcer size and duration; there were no differences in comorbidities. Comparing the no-compression with the compression groups, the healing rate at 6 months was 68% vs 48% in study 1, 12% vs 6% in study 2, and 26% vs 11% in study 3. Use of compression was found to be an independent predictor of not healing with an odds ratio of 0.422, 0.456 and 0.408 in studies 1, 2 and 3 res...
Journal of Vascular Surgery, 2006
Objective: To compare venous ulcer recurrence and compliance with two strengths of compression hosiery. Methods: This study was a randomized controlled trial with a 5-year follow-up. The setting was the leg ulcer clinics of a teaching and a district general hospital in Scotland, United Kingdom. Patients were 300 outpatients with recently healed venous ulcers, with no significant arterial disease, rheumatoid disease, or diabetes mellitus. Interventions were fitting and supply of class 2 or class 3 compression hosiery. Four-monthly refitting by trained orthotists and surveillance by specialist nurses were performed. The main outcome measures were recurrence of leg ulceration and compliance with treatment. Results: Thirty-six percent (107/300) of patients had recurrent leg ulceration by 5 years. Recurrence occurred in 59 (39%) of 151 class 2 elastic compression cases and in 48 (32%) of class 3 compression cases. One hundred six patients did not comply with their randomized compression class, 63 (42%) in class 3 and 43 (28%) in class 2. The difference in recurrence is not statistically significant, but our estimate of the effectiveness of class 3 hosiery is diluted by the lower compliance rate in this group. Restricted ankle movement and four or more previous ulcers were associated with a higher risk of recurrence. Conclusions: There was no evidence of a difference in recurrence rates at the classic level of significance (5%), but the lowest recurrence rates were seen in people who wore the highest degree of compression. Therefore, patients should wear the highest level of compression that is comfortable.
International Wound Journal, 2012
The aim of this study was to determine the rate of venous ulcer recurrence and the level of compliance in patients wearing European class 1 or class 2 compression stockings. A total of 100 patients with healed venous leg ulcers were recruited, and were randomised to either class 1 (n = 50) or class 2 (n = 50) compression stockings. Follow-up was at 1 week, 3, 6, 9 and 12 months to monitor ulcer recurrence and compliance. Patients had a duplex scan to identify the source of venous incompetence. The rate of ulcer recurrence after 12 months was 16•1%, and the difference in recurrence rate between classes was not statistically significant (P = 0•287) although greater numbers in class 1 developed a recurrence. Participants (88•9%) were compliant; non-compliant patients were at a significantly greater risk of recurrence (P ≤ 0•0001). Thirteen patients had both superficial and deep incompetence; those randomised to class 1 stockings (n = 4) developed ulcer recurrence. Patients with a history of multiple episodes of ulceration were more likely to develop a recurrence (P = 0•001). The lowest venous ulcer recurrence rates were seen in patients who were compliant with hosiery regardless of the compression level. Patients with both superficial and deep incompetence had a lower rate of recurrence with class 2 compression.
BMC nursing, 2011
Background: Objective: To determine the relative effectiveness of evidence-informed practice using two high compression systems: four-layer (4LB) and short-stretch bandaging (SSB) in community care of venous leg ulcers. Design and Setting: Pragmatic, multi-centre, parallel-group, open-label, randomized controlled trial conducted in 10 centres. Cognitively intact adults (≥18 years) referred for community care (home or clinic) with a venous ulceration measuring ≥0.7cm and present for ≥1 week, with an ankle brachial pressure index (ABPI) ≥0.8, without medicationcontrolled Diabetes Mellitus or a previous failure to improve with either system, were eligible to participate. Methods: Consenting individuals were randomly allocated (computer-generated blocked randomization schedule) to receive either 4LB or SSB following an evidence-informed protocol. Primary endpoint: time-to-healing of the reference ulcer. Secondary outcomes: recurrence rates, health-related quality of life (HRQL), pain, and expenditures.
Controlling compression bandaging pressure in leg ulcer research trials: A summary of the literature
Phlebology: The Journal of Venous Disease, 2019
Compression bandaging remains the ‘gold standard’ intervention for the treatment of venous leg ulcers. Numerous studies have investigated the effect of a large variety of compression bandaging techniques and materials on venous leg ulcer healing. However, the majority of these studies failed to monitor both actual bandage application pressures and the bandaging competency of participating clinicians. A series of literature searches to explore the methods, practices, recommendations and results of monitoring compression bandaging pressures in leg ulcer research trials were undertaken. This included investigating the reliability and validity of sub-bandage pressure monitors and the degree to which compression bandaging achieves the recommended sub-bandage pressure. The literature revealed inconsistencies regarding the monitoring of sub-bandage pressure and in sub-bandage pressures produced by clinicians. This creates difficulties when comparing study outcomes and attempting to develop...
Compression modalities and dressings: their use in venous ulcers
Dermatologic Therapy, 2006
Among the standard of care for venous ulcer treatment are the use of compression therapy to reverse the effect of venous hypertension and the use of occlusive dressings to maintain a moist wound-healing environment and for treatment of abnormalities of the ulcer bed. The use of multilayered elastic bandages for compression in patients with normal arterial flow currently provides the treatment with the highest level of evidence for treatment of venous ulcers. Additionally, treatment of the ulcer bed, especially with cadexemer iodine dressings, is also supported by evidence from randomized controlled trials, whereas newer dressings provide less well proven alternative opportunities to speed the healing of venous ulcers.
Compression therapy in the treatment of leg ulcers
2009
The group of experts who developed this consensus document has to be congratulated for delivering clear and updated guidelines on the management of leg ulcers by compression. A classification of compression devices is proposed that is based more on the performance in vivo than on laboratory data from the producers alone. This has become possible by the introduction of devices measuring the sub-bandage pressure on the individual leg, which is the dosage of compression therapy. Pressure measurement has improved our understanding of compression management and is also very useful for training purposes. Since most of the bandages performed in daily practice consist of mixture of several types of materials, all with different elastic properties, the physical data alone given for the individual components are insufficient to describe the performance of the final bandage. The complex effects of compression are explained as a logic basis for the clinical indications that do not only concentr...
Dubai Medical Journal, 2018
Background: Venous ulcers have considerable human and financial costs. Bandage compression is the most common type of compression used to enhance healing. Ulcer size, pretreatment ulcer duration, and the consistency of pressure (depending on the competency of the bandager) significantly affect the healing process. Summary: The aim of this review is to explore whether the variability in bandagerelated baselines contributes to the differences in healing outcomes among the empirical studies designed to evaluate bandage compression for treating venous ulcers in community and outpatient settings. Two health-related databases were searched: Medline and the Cumulative Index for Nursing and Allied Health. A manual search of relevant reviews and publication reference lists was also undertaken. Fourteen studies were included. The most common study design was a randomized controlled trial. Only one study used a cohort design. This review focused on two variables: healing rate and healing time. The ulcer features, the consistency of the pressure level, and the competency of the bandager were the main factors within the reviewed studies that affect the baselines and healing outcomes. Key Messages: This integrative review confirms that the large variability in the baselines results from differences in the ulcer size, duration, competency level, and amount of pressure that led to differing healing outcomes. Future research designs need to pay attention to make the baselines consistent by ensuring that the ulcer size, duration, competency of the nurses, and level of compression are comparable and consistent within the studies' design.
Phlebology: The Journal of Venous Disease, 2019
ObjectiveTo evaluate the efficacy, safety and acceptability of an innovative two-component versus a well-established four-component compression systems in the management of venous leg ulcer.MethodMulticentre randomized controlled trial in patients with active venous leg ulcer. Patients were followed-up monthly for a maximum of 16 weeks. The primary endpoint was the complete healing rate at 16 weeks.ResultsNinety-two patients were randomized to either the two-component BIFLEX® Kit group ( n = 49) or the four-component PROFORE® group ( n = 43). In the full analysis set ( n = 88), a complete healing rate of 48.9% and 24.4% was reported in BIFLEX® Kit versus PROFORE® groups, respectively (i.e. a superiority of 24.5%, p = 0.02). Acceptability of BIFLEX® Kit was higher from both the patients’ and physicians’ perspectives.ConclusionThe BIFLEX® Kit represents a valid alternative therapy in the management of venous leg ulcer according to its clinical efficacy, safety and acceptability with p...