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COMPRESSION THERAPY
10 JCN supplement
2014,Vol 28, No 6
being combined with clinical
expertise and patient values to
achieve the best possible patient
management (Sackett et al,
1996). Without evidence to guide
practice, a ‘this is how we do it here’
mentality can lead to poor and
outdated care (White, 2013).
What influences
compression choice?
Nursing care is steeped in tradition
and ritual. Practice is often
influenced by personal experience
and the opinion of colleagues, as
well as tried and tested treatment
approaches that have had good
results in the past (Flanagan, 2005).
Traditional knowledge and practice
successfully passes down through
generations of practitioners, but at
its worst this can perpetuate poor or
outdated practice (Flanagan, 2005).
Williams (2014) indicated that for
some, selection of compression is
rooted in tradition and dogma. For
example, a clinician may continually
use a particular compression
bandage due to habit, rather than
matching a product to the clinical
needs of the individual.
When used appropriately,
compression therapy can greatly
improve a patient’s quality of life,
but all too often poor knowledge
and skills are a common reason
why patients complain about this
Patients were randomly allocated
to leg ulcer hosiery kits or four-
layer compression bandaging, and
received care as usual until:
Their ulcer healed
They could not continue with
the allocated treatment
They switched, or were lost to
follow-up or died.
Healing was defined as complete
epithelial cover with no scab, with
those who healed being followed
up for 12 months. In total, data
from 454 patients was analysed
(bandaging, n=224; stockings,
n=230).
Healing rates
Results showed that a similar
number of patients in the
bandaging and hosiery kit groups
healed (bandaging, n=70%; hosiery,
n=71%) in a similar amount of
time (bandaging, n=98 days;
hosiery, n=99 days). Of those who
experienced ulcer recurrence, more
were in the bandaging (23%) than
hosiery group (14%).
Cost-effectiveness
Average costs were about £300
per participant per year lower
for the group managed with leg
ulcer hosiery kits. This was mainly
because these patients required
fewer nursing consultations, and
this group also reported slightly
higher average quality-adjusted
life year scores (highlighting
improvement in the quality and
quantity of life lived). Overall, the
trial showed that hosiery had a 95%
probability of being the most cost-
effective treatment.
advantages of using
leg ulcer hosiery kits
In terms of organisational
benefits, using leg ulcer hosiery
kits presents the NHS with better
value for money, while also being
as clinically-effective as four-
layer compression bandaging. In
addition, fewer consultations are
required, as patients can also be
involved in their care (Beldon, 2013;
Ashby et al, 2014); a factor which
is known to improve concordance
with compression therapy
(McNichol, 2014).
‘Poor professional knowledge
and skills are a common
reason why patients complain
about compression therapy...
the patient’s access to
effective compression should
not be restricted by the
experience or knowledge of
the practitioner’
treatment (Moffatt, 2014). It is
obvious, therefore, that practitioners
can have an impact on patient
concordance with compression
therapy. By understanding the
key principles of compression
therapy, products available and
their properties, practitioners can
best meet their patients’ needs
(Gray, 2013).
What is the case
for change?
The WUWHS first highlighted
in their international consensus
document that two-component
compression hosiery can be used
as first-line treatment (e.g. leg
ulcer hosiery kits), ‘particularly for
patients with small, uncomplicated
ulcers who wish to self-care, who
require daily skin care, or who
find bandages too hot and bulky’
(WUWHS, 2008).
Following this, the findings of
the VenUS lV randomised controlled
trial (RCT) (Ashby et al, 2014)
highlighted the benefits of using leg
ulcer hosiery kits at the forefront of
lower limb care.
The VenUS IV study was a
multicentre, two-group RCT that
recruited patients with venous leg
ulcers from 34 centres in England
and Northern Ireland, including
community and tissue viability
teams/services, GP practices,
community and outpatient leg-
ulcer clinics, and wound clinics.
The trial compared the clinical- and
cost-effectiveness of two-layer
compression hosiery with four-layer
bandaging for healing of venous
leg ulcers. The efficacy of leg ulcer
hosiery kits in preventing ulcer
recurrence was also evaluated.
›
Understanding RCTs
A randomised controlled
trial (RCT) is a scientifically
rigorous study in which
participants are assigned
randomly to one or more
interventions.
RCTs are thought to provide
the most reliable evidence,
as the processes used during
the trial minimise the risk
of other factors influencing
results.
Therefore, the findings from
an RCT are likely to be closer
to the true effect than findings
from other research methods
(Akobeng, 2005).