Mark Collier: Compression therapy

Why don't people use a range of compression therapy that's got lots of evidence for, is well being produced and sound rationale for the use of it clinically and otherwise? I think most of the issues are more about perceptions and what the patients actually understand by what we're meaning by compression. I think that's a very real issue. Multi-layer systems of course have been around a long time, so have the most evidence for them. But newer systems and different systems have good, robust evidence as well. I think the important bit is there's no one system that's right for every patient. So as you would with a wound dressing, it's very important to target or choose the right compression therapy for the right patient for the right length of time, know what the objectives are from a practitioner point of view, and actually be able to discuss and talk through your rationale for those objectives with the patient before you start to apply the compression. I think it's really important that a lot of people don't take on the patient role and are very sedentary. They should be very actively involved in the decision-making process. Obviously, other things become important like the pain, the symptomatology that the patient may have. That may or may not include pain, but equally, you know, is the dressing going to be, is that going to be OK under compression profile? And all the evidence would suggest that there's no problem putting dressings on. Multi-layers is a different matter. You might have to compensate in that way. But again, the pain that the patient perceives that they will experience is a very real issue for them. So it's important that we talk that through. Equally, show them the materials, demonstrate the materials. If somebody is a little hesitant about putting it on for any of those reasons or all of them, then of course work with the patient to maybe introduce a reduced compression system initially which of course the four layer system gives you that flexibility because you can leave one of the layers out, explain to the patient, get them used to wearing some compression and then when they've had a couple of weeks and they actually report back to you, well actually it is quite comfortable, it isn't causing me any additional pain, you've taken account of their pain by the right prescription of analgesia or whatever is appropriate for them as an individual, then of course you can then start to reintroduce another layer. And over time the leg shape or the leg also may change and their mobility may change so you may have to consider another type of compression therapy but that should only be clinically based and again in discussion with the patient. And again, it's the same for hosiery. Very early on, we introduced the fact to the patient that compression is for life. So once the therapy with the bandages is complete, they will still need to have some compression for the rest of their life. Now, of course, we're lucky in the sense of over the last few years, the availability and the range of compression hosiery and management systems has increased, changed, there's a lot more colours, there's compression socks for gentlemen now as opposed to compression hosiery, you can get it in black, blue, pink, so you know we can be a lot more flexible with asking if the patient wants to go to a tea dance and not quite fitting their suit, not totally fitting their outfit but at least making it more acceptable that it looks less clinical And of course telling them that, because most people will say well do I have to have this compression on 24 hours a day? And of course when their leg is elevated in bed at night, the answer is no. So again, giving them the right information to allow them to take it off at night, wash their legs so they feel good about themselves, in the morning put it on. And more recently now we've got other compression as well as the compression stockings of which there's a range, two layer, easy systems to apply. We now have the wraps which again won't be right for everybody but may be right if the patient is on their own. They would find putting a hosiery on in the traditional way difficult. They may have rheumatoid arthritis. So from a very practical point of view, then a wrap with a Velcro-type strap might be better for them, but you're still applying compression. And as we know, all the evidence suggests that one compression is for life, but some compression is better than none at all, and it will improve the healing rates. And I think if you've worked with the patient, you know what the outcomes are, you're working together you will get more positive results and we're not saying you'll achieve every concordance in every patient but I think the incidence of non-concordance will definitely reduce and that's certainly our experience in our complex wound clinic.