Compression Pressure Variability in Upper Limb Multilayer Bandaging Applied by Lymphedema Therapists.

Background: Multilayer bandaging (MLB) is often used for lymphedema treatment. Even experienced lymphedema therapists have difficulty applying bandages correctly. The aim of this study was to demonstrate upper limb MLB pressure variability applied by lymphedema therapists. Methods and Results: Twenty-four lymphedema therapists were asked to apply MLB to the healthy volunteer's upper limb. The participants consisted of 20 females and 4 males with a mean age of 43.4 (range: 24-62) years. They included licensed massage therapists, nurses, a judo therapist, an occupational therapist, and a medical doctor. Twenty therapists (83.3%) had clinical experience applying MLB. Compression pressure was measured with PicoPress at 5 cm proximal to the wrist, immediately after the application (phase 1) and after exercise (phase 2). The mean MLB pressure was 67.7 ± 5.0 mmHg in phase 1 and 55.3 ± 4.1 mmHg in phase 2, which were significantly different (p = 1.2 × 10-10). There was a weak negative correlation between how long the therapist had been practicing MLB and MLB pressure (R = 0.29). Seventeen participants (70.8%) expressed that they had a target pressure in mind when performing MLB. Among the 17 participants, there was no correlation between the target and actual pressures (R = -0.055). Only three participants (17.6%) had an actual MLB pressure within 5 mmHg of their target. Conclusions: The mean MLB pressure was 55.3 ± 4.1 mmHg, which was thought to be too high for the upper limb. Education about applying appropriate MLB pressures to the limbs is necessary.

Variability in compression pressure of multi-layer bandaging applied by lymphedema therapists.

BACKGROUND: The success in multi-layer bandaging (MLB) relies on the technique of the therapists. The purpose of this study was to elucidate the compression pressure of MLB by lymphedema therapists. METHODS: We investigated the pressure of MLB applied by 48 lymphedema therapists. The average age was 43.5 (range 23-66) years old. Seventeen (35.4%) of the therapists had the clinical experience of MLB. We prepared ordinary compression materials and asked them to apply MLB to the whole lower limb of healthy volunteers, presuming moderate lymphedema. We attached the probe of Picopress at the Achilles tendon-muscle junction and measured the pressure three times: phase 1, resting condition; phase 2, after ankle exercise; and phase 3, after knee bend. RESULTS: The average pressure in phases 1-3 was 51.9, 48.9, and 45.5 mmHg, respectively. Only 13 (27.1%) of the therapists achieved 50-59 mmHg which is suitable for lymphedema treatment and the pressure varied by the training courses. The pressure decreased as the blank period got longer after finishing training courses (R = - 0.39). CONCLUSIONS: The pressure of MLB varied in different therapists and different training courses. This fact indicated the necessity of uniform curriculum in training courses including measurement of the bandaging pressure.