Construct validity of functional status scores of patients with lymphedema.

During treatment of lymphedema, routine use of patient-reported outcomes measures (PROMs) is recommended to monitor patient progress; however, the validity functional status (FS) PROMs in these patients is unknown. Our aims were to examine construct validity of the shoulder computerized adaptive testing (CAT) and the foot-and-ankle CAT, as a measure of FS for patients selecting the shoulder or the foot-and-ankle as their main body part affected by their lymphedema. We assessed the ability of the FS scores to distinguish between patient groups in clinically expected ways at admission and discharge from physical therapy. At admission (n=1600), patients who were younger and had more acute symptoms, less severe lymphedema, less co-morbidities, no relevant surgical history, did not use medications for chronic conditions, and exercised regularly, had higher FS. At discharge (n=611), patients who were younger and had less advanced lymphedema, fewer co-morbidities, no relevant surgical history, did not use medications for chronic conditions, exercised regularly, and had more acute symptoms had higher FS change, after controlling for their baseline FS score. Low participation rates in FS outcomes data collection could have biased results. Overall, the CAT-based FS PROMs used in this study discriminated between patient groups in clinically logical ways both at intake and at discharge from lymphedema treatment.

Effectiveness of compression bandaging education for wound care nurses.

OBJECTIVE: Compression bandaging is an essential component in the treatment of venous leg ulcers (VLUs). An adequate pressure and stiffness is needed in order for the treatment to be successful. The aim of this study was to evaluate the effectiveness of a training workshop on compression bandaging among wound care nurses who had no previous experience in application of compression bandages, immediately post-training and six months after training. METHOD: A quasi-experimental design, conducted at Maccabi Healthcare Services, in which nurses underwent a four-hour educational session, including practising with a device that measures sub-bandage pressure. RESULTS: We assessed 37 nurses. Before training, 5.4% of nurses bandaged in the optimal range; after training, 58% bandaged in optimal range, and six months post-training, 37% bandaged in optimal range. At post- and six months post-training, no nurse bandaged 'too low' (≤20mmHg). Stiffness of the bandage was achieved in only 5.4% of nurses before training; 62% immediately after, and 75% six months after training. CONCLUSION: We conclude that the proposed educational session using a device that measures the pressure applied is an effective way to teach wound care nurses how to use compression bandages. However, more practise is needed to achieve an optimal range of pressure over time.