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1.
BMJ Open ; 12(4): e053165, 2022 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-35379618

RESUMO

INTRODUCTION: Breast cancer-related lymphoedema (BCRL) is a chronic swelling in the arm on the side of the breast cancer surgery, affecting one in five women. Recent studies in BCRL have demonstrated that resistance exercise can improve symptoms and quality of life without worsening lymphoedema. No studies have explored whether combining the principles of progressive resistance exercise training with therapeutic strategies of compression therapy and the decongestive lymphatic exercise sequence are beneficial in reducing arm lymphoedema volume. The aim of this three-arm, provincial randomised controlled trial is to determine the efficacy of a 12-week decongestive progressive resistance exercise (DRE) programme in combination with the one of two types of compression garments compared with standard care. METHODS AND ANALYSIS: Sixty women with BCRL will be recruited and randomly assigned to one of the following three groups: (1) Standard care, (2) DRE with use of a daytime compression garment during exercise and (3) DRE with use of an adjustable compression wrap during exercise. The primary outcome is the percentage reduction in arm lymphoedema volume. Secondary outcomes include bioimpedance analysis, muscular strength, shoulder range of motion, physical activity level and health-related quality of life. Exploratory outcomes include evaluating changes in arm tissue composition using MRI and examining outcomes between the two DRE experimental groups. The primary analysis will compare changes between the groups from baseline to week 12 reflecting the end of the randomised control trial period. ETHICS AND DISSEMINATION: The trial has received ethics approval from the Health Research Ethics Board of Alberta: Cancer Committee. The study results will be disseminated through scientific peer-reviewed publications, and presented at national and international conferences, and other media portals. The programme protocol will be shared with healthcare professionals and patient groups through clinical workshops and webinars. TRIAL REGISTRATION NUMBER: NCT05022823. PROTOCOL VERSION: 12 November 2021. ISSUE DATE: 26 April 2021.


Assuntos
Neoplasias da Mama , Linfedema , Treinamento de Força , Neoplasias da Mama/complicações , Neoplasias da Mama/cirurgia , Bandagens Compressivas , Exercício Físico , Feminino , Humanos , Linfedema/complicações , Linfedema/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Br J Community Nurs ; 27(Sup4): S28-S31, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35373613

RESUMO

As one of the mainstays for the management of chronic oedema, compression is unquestionably an efficacious and important element in treatment pathways during the intensive acute, transition and maintenance phases. Despite the variety of compression technologies on the market, devices to aid application and innovative methods employed by caregivers to encourage adherence to treatment, concordance remain a challenge. Balancing clinical effectiveness and patient comfort, the 24-hour interval plan considers wearer lifestyle and treatment options to tailor types of compression and times during the day and night when compression is worn. This article reviews previously published theories and evidence on which the 24-hour compression plan has been based (Bock et al, 2022).


Assuntos
Bandagens Compressivas , Edema , Humanos , Pressão , Resultado do Tratamento
3.
Br J Community Nurs ; 27(Sup4): S40-S42, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35373615

RESUMO

Massive localised lymphoedema (MLL) is an issue that affects patients with obesity. Much of the literature surrounding MLL focuses upon surgical management. This case study will explore the conservative management of a patient with MLL of the distal thighs. MLL of the legs negatively impacts patients' mobility, which, in turn, affects their ability to undertake physical activity. Encouraging exercise and activity forms part of conventional lymphoedema treatment, as well as compression garments (in this case, compression wraps), good skin care and weight management. The impact of the COVID-19 pandemic on this patient's lymphoedema treatment will also be considered. The treatment of not just MLL, but lymphoedema in general, requires commitment from patients, their carers and staff. This case study illustrates what can be achieved, despite a pandemic, when a patient, their carers and lymphoedema therapists fully commit to a treatment regimen that is manageable and well-supported. The patient's MLL has shrunk significantly, and her weight continues to reduce. Informed consent was gained from the patient concerned in this case study.


Assuntos
COVID-19 , Linfedema , Bandagens Compressivas , Tratamento Conservador , Feminino , Humanos , Linfedema/terapia , Pandemias
4.
Sensors (Basel) ; 22(5)2022 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-35270942

RESUMO

Compression therapy is widely used as the gold standard for management of chronic venous insufficiency and venous leg ulcers, and the amount of pressure applied during the compression therapy is crucial in supporting healing. A fibre optic pressure sensor using Fibre Bragg Gratings (FBGs) is developed in this paper to measure sub-bandage pressure whilst removing cross-sensitivity due to strain in the fibre and temperature. The interface pressure is measured by an FBG encapsulated in a polymer and housed in a textile to minimise discomfort for the patient. The repeatability of a manual fabrication process is investigated by fabricating and calibrating ten sensors. A customized calibration setup consisting of a programmable translation stage and a weighing scale gives sensitivities in the range 0.4-1.5 pm/mmHg (2.6-11.3 pm/kPa). An alternative calibration method using a rigid plastic cylinder and a blood pressure cuff is also demonstrated. Investigations are performed with the sensor under a compression bandage on a phantom leg to test the response of the sensor to changing pressures in static situations. Measurements are taken on a human subject to demonstrate changes in interface pressure under a compression bandage during motion to mimic a clinical application. These results are compared to the current gold standard medical sensor using a Bland-Altman analysis, with a median bias ranging from -4.6 to -20.4 mmHg, upper limit of agreement (LOA) from -13.5 to 2.7 mmHg and lower LOA from -32.4 to -7.7 mmHg. The sensor has the potential to be used as a training tool for nurses and can be left in situ to monitor bandage pressure during compression therapy.


Assuntos
Bandagens Compressivas , Úlcera Varicosa , Calibragem , Humanos , Temperatura , Úlcera Varicosa/terapia , Cicatrização
5.
J Wound Care ; 31(Sup3): S39-S50, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-35199559

RESUMO

OBJECTIVE: This study aimed to compare the healing outcomes between three types of compression therapy-two-layer bandage (2LB), four-layer bandage (4LB), and compression stockings, and to identify the predictors of venous leg ulcer (VLU) healing. METHOD: A retrospective review of the medical records of patients diagnosed with VLU between 2011 and 2016 in Singapore was conducted. Univariate and multivariate analyses were done between healed and unhealed VLU patients at three and six months, based on potential factors, ranging from demographic profile to comorbidities and treatment-related variables. RESULTS: Data from 377 patients' medical records were analysed. The healing rates with the three types of compression system, 4LB, 2LB and compression stockings, were 22.3%, 34.9% and 8.7% respectively at three months; at six months they were 44.2%, 41.9% and 34.8% respectively. Patients on 2LB reported a significantly higher proportion of healed ulcers at three months (p=0.003) but at six months there was no difference in healing rates between the three types of therapy. At three and six months, the duration of compression therapy was found to be an independent predictor of healing (p<0.001). CONCLUSION: In this study, the 2LB appeared to show the most favourable healing outcome in the short-term but as VLUs persisted beyond the months, the type of compression system used did not make a difference in the healing outcome. Our findings suggested that, as the duration became more prolonged, VLUs became more resistant to healing despite compression therapy. Therefore, it may be necessary for clinicians to consider adjuvant therapies for hard-to-heal ulcers at an earlier stage.


Assuntos
Úlcera Varicosa , Bandagens Compressivas/efeitos adversos , Humanos , Pressão , Meias de Compressão , Úlcera Varicosa/terapia , Cicatrização
6.
J Wound Care ; 31(3): 218-223, 2022 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-35199599

RESUMO

OBJECTIVE: The aim of this case series was to retrospectively assess the impact on volume control and patients' quality of life (QOL) when a night-time garment was added to their previous compression regimen for a full 24-hour interval compression plan. METHOD: Patients who had a history of chronic oedema presented to one of two oedema management centres in the US for treatment for oedema exacerbation and/or suboptimal performance of their current garments. Objective data examined were circumferential limb volume (cm3) measurements and QOL measured with the Lymphoedema QOL Tool (LYMQOL-Leg and LYMQOL-Arm). Subjective comments on functional abilities and perception of improvement with a compression plan that comprised a 24-hour interval were documented. RESULTS: All three patients presented in this case series had a reduction in limb volume and improvement in QOL when their daytime regimen of garments was updated and new night-time garments were added. Their subjective comments indicated improvement in activities of daily living and ease of controlling daytime oedema with a 24-hour interval compression plan. CONCLUSION: This case series illustrates the need for clinicians to create a partnership with the patient to promote concordance and adherence as part of their individual 24-hour interval compression plan. This partnership allows the plan to be uniquely changed and adjusted to allow each patient to feel in control of refreshing their mood, their skin and their garments.


Assuntos
Linfedema , Qualidade de Vida , Atividades Cotidianas , Bandagens Compressivas , Edema/terapia , Humanos , Estilo de Vida , Linfedema/terapia , Estudos Retrospectivos
7.
J Wound Care ; 31(Sup2): S4-S9, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35148639

RESUMO

Compression, skin care, manual lymph drainage and exercise form the mainstays of treatment of chronic limb oedema. The compression aspect of the regimen is often prescribed and used without conscious concern for the patient's ability for self-adjustment and skin hygiene. This article will focus on the action of compression therapy using a new concept of encouraging patients to apply and reapply an adjustable compression garment or multiple garment types during a 24-hour interval. The benefits of this focus on interval compression therapy on all aspects of care will be explained and case studies presented.


Assuntos
Bandagens Compressivas , Linfedema , Vestuário , Edema/terapia , Humanos , Linfedema/terapia , Higiene da Pele
8.
BMC Cancer ; 22(1): 25, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34980013

RESUMO

BACKGROUND: Lower limb lymphedema (LLL) is one of the most refractory and debilitating complications related to gynecological cancer treatment. We investigated factors associated with response to compression-based physical therapy (CPT) for secondary LLL after gynecologic cancer treatment. METHODS: We performed a multicenter retrospective study using the records of seven medical institutions from 2002 and 2014. Patients who developed LLL after gynecological cancer treatment were included. Limb volumes were calculated from the lengths of the limb circumferences at four points. All participants underwent compression-based physical therapy for LLL. Factors, including MLD, indicative of circumference reductions in LLL were determined. RESULTS: In total, 1,034 LLL met the required criteria of for the study. A multivariate linear regression analysis identified age; body mass index (BMI); endometrial cancer; radiotherapy; and initial limb circumference as significant independent prognostic factors related to improvement in LLL. In analysis of covariance for improvement in LLL adjusted by the initial limb circumference and stratified by BMI and radiotherapy, patients with BMI 28 kg/m2 or higher and receiving radiation rarely responded to CPT. CONCLUSIONS: Improvements in the lower limb circumference correlated with clinical histories and physical characteristics, which may be used as independent prognostic factors for successful CPT for LLL after gynecological cancer treatment.


Assuntos
Bandagens Compressivas , Neoplasias dos Genitais Femininos/fisiopatologia , Linfedema/terapia , Modalidades de Fisioterapia , Complicações Pós-Operatórias/terapia , Idoso , Índice de Massa Corporal , Feminino , Neoplasias dos Genitais Femininos/cirurgia , Humanos , Modelos Lineares , Extremidade Inferior/fisiopatologia , Excisão de Linfonodo/efeitos adversos , Linfedema/etiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Prognóstico , Radioterapia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
9.
Adv Wound Care (New Rochelle) ; 11(4): 179-191, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34078127

RESUMO

Significance: The physical and psychological sequalae of burn injuries account for 10 million disability-adjusted life years lost annually. Hypertrophic scarring (HSc) after burn injury results in reduced mobility, contracture, pain, itching, and aesthetic changes for burn survivors. Despite the prevalence of scarring and the number of scar therapies available, none are highly effective at preventing HSc after burn injury. Recent Advances: Recent studies modulating the mechanical environment surrounding incisional and excisional wounds have shown off-loading of tension to be a powerful strategy to prevent scar formation. Preclinical studies applying force perpendicular to the surface of the skin or using a combination of pressure both circumferentially and perpendicularly have shown substantial reductions in scar thickness and contraction after burn injury. Critical Issues: Though pressure therapy is highly effective in preclinical studies, outcomes in clinical studies have been variable and may be a result of differing therapy protocols and garment material fatigue. A recent adult clinical study reported a significant reduction in pressure after 1 month of use and significant reduction between 1 and 2 months of use, resulting in below therapeutic doses of pressure applied after only 1 month of use. Future Directions: To enhance efficacy of pressure garments, new low-fatigue materials must be developed for use in standard garments or garments must be redesigned to allow for adjustment to compensate for the loss of pressure with time. Additionally, measurements of applied pressure should be performed routinely during clinic visits to ensure that therapeutic doses of pressure are being delivered.


Assuntos
Queimaduras , Cicatriz Hipertrófica , Contratura , Adulto , Queimaduras/complicações , Queimaduras/terapia , Cicatriz Hipertrófica/etiologia , Cicatriz Hipertrófica/prevenção & controle , Vestuário , Bandagens Compressivas , Contratura/etiologia , Contratura/prevenção & controle , Humanos
10.
Wien Med Wochenschr ; 172(1-2): 52-56, 2022 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33738631

RESUMO

The treatment of chronic wounds is usually a major challenge for the involved medical staff. Various different treatment options have to be tested achieving a satisfactory result. In this retrospective case report, we describe successful treatments with hyaluronan acid ester fleece in six patients with chronic wounds of different origins. Furthermore, all patients received compression bandages or compression stockings, two patients were treated additionally with pressure relief devices and all were debrided if necessary. The chronic wounds of five out of the six patients healed completely over a period of 1.5-11 months or only with a minimal residual defect. However, one patient was still resistant to therapy over five months. In summary, the treatment with hyaluronan esters achieved good results especially in patients with complex medical history that makes a successful therapy particularly difficult.


Assuntos
Ésteres , Cicatrização , Bandagens Compressivas , Humanos , Estudos Retrospectivos , Meias de Compressão
11.
J Burn Care Res ; 43(1): 240-248, 2022 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-34061950

RESUMO

Pressure garment treatment (PGT) is currently recognized as an effective method to prevent scar formation or treat scar hyperplasia. Research on PGT remains controversial. These controversies indicate that PGT lacks reliable evidence of evidence-based medicine. Different studies on PGT need to be conducted under the same "gold standard" so that different studies can be compared. We consider this "gold standard" to be that the pressure remains stable within a confidence interval during treatment. We calibrated and verified the reference value of the sensor using a cuff of sphygmomanometer. A pressure-adjustable pressure system was obtained by installing a soft tissue expander on the pressure garment. Local pressure was adjusted by charging and releasing air. Subsequently, the flexible pressure sensor was placed on the upper arm of the healthy volunteers. We validated the compression system on healthy volunteers' forearms and AO standard prostheses (forearms). The reference value of the sensor was calibrated on Volunteer 1. Measuring repeated on Volunteers 2 and 3. The measurement was very reproducible. The test results in the experimental group showed that the local pressure gradually increased with the increase of the inflation of the airbag. However, the pressure at the opposite position of the forearm changed little. Real-time pressure monitoring and pressure adjustment enable the pressure to be maintained at a certain value. Our study provides a new idea for the production of elastic clothing with the function of pressure measurement and pressure regulation, which may promote the accuracy and reliability of PGT.


Assuntos
Queimaduras/terapia , Cicatriz Hipertrófica/prevenção & controle , Vestuário , Bandagens Compressivas , Extremidade Superior , Adulto , Desenho de Equipamento , Voluntários Saudáveis , Humanos , Pressão , Reprodutibilidade dos Testes
12.
J Wound Care ; 30(Sup12): S6-S12, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34882009

RESUMO

OBJECTIVE: Venous leg ulcers (VLUs) are considered the most frequent category of hard-to-heal limb ulcers. Although evidence-based care of VLUs suggests that compression therapy plays a pivotal role in the standard of care, patient adherence is considered low, with at least 33% non-compliance, either due to perceived problems from clinicians regarding their own competency in applying the bandages, or from the patient finding the wrapping bothersome. For many years, four-layer bandaging has been considered the 'gold standard', but application can be difficult and may also prove uncomfortable for patients. Accurate application may be facilitated by a stretch indicator which has been engineered to act as a surrogate for appropriate pressure application that can address the skill concern, while fewer layers can save clinicians' time and improve the quality of life of patients. Here, we review the literature supporting a two-layer system which combines elastic (long stretch) and inelastic (short stretch) components as well as both layers having graphic markers to define that the dressing has been applied at the proper tension. METHOD: An initial search was conducted on PubMed and then followed up by a manual search of Google Scholar to retrieve evidence of different levels, in order to evaluate the outcomes of use of the specific two-layer compression system with pressure indicators in the management of patients presenting with VLUs. RESULTS: A total of four papers discussing the specific compression system in question were identified from 32 publications retrieved from PubMed, while a further six were retrieved from Google Scholar. These 10 publications were considered relevant to the two-layer system and were analysed for the outcomes of care, including wound healing, appropriate application, time-saving and better patient acceptance and adherence. CONCLUSION: Previous authors have demonstrated that two-layer systems are equivalent to four-layer systems. However, the ability to reproducibly apply appropriate compression has remained a question. The papers reviewed demonstrate that evidence suggests that the two-layer compression bandage system with indicators provides continuous, consistent and comfortable treatment that may be easier to apply with accurate pressure levels due to their indicator systems, and therefore, is a procedure that may increase patient adherence and acceptability to the wound therapy.


Assuntos
Qualidade de Vida , Úlcera Varicosa , Bandagens Compressivas , Humanos , Cooperação do Paciente , Úlcera Varicosa/terapia , Cicatrização
13.
Lymphology ; 54(3): 122-132, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34929073

RESUMO

Secondary lower extremity lymphedema is a common complication of treatment for gynecological cancers. Conservative therapy plays an important role in the treatment of patients with secondary lower extremity lymphedema; in particular, complex decongestive therapy (CDT) has been recognized as an effective nonoperative technique for these patients. But CDT therapy for secondary lower extremity lymphedema remains a problem in China because this technique and its effectiveness have not achieved widespread use and popularity. Our goal was to assess effects of CDT in patients with secondary lower limb lymphedema after treatment for gynecological cancers. The retrospective study consisted of 60 patients who were treated with 20 sessions of CDT. Assessments included objective changes in limb circumference, degree of LE, imaging features, and incidence of erysipelas before and after CDT treatment. We found that CDT can effectively improve lymph stasis and promote backflow, and decrease circumference, interstitial fluid content, and incidence of erysipelas of lymphedematous lower limb. Our results demonstrate that CDT is an effective treatment method for patients with secondary lower limb lymphedema following treatment for gynecologic cancers. This technique should be more widely utilized and popularized in China to improve the quality of life of millions of patients with secondary lower limb lymphedema.


Assuntos
Linfedema , Neoplasias , Bandagens Compressivas , Feminino , Humanos , Extremidade Inferior , Linfedema/diagnóstico , Linfedema/etiologia , Linfedema/terapia , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
14.
Lymphat Res Biol ; 19(5): 412-422, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34672790

RESUMO

Objectives: To identify predictive factors associated with limb volume reduction using different decongestive lymphatic therapy (DLT) systems in patients with lymphoedema, over a period of up to 28 days. Methods: A multicountry (Canada, France, Germany, the United Kingdom) prospective cohort study using (DLT): skin care, exercise, compression bandaging, and manual lymphatic drainage for up to 4 weeks. Reduction in limb volume comparing DLT with (1) standard multilayer bandaging with inelastic material, and with (2) multilayer bandaging with Coban2, together with the identification of factors associated with limb volume changes. Results: Out of 264 patients with upper or lower limb lymphedema, 133 used Coban2 and 131 used standard care. Following DLT, mean limb volume reduction was 941 mL using Coban2 compared with 814 mL using standard care. A difference of 127 mL was found (95% confidence interval -275 to 529 mL, p = 0.53). Of the 176 patients with leg swelling, 166 (94.3%) had a limb volume measurement after 28 days and were included in the risk factor analysis. Of these, 132 (79.5%) were female, with overall mean age of 60.1 years (standard deviation = 14.7), with secondary lymphedema in 102/163 (62.6%). Duration of lymphedema was >10 years in 75/161 (46.6%) and 99/166 (59.7%) were International Society of Lymphology late-stage II/III, indicating longstanding and/or a high frequency of patients with advanced stages of lymphedema. Ninety-one (54.8%) received Coban2 and 75 (45.2%) had standard care. Multivariable factors for a greater leg volume reduction were large initial leg volume (p < 0.001), DLT treatment duration of 4 weeks compared with 2 weeks (p = 0.01), and peripheral arterial disease (p = 0.015). Conclusion: Limb volume changes were found to be similar between groups. Lack of standardization of DLT makes interpretation of effectiveness problematic. There is an urgent need for randomized-controlled trials. Despite this, severe lymphedema with a large limb volume responded well to DLT in this study.


Assuntos
Linfedema , Bandagens Compressivas , Edema , Feminino , Humanos , Linfedema/diagnóstico , Linfedema/etiologia , Linfedema/terapia , Masculino , Drenagem Linfática Manual , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
15.
Lymphat Res Biol ; 19(5): 423-430, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34582725

RESUMO

Background: Little is known of the impact in terms of health-related quality of life (HRQoL) and cost-effectiveness with decongestive therapy. Objectives: To examine changes in limb volume, quality of life (QoL), and treatment cost of methods of decongestive lymphatic therapy (DLT). Methods: Patients with chronic edema/lymphedema of the leg were invited to participate in a study of DLT in four countries (United Kingdom, France, Germany, and Canada). In each country two sites were selected. One site used their standard method of DLT in their service, including compression with multilayer bandaging with inelastic material. The other site used a system that included 3M™ Coban 2™ as the bandage treatment alongside other standard components of DLT. Patients were followed for either 2 or 4 weeks depending on the local protocols. At entry, at 2 weeks, and at 4 weeks, patients were assessed by using a health index (EQ-5D), a disease-specific HRQoL tool (LYMQOL) and resource usage was recorded over the treatment period. Results: Of the 165 patients with cost data, 90 were treated with Coban 2 and 75 with standard care compression bandaging. There was good evidence of an improvement in EQ-5D of 0.077 (p < 0.001) in all patients. LYMQOL showed significant improvements (p < 0.001) with lower scores. There were no major differences between the two arms of the study with respect to HRQoL. The number of treatment episodes was higher in those treated with standard care (8.15 vs. 6.37), but the overall treatment cost was higher with Coban 2 (£890.7) compared with standard care (£723.0). Conclusion: QoL improved in the standard care and Coban 2 group bandages, and there was no demonstrable difference between the care systems. Further work is required to examine the role of the individual parts of DLT that provide the greatest benefit to patients and the health systems that support them.


Assuntos
Linfedema , Qualidade de Vida , Bandagens Compressivas , Humanos , Perna (Membro) , Linfedema/diagnóstico , Linfedema/terapia , Estudos Prospectivos , Resultado do Tratamento
17.
Br J Community Nurs ; 26(Sup10): S6-S15, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34542313

RESUMO

Management of secondary head and neck lymphoedema has undergone little research investigation. Its treatment is time and labour intensive and involves multiple therapeutic modalities without a clear understanding of which is most effective. This study aimed to determine the feasibility of a randomised controlled trial comparing two therapeutic modalities to manage head and neck lymphoedema. The secondary objective was to evaluate the clinical effects of these treatments. Participants were randomised to receive treatment with manual lymphatic drainage or compression over 6 weeks, with the primary outcome-percentage tissue water-measured 12 weeks after treatment. Six participants were recruited until the study was ceased due to restrictions imposed by the COVID-19 pandemic. Some 86% of required attendances were completed. Percentage tissue water increased in all participants at 12 weeks. No consistent trends were identified between internal and external lymphoedema. The small number of people recruited to this study informs its feasibility outcomes but limits any conclusions about clinical implications.


Assuntos
COVID-19 , Linfedema , Pesquisa em Enfermagem , Pandemias , COVID-19/epidemiologia , Bandagens Compressivas , Estudos de Viabilidade , Cabeça , Humanos , Linfedema/enfermagem , Drenagem Linfática Manual , Pescoço , Pesquisa em Enfermagem/organização & administração , Resultado do Tratamento , Reino Unido/epidemiologia
18.
Br J Community Nurs ; 26(Sup9): S12-S17, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34473543

RESUMO

Compression therapy is used to treat leg symptoms arising from chronic venous disease and lymphoedema. Heart failure, which is traditionally regarded as a contraindication for compression therapy, is prevalent among patients with such leg symptoms. This article aims to assess the evidence on the safety and effectiveness of compression therapy, as well as recommending the assessment and measures required when initiating compression therapy in patients with heart failure. Recent evidence suggests that initiating compression therapy in patients with stable and compensated heart failure is safe if appropriate precautionary measures are undertaken. However, there is still insufficient evidence to support the safety of compression therapy in patients with severe and decompensated heart failure. A standardised, evidence-based guideline on compression therapy in patients with heart failure will help medical and nursing professionals and improve informed consent for the patients.


Assuntos
Bandagens Compressivas , Edema/terapia , Insuficiência Cardíaca/complicações , Úlcera Varicosa/terapia , Doença Crônica , Humanos , Resultado do Tratamento
19.
Clin Rehabil ; 35(12): 1743-1756, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34514891

RESUMO

OBJECTIVE: To assess whether the treatment with intermittent pneumatic compression plus multilayer bandages is not inferior to classical trimodal therapy with manual lymphatic drainage in the decongestive lymphedema treatment. STUDY DESIGN: Randomized, non-inferiority, controlled study to compare the efficacy of three physical therapies' regimens in the Decongestive Lymphatic Therapy. PARTICIPANTS: 194 lymphedema patients, stage II-III with excess volume > 10% were stratified within upper and lower limb and then randomized to one of the three treatment groups. Baseline characteristics were comparable between the groups. INTERVENTION: all patients were prescribed 20 sessions of the following regimens: Group A (control group): manual lymphatic drainage + Intermittent Pneumatic Compression + Bandages; Group B: pneumatic lymphatic drainage + Intermittent Pneumatic Compression + Bandages; and Group C: only Intermittent Pneumatic Compression + Bandages. END-POINT: Percentage reduction in excess volume (PREV). RESULTS: All patients improved after treatment. Global mean of PREV was 63.9%, without significant differences between the groups. The lower confidence interval of the mean difference in PREV between group B and group A, and between group C and group A were below 15%, thus meeting the non-inferiority criterion. Most frequent adverse events were discomfort and lymphangitis, without differences between groups. A greater baseline edema, an upper-limb lymphedema and a history of dermatolymphangitis were independent predictive factors of worse response in the multivariate analysis. CONCLUSIONS: Decongestive lymphatic therapy performed only with intermittent pneumatic compression plus bandages is not inferior to the traditional trimodal therapy with manual lymphatic drainage. This approach did not increase adverse events.


Assuntos
Neoplasias da Mama , Linfedema , Bandagens Compressivas , Terapia por Exercício , Feminino , Humanos , Dispositivos de Compressão Pneumática Intermitente , Linfedema/etiologia , Linfedema/terapia , Modalidades de Fisioterapia , Resultado do Tratamento
20.
Adv Skin Wound Care ; 34(9): 1-6, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34415258

RESUMO

OBJECTIVE: To investigate the evolution of pressure-measuring devices used in compression treatment for venous leg ulcers and assess the most practical and effective devices to determine optimal pressure in compression therapy. DATA SOURCES: Relevant information was retrieved from databases including Google Scholar, PubMed, Wiley Online, and ScienceDirect without publication date restrictions. The keywords included venous leg ulcer, compression therapy, pressure measuring device, pressure sensor, and wireless system. STUDY SELECTION: Studies included in the review had to be published in English and discuss or compare pressure-measuring devices/sensors for compression therapy, the development of alternative sensors, and the applications of wireless technologies. Veterinary studies, conference proceedings, and unpublished articles were excluded. Applicable studies and articles were critically evaluated and synthesized. DATA EXTRACTION: After abstract review, 39 studies were identified. During full-text review, study details were collected using a data extraction form and organized into tables. Device attributes, accuracy, price, and limitations were categorized and analyzed. DATA SYNTHESIS: Studies disagree on the effectiveness and user-friendliness of existing pressure-measuring devices. These devices often impact user comfort and convenience, which are crucial factors in the adoption and use of wearable devices. Potential solutions for pressure-measuring devices with promising technologies were proposed: four feasible alternative sensors are described that could improve comfort and facilitate prolonged use under bandages. Advanced communication technologies may provide more convenience for users and practitioners. CONCLUSIONS: Conventional pressure-measuring devices used in compression therapy are not designed for the user's comfort and convenience. The use of flexible and stretchy pressure sensors (e-skin) provides good biocompatibility, conformability, and comfort and when integrated with near-field communication technology could address the drawbacks of current pressure-measuring devices.


Assuntos
Bandagens Compressivas/normas , Úlcera da Perna/terapia , Pesos e Medidas/instrumentação , Bandagens Compressivas/estatística & dados numéricos , Equipamentos e Provisões/normas , Humanos , Pressão/efeitos adversos
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