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The article focuses on a study on the use of compression therapy in the assessment and management of the venous and arterial aetiologies underlying leg ulceration as part of a holistic care plan, which was presented in an expert panel discussion held in October 2023.

Lymphoedema effects approximately 200 000 people in UK. It is a chronic condition without a cure but there is much that can be done to ease and manage these complications. This article looks at the eight most common complications, providing advise on how to manage them, derived from the literature and the author's own experience. It also presents advise on how nurses can promote self-management of these complications, promoting patients' self-care. [ABSTRACT FROM AUTHOR]

The 11th annual National Lymphoedema Conference, organised by the British Journal of Community Nursing in association with the British Lymphology Society and Lipoedema UK, was hosted at the America Square Conference Centre, London, on 22 February 2024. The conference, which aims to provide new insights into the latests developments in lymphoedema care and management through talks by leading experts in the field, was attended by an impressive number of delegates and exhibitors. The sessions were Chaired by BLS Trustee Rebecca Elwell, and are summarised below. [ABSTRACT FROM AUTHOR]

Toe and foot swelling can manifest as lymphoedema or chronic oedema but can also be a complication of the treatment of these conditions. In this article, the authors discuss the assessment and treatment options for toe and foot swelling, highlighting the importance of prevention in the first instance. [ABSTRACT FROM AUTHOR]

This systematic literature review was carried out by a final-year nursing student in response to clinical experience, and to understand the rationale and evidence around managing venous ulcers. In the student's clinical experience, the two most commonly used treatment methods were forms of compression hosiery and compression bandaging. The CINAHL, Science Direct, Cochrane Library, Internurse and MEDLINE databases were searched for literature published over the period 2003–2023. From the resulting five papers, five key themes were identified: types of compression systems used and the rationale for decision-making; clinical effectiveness; the impact on patient experience and quality of life; pain levels following application of compression systems; and cost effectiveness. Conclusion: Management and prevention of venous ulceration is complex. The decisions should be made in partnership with the patient and will be influenced by context. Overall, compression hosiery was identified as the more favourable system. [ABSTRACT FROM AUTHOR]

This case study describes the successful management of a patient with primary lymphoedema, who was experiencing lymphorrhoea and epidermolysis, using a multidisciplinary approach. The patient had Klippel–Trenaunay syndrome. The multidisciplinary team, in an outpatient clinic in Japan, included a certified lymphoedema therapist, plastic surgeons, and a wound, ostomy and continence nurse. The team performed complex physical therapy and lymphaticovenular anastomosis, which promoted the resolution of the lymphorrhoea. This resulted in improvements in skin condition, the prevention of recurrent cellulitis, and no increase in limb circumferences during the 1-year follow-up period. This report highlights the importance of a multidisciplinary approach to lymphoedema management, including lymphorrhoea control that fitted in with the patient's daily life. It is hoped that this article will contribute to the improvement of the quality of life of patients with lymphoedema. [ABSTRACT FROM AUTHOR]

The article provides information on lymphatic insufficiency and stiff compression in venous leg ulceration.

Objective: The impact of hard-to-heal wounds extends beyond traditional clinical metrics, negatively affecting a patient's health-related quality of life (HRQoL). Yet treatment outcomes are seldom measured from the patient's perspective. The purpose of the present study was to perform in-depth qualitative interviews with patients diagnosed with varying types of hard-to-heal wounds to identify outcomes important to them. Method: Participants were recruited from wound care clinics in Canada, Denmark, the Netherlands and the US, and were included if they had a hard-to-heal wound (i.e., lasting ≥3 months), were aged ≥18 years, and fluent in English, Dutch or Danish. Qualitative interviews took place between January 2016 and March 2017. An interpretive description qualitative approach guided the data analysis. Interviews were audio-recorded, transcribed and coded line-by-line. Codes were categorised into top-level domains and themes that formed the final conceptual framework. Results: We performed 60 in-depth interviews with patients with a range of wound types in different anatomic locations that had lasted from three months to 25 years. Participants described outcomes that related to three top-level domains and 13 major themes: wound (characteristics, healing); HRQoL (physical, psychological, social); and treatment (cleaning, compression stocking, debridement, dressing, hyperbaric oxygen, medication, suction device, surgery). Conclusion: The conceptual framework developed as part of this study represents the outcome domains that mattered the most to the patients with hard-to-heal wounds. Interview quotes were used to generate items that formed the WOUND-Q scales, a patient-reported outcome measure for patients with hard-to-heal wounds. [ABSTRACT FROM AUTHOR]

The article comments on the impact of public policies and legislation on the U.S. wound care community and patient access to treatment and care in 2023 and outlines wound care advocacy initiatives for 2024 covering cellular and/or tissue-based products, antimicrobial dressings, lymphoedema compression and surgical dressings.

Background/Aims: Hypermobility spectrum disorders and hypermobile Ehlers–Danlos syndrome are multisystem, connective tissue disorders, associated with problems such as joint hyperextensibility, tissue fragility, poor proprioception and pain. Fabric orthoses might improve proprioception and assist with joint protection. No previous research has investigated this possibility. This study aimed to explore the perceptions and experiences of experts with experience of fabric orthoses who have used fabric orthoses with individuals with hypermobility spectrum disorders and hypermobile Ehlers–Danlos syndrome. Methods: A total of six experts in fabric orthoses and hypermobility spectrum disorders/hypermobile Ehlers–Danlos syndrome participated in semi-structured interviews. A thematic analysis was undertaken by two analysers. Themes were validated with a member checking exercise involving three of the original participants. Results: Three themes were identified. The first theme, 'it is immediate', described the reported positive effects when the orthosis is first donned. The second theme described a proposed mechanism of effect in which improved proprioception and realignment work together to support improved joint stability. The third theme, 'tips for success', captured ways in which effectiveness and acceptability are maximised, with importance ascribed to collaborative assessment. Conclusions: Fabric orthoses have the potential to be effective in people with hypermobile Ehlers–Danlos syndrome or hypermobility spectrum disorders. This study is to inform futher research into the use of fabric orthoses. Further research could prioritise short-term effect, using mixed methods to explore users' experiences alongside measures of pain, joint stability and function. Crossover studies could compare custom-made orthoses vs off-the-shelf, or orthoses with directional support vs compression alone. If short-term studies support effectiveness and acceptability, longer-term studies could include the role of fabric orthoses in prevention of disability. [ABSTRACT FROM AUTHOR]

In the article, the author discusses how community nurses in the United Kingdom (UK) can empower people with lymphoedema based on the concept of patient accountability and empowerment. Also cited are the features of lymphoedema like chronic swelling, pain and heaviness in the tissues, and the focus of treatment like lymphatic drainage, exercise, and skincare.

As an incurable condition, lymphoedema, whether primary or secondary, is a significant burden for patients, impacting every aspect of their lives, ranging from the personal to the professional. While daytime compression is a pillar of lymphoedema management, night-time compression delivery is also gaining credence. Health writer Francesca Ramadan summarises the exploration of this growing phenomenon in the literature, overviewing the benefits and dispelling the myths. [ABSTRACT FROM AUTHOR]

Lymphoedema is more than 'swollen legs'; it is an unpleasant condition that affects approximately 260 000 people in the UK. This article briefly looks at what the lymphatic system is and what lymphoedema is. It then looks at compression wraps and argues for wider use with patients, as they can promote self-care in patients. [ABSTRACT FROM AUTHOR]

Venous eczema—also known as varicose, gravitational or stasis eczema—is a common form of eczema. In fact, 37−44% of patients with leg ulcers can present with a venous eczema. It is highly unpleasant, and can disrupt an individual's personal and social life. In this article, Drew Payne provides a community nurse's perspective on what venous eczema is, how to manage it in patients, and how to prevent further reoccurences. [ABSTRACT FROM AUTHOR]

The article reviews the JOBST Confidence line of flat-knit garments, including the panty-style garments, for the treatment of lipoedema from Essity.

There is an established link between hypothyroidism and leg oedema. This article presents a case study of a female known to have an underactive thyroid gland who developed symptoms and was referred to a local Lindsay Leg Club. [ABSTRACT FROM AUTHOR]

The article addresses challenges of accessing medical compression garments in the United Kingdom (UK). Topics discussed include factors that can influence access to medical compression garments, aim of the economic evaluation published by Lymphoedema Wales Clinical Network in collaboration with medicine management personnel of the local health board pharmacy department, and four key processes of the standard prescription service in England.

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). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Compression garments are the mainstay of lymphoedema treatment, yet the process of obtaining by prescription is lengthy, governed by funding, involves numerous professionals with little patient value and often involes copious inaccuracies, delays and errors. This service evaluation estimates the potential impact of changing the way compression garments are accessed from a prescription to a procurement process. The main objective was to estimate the impact and costs of altering the process within the NHS Wales setting. A service evaluation was formally supported by Medicine Management and Lymphoedema Wales Strategy Board to compare the prescription process to a new procuring route. A form was devised so that data was could be collected over 12 months by lymphoedema therapists on each compression garment issued to patients attending two lymphoedema services in NHS Wales. The data collected included information on the garment ordered, costs (prescribed compared to procured), timing between garment ordered and received plus a comparison of the processes. All non-patient identifiable data was entered into a database and comparison analysis was completed to identify any correlations between the variables collected. The project was ratified by research and development as service evaluation. There was a total of 5392 completed patient data forms were included, which when compared to the processes indicated that using a prescription route is overwhelmingly more costly than procuring. Overall costs suggest the potential for substantial savings to NHS Wales (£71.10 per patient) were statistically significant (P<0.001). Potential for improved patient outcomes was observed as garments were provided directly on appointment instead of significant delays promoting value-based healthcare. [ABSTRACT FROM AUTHOR]

The article presents a case study of a male patient with a three month history of static left medial malleolus ulceration.

The article presents a case study of a male patient with venous leg ulceration and compression hosiery that had not been changed for 2.5 years.

The article reviews the flat-knit compression class (CCL) 2 JOBST Confidence panty for the treatment of lipoedema from Essity.

The article reviews the JOBST Confidence panty for the treatment of lipoedema from Essity.

The article reviews the JOBST Confidence panty for the treatment of lipoedema from Essity.

The authors reflect on a Norwegian study which examined the effectiveness of objective structured clinical examination (OSCE) in assessing the clinical skills of students in advanced nurse practitioner (ANP) education.

The article discusses studies about lymphoedema, a disease which causes swelling in the tissue of any part of the body. Topics include body parts that are usually most affected, the need to know how to approach the patient's condition, and the first-line of treatment which involves using compression of some kind. Also mentioned is a study on the use of compression garments in a conventional lymphoedema prevention programme for breast cancer patients.

Oedema and lymphoedema commonly occur in patients receiving palliative care. Community nurses frequently manage both in the home or must decide to refer for medical or specialist lymphoedema assessment. This article describes the types of oedema seen in palliative care and assists in clinical reasoning around the type of oedema presented and when to refer onwards. The treatments for palliative care oedema and lymphoedema are described, including how to adapt for complex cases and for patient comfort. Genital swelling, abdominal swelling, head and neck oedema and lymphorrhoea are also discussed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article discusses facts about the chronic condition called lipoedema, some new developments on its pathophysiology, its effects on mental health, as well as some expert consensus on its treatment.

Lipoedema is an incurable chronic disease causing limb deformity, painful skin and excessive ecchymosis. Compression garments are frequently recommended to manage symptoms, but the existing products are not designed specifically for lipoedema, and are for other medical conditions. A structured questionnaire was prepared in Online Surveys in October 2018 to investigate lipoedema symptoms and the use of compression garments to manage them. Some 279 people with lipoedema completed the survey; 70% wore compression garments in all four compression classes, of which class 2 was most common (58% of wearers). The top three reasons for wearing compression garments were to feel supported (73%), reduce lipoedema pain (67%) and improve mobility (54%). Most people with lipoedema who wore compression garments found compression helpful in managing their symptoms, but overall satisfaction was low. Problems with existing compression garments were so severe in some cases that the garments were not worn at all or used less often. The information collected in this survey might be useful for the design and development of compression garments specifically for lipoedema. [ABSTRACT FROM AUTHOR]

Background/Aims: Compression garments, joint supports and dynamic-movement orthoses all use elastic fibres and close-fitting designs and have been researched for their effects on movement. There is little cross-referencing between research into these interventions. This review aimed to improve interdisciplinary understanding by analysing key characteristics of the published evidence. Methods: Systematic mapping reviews identify gaps in an evidence base and identify questions for more in-depth reviews. This review was conducted in line with current guidance. MEDLINE, CINAHL and Sports Discuss were searched for primary research investigating compression garments and orthoses for movement and function. The following search terms were used: 'elastane', 'spandex', 'Lycra', 'elastomer*' 'Theratog*', 'compression', 'Neoprene', 'orthotic', 'orthosis', 'shorts', 'garment*', 'splint', 'brace', 'sock*' and 'stockings'. Studies were screened against predetermined criteria and key study characteristics extracted. Findings: A total of 351 studies were selected and analysed. Compression garment research was most common (236 studies), followed by research into joint supports (64 studies) and dynamic-movement orthoses (42 studies). Research largely reflects the purpose for which each intervention was originally designed. Common topics investigated include posture and movement control, proprioception and muscle activity. Pressure applied beneath compression garments was measured in only 30% of studies. Conclusions: The review highlights a need for more robust study designs in patient populations and accurate description of interventions. There is a need for a review on the possible effects of compression and support on movement control, which should be used to inform future primary research. [ABSTRACT FROM AUTHOR]

This prospective, single-centre, observational study set out to evaluate the clinical performance and safety of JOBST Relax®, a custom-made compression garment, when worn by a series of patients with lymphoedema during resting hours and at night. Patients were recruited after undergoing complete decongestive therapy (CDT) and wore the night-time compression garment for 21 days as part of their compression therapy regimen. Questionnaires were used to capture their views on parameters such as the garment's comfort, ease of use, fit, ability to avoid excessive heat and perspiration, its effect on their quality of life and their overall satisfaction with it. Occurrences of erythema, skin rash, skin dryness and pain were also evaluated. Ninety-one patients completed the study. Most perceived the night-time compression garment to be 'very good' or 'good' in terms of its ease of use and comfort, its ability to control their oedema and its effect on their quality of sleep. The prevalence of erythema, skin rash, skin dryness and pain was reduced when compared with baseline. Patients also reported that the night-time garment reduced their dependence on others and improved their quality of life. Overall, most rated their satisfaction with the garment as 'very good' or 'good'. Patients reported a high level of satisfaction with both the garment and the comfort associated with it when wearing it frequently. [ABSTRACT FROM AUTHOR]

Compression hosiery is commonly used for the management of lymphoedema as well as lipoedema, but it is more commonly indicated for the lower limbs than for the upper limbs. The effects of compression hosiery on upper-limb lipoedema are poorly understood and researched. It is known that compression hosiery works in conjunction with activity or movement when standing or walking, which produces anti-inflammatory and oxygenating effects in the tissues. This effect is naturally difficult to realise in the upper limbs. Lymphoedema practitioners who treat those with lipoedema should bear in mind that compression treatment might not produce the same effects in upper-limb lipoedema as it does in lower-limb lipoedema. In these times of an overstretched health service, pragmatic resource use is essential. [ABSTRACT FROM AUTHOR]

The article projects an era in lymphoedema insurance coverage in the U.S. in 2024 driven by the Lymphedema Treatment Act, grassroots effort by the Lymphedema Advocacy Group, and the coverage plan for compression garments and supplies proposed by the U.S. Centers for Medicare and Medicaid Services (CMS).

The aim of compression therapy is to apply pressure on the skin and underlying structures to counteract the force of gravity, supporting venous and lymphatic function, to prevent or minimise oedema in the affected tissues. Compression therapy to manage lymphoedema is supported by a plethora of research, as it helps to increase the velocity of flow and lymphatic contraction of the lymphatic collecting vessels. This encourages drainage to the route of the limb, which increases fluid drainage from the tissues into the lymphatics. It is becoming more apparent that with an increase in clinical knowledge of how compression therapy works, clinicians are becoming less focused on the level of compression and more concerned with the stiffness of fabrics. This article looks at how adapting compression therapy regimes can improve patient outcomes of treatment and maintenance, while empowering patients to self-manage. [ABSTRACT FROM AUTHOR]

The wearing of compression garments is an essential aspect of the management of lymphoedema. Patients however, do not always receive the requested garment on an NHS prescription from their general practitioner (GP). Through an audit cycle over 3 years, necessary changes in clinical practice were identified and introduced. The aim was to improve the number of patients obtaining the correct garment on an NHS prescription. The audit standard was not met in any of the audits and the conclusion made is that compression garments are difficult to find on NHS electronic prescribing systems leading to a delay in patients receiving their prescription and a risk of error due to the wide range of options available. Further work is necessary to ensure that electronic prescribing systems address the problem of product recognition for compression garments so that the process of obtaining compression garments is smooth, accurate and timely for patients and their GPs. [ABSTRACT FROM AUTHOR]

The rates of chronic oedema in the US continue to grow from multiple causative factors. One such factor is the skyrocketing rates of morbid obesity. There are about 40 million obese people in the US today. Among those people, the prevalence rate of lymphoedema is 74% (Fife and Carter, 2008). Treatment usually involves some type of compression for life, but that is easier said than done. Many patients with chronic oedema have dexterity issues or have limited abilities to put on tight compression options. This article explores a product that has just been recently launched on the market: the Extremit-Ease® compression garment. This article also looks at five case studies involving the product to evaluate its effectiveness in the treatment of this growing condition. We explore the increasing problem of chronic oedema, specifically oedema caused by lymphoedema and venous stasis, and how Extremit-Ease compression garments could assist patient compliance with the gold standard treatment [ABSTRACT FROM AUTHOR]

The article discusses the therapeutic use of compression garments in the management of lymphoedema, and it mentions nurse-patient relations, as well as the claim that cancer-related lymphoedema often develops in the wake of cancer treatments involving the irradiation or removal of a patient's lymph nodes. It states that arterial insufficiency, severe cardiac failure, and untreated infections are all contraindications to the use of compression garments such as bandages.

Lower extremity lymphoedema is common after many cancers. Nevertheless, epidemiological estimates of the prevalence of lower extremity lymphoedema vary widely. A recent study, however, clarified the rates in women with colorectal, endometrial and ovarian malignancies: about one third self-reported lower extremity lymphoedema. The study also confirmed that lower extremity lymphoedema can markedly undermine physical functioning. Some patients, however, seem to be at especially high-risk of developing lower extremity lymphoedema, such as those who undergo extensive lymphadenectomy. Moreover, until recently, few clinical trials assessed treatment benefits from the patient's perspective. A recent study explored the goals and benefits that matter most to patients, which may help healthcare professionals individualise management. [ABSTRACT FROM AUTHOR]

Selecting the most appropriate compression garments is vital in the longterm management of venous disease and chronic oedema. The range of styles has improved greatly over the years and many garments are available on the UK Drug Tariff. Practitioners now have a wide range of options to choose from including the type of fabric, colour, compression class, and style of garment. These options increase the pratitioner's ability to select the most suitable garments and combine clinical and aesthetic needs, with the ultimate aim of improving compliance. The focus of this article is to highlight the aims and qualities of the various types of compression garments available, discuss the rationale for prescribing choice, and describe the benefits of Haddenham's Veni made-to-order compression leg garments in the management of chronic oedema and venous disease. Three case studies will demonstrate the effectiveness of the Veni made-to-order range of compression garments. [ABSTRACT FROM AUTHOR]

At present, there is no proven cure for lipoedema. Nevertheless, much can be done to help improve symptoms and prevent progression. Many of these improvements can be achieved by patients using self-management techniques. This article describes the range of self-management techniques that community nurses can discuss with patients, including healthy eating, low-impact exercise, compression garments, self-lymphatic drainage, and counselling. [ABSTRACT FROM AUTHOR]

Kathryn Taylor, Lymphoedema Clinical Nurse Specialist and Service Lead, Community Lymphoedema Service, Manchester Local Care Organisation (kathryn.taylor3@mft.nhs.uk), was runner-up in the Chronic Oedema Nurse of the Year category in the BJN Awards 2021 [ABSTRACT FROM AUTHOR]

The article focuses on the use of compression for chronic oedema and lymphoedema. It will provide information and advice to community nurses to aid the decision making process when selecting compression garments. It will discuss the extensive options available from the Veni range of compression garments for lower limb swelling from Haddenham Healthcare and through case studies demonstrate its versatility in practice. [ABSTRACT FROM AUTHOR]

Compression hosiery is commonly used for the management of lymphoedema as well as lipoedema, but it is more commonly indicated for the lower limbs than for the upper limbs. The effects of compression hosiery on upper-limb lipoedema are poorly understood and researched. It is known that compression hosiery works in conjunction with activity or movement when standing or walking, which produces anti-inflammatory and oxygenating effects in the tissues. This effect is naturally difficult to realise in the upper limbs. Lymphoedema practitioners who treat those with lipoedema should bear in mind that compression treatment might not produce the same effects in upper-limb lipoedema as it does in lower-limb lipoedema. In these times of an overstretched health service, pragmatic resource use is essential. [ABSTRACT FROM AUTHOR]