Overview of systematic reviews on compression therapy
Database search and selection:
- 352 articles were retrieved
- 15 articles met the inclusion criteria for detailed analysis
- Most reviews reported data from Randomized Controlled Trials (RCTs), followed by real-world studies and single-arm observational cohort studies
Focus of the reviews:
- Comparison of different compression systems against no compression or other types.
- Primary outcomes: Wound healing.
- Secondary outcomes: Quality of Life (QoL) and pain.
- Additional focus areas: VLU recurrence, association of compression with surgery, or physical activity.
Compression systems and their effectiveness
Compression systems compared to no compression:
- Two systematic reviews analyzed various compression types (e.g., short-stretch bandage, 4-layer bandage, Unna’s boot) versus no compression.
- Key findings:
- Shorter time to complete healing (HR: 2.17; CI: 1.52-3.10).
- Higher complete healing risk ratio (RR: 1.77; CI: 1.41-2.2).
- Reduced pain (MD: -1.39; CI: -1.79 to -0.98).
- Improved QoL over follow-up periods (MD: -6.87; CI: -13.10 to -0.64).
Comparison between different compression systems
4-layer Bandage (4LB) vs Short-stretch Bandage (SSB):
- Better healing at 24 weeks for 4LB (RR: 0.74; CI: 0.59-0.92).
- Median days to healing: 90 (4LB) vs 99 (SSB).
Elastic vs Non-Elastic Components:
- Elastic bandages showed significantly more ulcers healed at 3-4 months (RR: 1.83; CI: 1.26-2.67).
High-compression stockings:
- Associated with better VLU healing outcomes at 2-4 months (RR: 1.62; CI: 1.26-2.10).
Compression combined with physical activity
Evidence from reviews:
- Combination of physical activity and compression led to 14 more healed cases per 100 patients at 12 weeks (RD: 14%; CI: 1-27%).
- Prescribed physical activities, such as aerobic exercises, showed significantly more healed patients at 12 weeks.
Effects of compression on VLU recurrence
Key findings:
- Lower recurrence rates with compression stockings (RR: 0.43; CI: 0.27-0.69).
- Treatment adherence significantly reduced recurrence risk (6 times lower).
- High compression stockings showed better efficacy in reducing recurrence rates compared to medium pressure stockings.
Compression combined with endovenous interventions
Findings from reviews:
- Early endovenous ablation combined with compression showed higher healing rates (85.6%) compared to compression alone (76.3%).
- Longer ulcer-free periods with surgery plus compression (62% vs 33%).
Compression for mixed ulcers
Modified compression therapy (MCT):
- Effective for mixed ulcers with moderate arterial insufficiency (ABI 0.5-0.8).
- MCT showed similar healing rates for mixed ulcers and VLUs.
Intermittent Pneumatic Compression (IPC)
Evidence from a systematic review:
- IPC may increase healing compared to no compression.
- Limited evidence suggests IPC plus compression improves healing over compression alone.
Applying compression bandages
Conclusions
Summary
- Compression therapy significantly improves healing time and complete healing of VLUs compared to no compression.
- High-compression stockings and 4LB show better outcomes than SSBs.
- Compression therapy also improves QoL and reduces pain.
- Combining compression with physical activity or endovenous interventions can enhance healing outcomes.
Recommendations
- Use compression therapy from the first visit for lower leg ulcer management if there are no contraindications.
- Consider adjustable compression wrap devices for improving treatment outcomes and patient self-management.
- Further research is needed to optimize compression therapy and explore its cost-effectiveness and patient perspectives.
