There are several elements to lymphoedema treatment, such as compression, manual lymphatic drainage, skin care and exercise. Many recent advances, particularly in compression therapy, have resulted in better treatment outcomes. As part of the 28th Conference of the European Wound Management Association (EWMA) in Krakow, Lohmann & Rauscher (L&R) held a symposium on Thursday, 10 May 2018, entitled “Emerging Evidence in Compression Therapy: Tissue Density, Functionality and Self-Care”. The presentations of international experts focused on the particular challenges of and new findings for oedema treatment and on the importance of patient involvement.
The internationally renowned Australian lymphology expert, Prof. Neil B. Piller, opened the symposium with a presentation on lymphoedema assessment methods and treatment options that are available. In his presentation, he discussed tissue composition, density and thickness in relation to wound treatment with compression. He stressed the importance of first accurately assessing the type of lymphoedema before deciding on the correct treatment, as lymphoedema varies depending on the patient and the affected part of the body. Circumference and volume can be measured with instruments such as optoelectronic perometry that take readings using infrared radiation. Prof. Piller cited bioelectrical impedance analysis as one example of the methods available to determine fluid distribution and lymphoscintigraphy that measures lymph drainage. He concluded that measurements are not just about limb volume and should include tissue texture, the patient’s family and medical history, and functionality that all have a bearing on lymphoedema treatment.
Functionality to measure outcomes for safety, effectiveness and cost implications
In the second presentation, Suzie Ehmann, an American physical therapist with extensive experience specialising in wound care and compression, described the consequences of all oedemas. These include delayed wound healing, infection, impaired mobility and reduced quality of life. This illustrated in her view the importance of effective oedema management. In the compression sector, the ReadyWrap adjustable compression wrap (currently available in the Netherlands, Austria, the UK, Ireland, Finland, Denmark and Switzerland) was developed as an alternative to the current gold standard of compression stockings and bandages. The advantages of these compression garments are their simplicity to understand, ease of use and the therapeutic short-stretch compression profile that maximises venous return and accelerates wound healing whilst being comfortable for wearers. Patients can also be trained to use and adjust the ReadyWrap compression garments themselves without needing to see a healthcare professional. In contrast, use of compression stockings and bandages is often complicated for patients and healthcare professionals alike, frequently resulting in incorrect use, which may in turn result in pain and low patient compliance. A compression system may also have cost benefits, as it can be used in both the intensive and maintenance phase.
The presentation highlighted improvements in functionality measured by the validated Timed-Up and Go test that showed better walking rates and stability during movement following management with ReadyWrap.
Guidelines based on patients’ individual clinical picture are available to help select compression stockings and bandages with the appropriate compression category. No such guidelines are currently available for the use of the adjustable wraps. Based on a range of case studies (chronic venous insufficiency (CVI), lymphoedema, obesity and chronic wounds) involving the use of the ReadyWrap compression garments, Suzie Ehmann concluded that there is a need for an assessment of criteria for optimum treatment based on patient needs.
Making a difference to patients’ lives by appropriate clinical decision making and self-care Clinical measurements in everyday practice
Following an introduction on theory, UK lymphologist Justine Whitaker reported on her own direct experience in everyday practice. Using the case study of a 48-year-old woman with stage 2b lymphoedema in one leg, Whitaker stressed the importance of selecting the best combination of treatment methods for compression therapy. After establishing the patient’s personal goal – to be able to ride horses again – treatment was initiated with Rosidal Compression Bandages and manual lymphatic drainage. A compression stocking was then used in conjunction with the adjustable ReadyWrap compression garments. The primary purpose of the ReadyWrap compression garments in this treatment regime was to help prevent rebound oedema. She stressed the importance of involving specialists who have a thorough understanding of lymphoedema to facilitate treatment success. Simply taking readings and collecting information about the oedema are not enough if they cannot then be interpreted.
Alongside all treatment methods that are available, patients should always be involved in treatment choices to ensure that their individual goals can be achieved. Such goals can only be achieved by listening to patients and implementing knowledge about the tissue type and compression methods within the treatment pathway.
Concluding the symposium, Professor Neil Piller stressed that treatment should primarily focus on improving patients’ quality of life and monitoring tissue texture and functionality to record improvements in oedema.
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