title: Adaptive compression therapy for venous leg ulcers: a clinically effective, patient-centred approach.
abstract: A prospective, randomised, 12-week study was performed to evaluate the efficacy and tolerability of two compression methods for venous leg ulcers (VLUs); a new adaptive compression therapy (ACT) system, combining intermittent and sustained pneumatic compression (n = 38) and a conventional four-layer bandage system (n = 52). Primary outcomes were ulcer healing and safety. Secondary outcomes were comfort, compliance, ulcer pain, patient-perceived product performance and quality of life. Ulcer healing rate was similar (31·6% versus 42·3%, respectively, P = 0·30) between the treatments. Adverse events and patient-rated comfort were also similar. Average daily usage for the dual system was 10·5 and 1·8 hours in the sustained and intermittent modes, respectively, representing its use during 71% of waking hours. Predicted final ulcer pain was also similar (P = 0·68). Performance was subjectively better for adaptive compression and significantly higher for exudate management (P = 0·04), skin protection (P < 0·001), removal ease (P = 0·0007), bathing (P < 0·0001) and sleep comfort (P = 0·0405). The adjusted final quality-of-life score was 0·1025 higher for adaptive compression (P = 0·0375). Subjects with healed ulcers attained higher final scores than unhealed subjects (P = 0·0004). This study provides evidence that ACT is comparably efficacious to successfully heal VLUs compared with four-layer bandage management but is better accepted and achieves higher patient-reported quality-of-life scores in these challenging patients.
authors.affiliation: Clinical Innovation, Welsh Wound Innovation Centre, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: Keith G
authors.initials: KG
authors.lastname: Harding
authors.affiliation: Facharzt für Dermatologie Phebologie Allergologie, Freiburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Vanscheidt
authors.affiliation: Department of Dermatology, Medical University of Vienna, Vienna, Austria.
authors.forename: Hugo
authors.initials: H
authors.lastname: Partsch
authors.affiliation: Division of Vascular Surgery, NorthShore University HealthSystem, Evanston, IL, USA.|The University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Caprini
authors.affiliation: Jobst Vascular Institute, Toledo, OH, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Comerota
mesh_terms: D001458:Bandages; D006801:Humans; D003668:Pressure Ulcer; D011446:Prospective Studies; D011788:Quality of Life; D014647:Varicose Ulcer; D014945:Wound Healing
keywords: Adaptive compression therapy; Four-layer bandage; Pneumatic compression; Quality of life; Venous leg ulcer