title: A Compression Kit of a Stocking and Three Superimposed Leggings Is Easy to Don and Dose Adjustable.
abstract: BACKGROUND
  Forty percent of patients with chronic venous insufficiency (CVI) do not wear their indicated and prescribed compression stockings. Difficulties in donning and a feeling of constraint are the most common reasons for non-adherence.
  
  
  OBJECTIVE
  The aim was to develop a compression stocking system that is easy to don and dose adjustable.
  
  
  METHODS
  A modular compression stocking kit composed of an understocking and three superimposable leggings (SLLLs) was developed. Substocking pressures (P) at the thinnest part above the ankle (cB level) were 17 mm (understocking) + 15 + 10 + 10 mmHg (3 superimposed leggings; Hatra method). Twenty healthy subjects and 20 patients over 65 years with CVI donned the SLLL compression kit. P was measured in vivo (Picopress method) at the transition of the Achilles tendon to the calf muscle (level cB1) during rest and ankle movements (DSI; dynamic stiffness index) and compared with a strong compression stocking of 40 mmHg (S40).
  
  
  RESULTS
  Twenty (20/20) patients aged over 65 with CVI (C4-6) successfully donned the SLLL compression kit without aid, compared with 12 (12/20) who were able to don the S40 without aid (p = .02). In vivo resting P at level cB1 was 34.3 mmHg (SLLL) compared with 37.3 mmHg (S40) (p = .1). The DSI was 16.1 (SLLL) compared with 17.9 (p = .79; S40; CVI group).
  
  
  CONCLUSIONS
  The physical properties of the SLLL compression stocking kit correspond to the characteristics of a strong stocking at rest and exercise (DSI). The donning success rate is excellent (100%). A further potential advantage is that the SLLL leg compression kit is dose adjustable, according to indication or patient tolerance. Wearing comfort over periods of several days and clinical effectiveness need to be investigated in future trials.
authors.affiliation: Department of Dermatology, University Hospital Zurich, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Luder
authors.affiliation: Department of Dermatology, University Hospital Zurich, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Dziunycz
authors.affiliation: Department of Dermatology, University Hospital Zurich, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Omid
authors.affiliation: Department of Dermatology, University Hospital Zurich, Switzerland.
authors.forename: A-L
authors.initials: AL
authors.lastname: Radetzki
authors.affiliation: Department of Dermatology, University Hospital Zurich, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Lang
authors.affiliation: SIGVARIS AG, St. Gallen, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Hübner
authors.affiliation: Department of Dermatology, University Hospital Zurich, Switzerland. Electronic address: juerg.hafner@usz.ch.
authors.forename: J
authors.initials: J
authors.lastname: Hafner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D011312:Pressure; D053828:Stockings, Compression; D014689:Venous Insufficiency / Q000628:therapy*
keywords: Chronic venous insufficiency; Donning compression stockings; Dose-adjustable leg compression; Dynamic stiffness index; Leg compression kit; Substocking pressure; Superimposed leggings