![[decorative logo]](curves1.gif)
Lymphovenous Canada: Queen's School of Nursing spearheads randomized study on two
compression bandaging techniques
Lymphovenous Canada: Queen's School of Nursing spearheads randomized study on two
compression bandaging techniques![[cartoon of nurses' faces]](nurseslargefaces.gif)
There is consensus
internationally that the use of graduated multi-layer compression in the treatment
of ulcers works. High compression has been found to be more effective than low compression;
however, there is no clear evidence as to which high compression technology is more
effective.
"When we were funded," says Professor Margaret Harrison, "most of the studies had been done through industry. There were no large trials of adequate size to conclusively answer the question about the superiority of a particular compression system. We are hoping this randomized study will address this issue."
The study, entitled: Community Randomized Control Trial of the Effectiveness of Two Compression Bandaging Technologies, is a 10 centre randomized trial which is comparing the effectiveness of 2 high compression technologies delivered in the community on ulcer healing, recurrence rates, quality of life, and cost-effectiveness.
Four-layer bandages will be used versus short-stretch bandages. 414 individuals are being included in the study in total. The study is being carried out in multiple Ontario sites and in Saskatchewan. It will be linking up with a U.K study in this area – which enable the researchers to do a large 2 country study. The UK study is being run out of York University by Dr.S. N. Cullum and Andrea Nelson. The Canadian study will look at time-to-healing, quality of life and expenditures for treatment. Durability of healing will be assessed through follow-up for up to 52 weeks post-healing to determine recurrence rates associated with both technologies.
"When I started in this area a few years ago there were few nurses who were actively involved in research. Nurses involved in wound care are dedicated practitioners and very keen to engage in research," says Harrison. "This study will demonstrate the best choice that includes not only healing times but also factors such as ease of use, cost and quality of life. The more effective the treatments are, the less expensive they are for our health care system. Our previous work with best practices is showing that effective compression treatment in this area can reduce costs to 23% of other practices and ensure healing within a three month period".
Although rarely recognized as a pressing health care problem, leg ulcers comprise a common, complex, and costly condition. Over 80% of ongoing management of chronic wounds occurs in the community, and leg ulcers are one of the most frequently seen chronic wounds. The cost of leg ulcer care is considerable, being reported in both the U.K. and France to account for 2% of their total national health budgets.
In Canada the impact is only now being recognized due to the pressure on home care caseloads resulting from hospital downsizing, nursing shortages, and growing numbers of complex health populations. In one Ontario study, the care for fewer than 200 community leg ulcer cases cost in excess of $1.5 million for supplies and nursing visits, which translates to $100s of millions yearly Canada-wide.
The impact on the individual is significant--chronic, painful, and often takes years to heal. Two-thirds of individuals with leg ulcers have at least one recurrence, and 45% have a history with the condition dating back 10 years. Over the past decade, evidence from randomized control trial studies and a Cochrane systematic review demonstrated that venous leg ulcers treated with compression therapy are more likely to heal.
Multi-layer high compression systems are more effective than low compression. However, the small number of people in trials comparing different high compression systems meant the review was unable to draw conclusions about their relative merit. Four of these trials have compared 4-layer bandage with short stretch technologies--the most commonly used technologies in Canada. In total, these trials involved only 220 patients, and were thus underpowered. Furthermore, they did not consider factors such as client preference and ease of use, or incorporate an economic evaluation.
 |
Copyright © 1996-2012 Lymphovenous Canada. |