Chronic edema of the lower extremities: international consensus recommendations for compression therapy clinical research trials.

August 2012

Stout N, Partsch H, Szolnoky G, Forner-Cordero I, Mosti G, Mortimer P, Flour M, Damstra R, Piller N, Geyer MJ, Benigni JP,Moffat C, Cornu-Thenard A, Schingale F, Clark M, Chauveau M.

Source

Breast Care Department, Walter Reed National Military Medical Center, Bethesda, MD, USA2 Department of Dermatology, Medical University of Vienna, Vienna, Austria3 Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary4 Lymphoedema Unit, University Hospital La Fe Valencia, Spain5 Barbantini-Hospital, Lucca, Italy6 Cardiac anc Vascular Sciences St George's, University of London, London, UK7 Department of Dermatology, University Hospital KU, Leuven, Belgium8 Department of Dermatology, Nij Smellinghe Hospital, Drachten, The Netherlands 9 Department of Surgery, School of Medicine, Flinders Medical Centre, Bedford Park, Australia10 Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA11 Hospital Begin, Paris, France12 Thames Valley University, London, UK13 Phlebology Department, Saint Antoine Hospital, Paris, France14 Lympho-Opt Clinic, Pommelsbrunn, Germany15 Wound Healing Research, Cardiff University, UK16 Boucicaut, Fontenay aux Roses, France.

Abstract

Chronic edema is a multifactorial condition affecting patients with various diseases. Although the pathophysiology of edema varies, compression therapy is a basic tenant of treatment, vital to reducing swelling. Clinical trials are disparate or lacking regarding specific protocols and application recommendations for compression materials and methodology to enable optimal efficacy. 

Compression therapy is a basic treatment modality for chronic leg edema; however, the evidence base for the optimal application, duration and intensity of compression therapy is lacking. The aim of this document was to present the proceedings of a day-long international expert consensus group meeting that examined the current state of the science for the use of compression therapy in chronic edema. 

An expert consensus group met in Brighton, UK, in March 2010 to examine the current state of the science for compression therapy in chronic edema of the lower extremities. Panel discussions and open space discussions examined the current literature, clinical practice patterns, common materials and emerging technologies for the management of chronic edema. This document outlines a proposed clinical research agenda focusing on compression therapy in chronic edema. 

Future trials comparing different compression devices, materials, pressures and parameters for application are needed to enhance the evidence base for optimal chronic oedema management. Important outcomes measures and methods of pressure and oedema quantification are outlined. Future trials are encouraged to optimize compression therapy in chronic edema of the lower extremities.

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