Compression Pressure Variability in Upper Limb Multilayer Bandaging Applied by Lymphedema Therapists

Abstract

Background: Multilayer bandaging (MLB) is often used for lymphedema treatment. Even experienced lymphedema therapists have difficulty applying bandages correctly. The aim of this study was to demonstrate upper limb MLB pressure variability applied by lymphedema therapists. Methods and Results: Twenty-four lymphedema therapists were asked to apply MLB to the healthy volunteer's upper limb. The participants consisted of 20 females and 4 males with a mean age of 43.4 (range: 24-62) years. They included licensed massage therapists, nurses, a judo therapist, an occupational therapist, and a medical doctor. Twenty therapists (83.3%) had clinical experience applying MLB. Compression pressure was measured with PicoPress at 5 cm proximal to the wrist, immediately after the application (phase 1) and after exercise (phase 2). The mean MLB pressure was 67.7 -5.0 mmHg in phase 1 and 55.3 -4.1 mmHg in phase 2, which were significantly different ( p = 1.2 • 10 -10 ). There was a weak negative correlation between how long the therapist had been practicing MLB and MLB pressure (R = 0.29). Seventeen participants (70.8%) expressed that they had a target pressure in mind when performing MLB. Among the 17 participants, there was no correlation between the target and actual pressures (R = -0.055). Only three participants (17.6%) had an actual MLB pressure within 5 mmHg of their target. Conclusions: The mean MLB pressure was 55.3 -4.1 mmHg, which was thought to be too high for the upper limb. Education about applying appropriate MLB pressures to the limbs is necessary.

Adjustable Compression Wraps (ACW) vs. Compression Bandaging (CB) in the Acute Phase of Breast Cancer-Related Arm Lymphedema Management—A Prospective Randomized Study

“…Compression bandaging turned out to be more effective, not only in reducing affected limb volume but also in reducing disease-related symptoms during the second week of treatment. Interestingly, the majority of patients in our study were able to learn the technique and applied the bandage themselves for 2 weeks, despite this process even being potentially problematic for some physiotherapists [ 19 ].…”

“…Some patients are able to learn the technique and apply the bandage themselves, although this process can be very difficult for the elderly or those with advanced arm lymphedema. Even experienced lymphedema therapists may have difficulty applying bandages correctly [ 19 ], especially in more advanced cases of lymphedema. The main problem in multi-layer bandaging is obtaining the optimal pressure under compression.…”

Chronic Venous Insufficiency With Emphasis on the Geriatric Population

“…Differences in garment or bandage materials produce functional differences [115][116][117]. For example, a material with a high percentage of elastic fibers forming the compression bandage is called a "long-stretch" bandage [118].…”

The effect of complex decongestive physiotherapy applied with different compression pressures on skin and subcutaneous tissue thickness in individuals with breast cancer-related lymphedema: a double-blinded randomized comparison trial

“…Compression application with short stretch bandages (non-elastic) is one of the most efficient parts of the CDP [ 17 ]. Short stretch bandages are difficult to apply, and the targeted interface bandage pressure is rarely achieved even by specialist healthcare professionals are often used in CDP [ 18 – 20 ]. Furthermore, interface pressure of bandage is an important factor in reducing edema.…”

“…However, excessive pressure can cause lymphatic occlusion [ 17 ]. As a result, measuring the bandage interface pressure is critical [ 20 ]. In studies examining changes in skin and subcutaneous tissue thickness, bandage interface pressures were not assessed [ 14 – 16 ].…”