TEMPLATE FOR PRACTICE Compression hosiery in lymphoedema Lymphoedema and the construction and classification of compression hosiery Evidence for the use of compression hosiery in lymphoedema Role of hosiery in lower limb lymphoedema LYMPHOEDEMA FRAMEWORK A EUROPEAN PERSPECTIVE SUPPORTED BY AN MANAGING EDITOR EDUCATIONAL GRANT Lisa MacGregor FROM BSN MEDICAL SENIOR EDITORIAL ADVISOR Christine Moffatt Professor of Nursing and Co-director, Centre for Research and Implementation of Clinical Practice, Faculty of Health and Social Sciences, Thames Valley University, London, UK The views expressed in this publication are those of the authors CONSULTANT EDITORS and do not necessarily reflect those Peter Mortimer of BSN medical. Professor of Dermatological Medicine, Cardiac and Vascular Sciences (Dermatology Unit), St George’s, University of London, London, UK THIS DOCUMENT IS ENDORSED BY: Hugo Partsch British Lymphology Society (BLS, UK) Professor of Dermatology, Medical University, Vienna, Austria Deutschen Gesellschaft für Lymphologie (DGL, Germany) EDITORIAL ADVISORS Fysioterapeuters Faggruppe for Rebecca Billingham Lymfødembehandling (FFL, Denmark) Lymphoedema Nurse Specialist, Hartshill Orthopaedic and Surgical Unit, University Hospital of North Staffordshire, Gesellschaft Deutschsprachiger Stoke-on-Trent, UK; Chair, British Lymphology Society (BLS) Lymphologen (GDL, Germany) Robert Damstra Lymphoedema Association of Australia Dermatologist, Department of Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital, Drachten, (LAA, Australia) The Netherlands Lymphology Association of North Etelka Földi America (LANA, USA) Medical Director, Földiklinik, Hinterzarten, Germany National Lymphedema Network (NLN, Isabel Forner Cordero USA) Physical Medicine and Rehabilitation Specialist, Lymphoedema Unit, Hospital Universitario La Fe, Valencia, Nederlands Lymfoedeem Netwerk (NLN, Spain The Netherlands) Sandro Michelini Norsk Lymfødemforening (NLF, Norway) Chief of Vascular Rehabilitative Unit and Day Hospital, Department of Vascular Rehabilitation, Ospedale San Österreichische Lymph-Liga (Austria) Giovanni Battista, Rome, Italy Professor Corradino Campisi on behalf of Winfried Schneider the Italian Society of Lymphangiology Medical Director, Klinik “Haus am Schloßpark”, Bad Berleburg, Germany (SIL, Italy) Stéphane Vignes Sociedad Española de Rehabilitación y Internist, Head, Lymphology Unit, Hôpital Cognacq-Jay, Paris, France Medicina Física (SERMEF, Spain) Société Française de Lymphologie (SFL, PUBLISHED BY France) Medical Education Partnership (MEP) Ltd Schweizerische Gesellschaft für 53 Hargrave Road, London N19 5SH, UK Lymphologie (SGL, Switzerland) Tel: +44 (0)20 7561 5400 Svensk Förening för Lymfologi (SFL, Email: [email protected] Sweden) HEAD OF WOUND CARE Suzie Calne © MEP LTD, 2006 PUBLISHING DIRECTOR Jane Jones EDITORIAL PROJECT MANAGER All rights reserved. No reproduction, copy or Kathy Day transmission of this publication may be made without written permission. No paragraph of DESIGNER this publication may be reproduced, copied or Jane Walker transmitted save with written permission or in accordance with the provisions of the Copyright, Designs & Patents Act 1988 or PRINTED BY under the terms of any licence permitting Viking Print Services, UK limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, FOREIGN EDITION TRANSLATIONS London W1P 0LP. RWS Group, Medical Translation Division, London, UK TO REFERENCE THIS DOCUMENT LYMPHOEDEMA FRAMEWORK SECRETARIAT CITE THE FOLLOWING: Centre for Research and Implementation of Clinical Practice Lymphoedema Framework. Template for Practice: compression hosiery in Thames Valley University, 32-38 Uxbridge Road, London, UK lymphoedema. London: MEP Ltd, 2006. Tel: +44 (0)20 280 5020. Web: www.lf.cricp.org TEMPLATE FOR PRACTICE 1 Compression hosiery in lymphoedema CJ Moffatt The Lymphoedema Although the worldwide incidence of contribute to the clinical effectiveness of Framework is a UK based lymphoedema has been estimated as 140 garments. The paper then discusses the remit of research partnership that million1, in Europe lymphoedema is perceived as compression hosiery standards, and compares aims to raise the profile of a rare condition for which there is little treatment. different compression classifications. lymphoedema and improve It is becoming clear, however, that lymphoedema The second paper outlines the evidence on standards of care through and venolymphatic dysfunction are relatively compression hosiery in the management of the involvement of specialist common and that the considerable suffering they lymphoedema. Partsch and Jünger describe the practitioners, clinicians, may cause can be greatly alleviated by skilled pathophysiology of lymphoedema, veno- patient groups, healthcare clinicians. The Template for Practice series is a new lymphatic dysfunction and rebound oedema, and organisations, and the educational initiative designed to raise the profile the mechanisms of action of compression wound care and of lymphoedema and to enhance the standard of therapy. They summarise studies of compression compression hosiery care by providing concise, relevant and highly hosiery efficacy, and discuss the clinical industry. practical information. implications of a new compression device This issue, Compression Hosiery in parameter – ‘static stiffness index’. Lymphoedema, recognises the central role that The final paper is a practical, decision making compression hosiery plays in the treatment of guide to the use of compression hosiery in lower lower limb lymphoedema. The guidance provided limb lymphoedema. The paper links a new is a synthesis of work undertaken by the classification of compression hosiery that Lymphoedema Framework with patients, encompasses existing European classifications to OVERVIEW clinicians and industry. The international clinical descriptions of lymphoedema. Clear expertise of the editorial board has now moved explanations guide the practitioner through the This document focuses on compression hosiery in lower the guidance into the European arena. processes involved in treatment with limb lymphoedema. The Lymphoedema Framework pays tribute to compression hosiery: the decision to prescribe the work of countries such as France, Germany, hosiery; choosing the appropriate compression the Netherlands and Spain that facilitated local level, construction type and style; measuring; and reimbursement of compression garments. The checking and evaluating fit. Emphasis is placed Lymphoedema Framework’s own guideline on providing hosiery that takes a holistic view and development has been influential in the decision accounts for all of the patient’s needs. of the UK Department of Health to include We know that the evidence base for the compression garments for lymphoedema on the treatment of lymphoedema is limited and much Reference: UK Drug Tariff from 1 March 2006. research remains to establish definitive 1. Boccardo F, Michelini S, Zili A, Optimal use of the diversity of compression treatment. The Lymphoedema Framework hopes Campisi C. Epidemiology of garments requires that clinicians understand the that its model of working in partnership with lymphedema. Phlebolymphology 1999; 26: 25-29. relevance of the technical aspects of hosiery patients, clinicians and industry will be more construction and the science of compression widely adopted, and will increase awareness of therapy. They also need to appreciate the wide lymphoedema and further stimulate innovative CBE, FRCN, Professor of Nursing ranging and complex needs of lymphoedema product development. and Co-director, Centre for Research and Implementation of patients, and to adapt their therapeutic approach By elucidating the rationale for and use of Clinical Practice, Faculty of Health to provide effective hosiery that fits correctly, is compression hosiery in the treatment of and Social Sciences, Thames comfortable and encourages long-term use. lymphoedema, this document aims to enhance Valley University, London, UK. In the first paper, Clark and Krimmel describe practitioners’ and patients’ use of compression Past President, European Wound Management Association the basic construction of compression hosiery hosiery, and to transform the experience of (EWMA) and how the characteristics of the fabric patients with lymphoedema. 2 TEMPLATE FOR PRACTICE Lymphoedema and the construction and classification of compression hosiery M Clark1, G Krimmel2 There are many styles of Lymphoedema is a consequence of impaired upon a complex interaction of the physical compression hosiery, ranging lymphatic drainage and can result in marked properties and construction of the bandage or from socks to pantyhose. The changes in the size and shape of the affected hosiery, the size and shape of limb to which it is style and level of compression area1. Management of limb swelling involves a applied, and the activity of the wearer4. prescribed for patients with variety of approaches intended to reduce As a broad principle, the level of compression lymphoedema is dependent localised swelling, including a specialised form of is directly proportional to the tension with which on many factors including the massage (manual lymphatic drainage) and the the compression device is applied and is inversely site, extent and severity of the use of compression bandages and hosiery2,3. related to the size of the limb – this general rule is swelling, the patient's ability known as Laplace's Law4. In compression hosiery, to