Optimising Compression Therapy: Insights from Industry Experts

Compression garments play a crucial role in managing lymphoedema, yet therapists often face challenges when selecting the most appropriate option. To support clinical decision-making, we invited compression garment suppliers to share their observations on common prescribing pitfalls, along with practical tools and resources they offer. Their collective insights can help clinicians improve garment selection and patient outcomes.

Where Things Go Wrong – and What You Can Do About It

Lack of Alignment with Clinical Needs and Patient Lifestyle

Several themes emerged when suppliers reflected on where garment selection goes off track. A major issue is garments being ordered without a clear match to the patient’s clinical presentation, goals, or lifestyle. For example, not considering mobility, hand dexterity, or sensitivity to fabrics can lead to garments that are uncomfortable or impractical for the patient – reducing wear time and ultimately, effectiveness.

Complex Presentations and Therapist Confidence

Challenges also arise when therapists encounter complex limb shapes, fluid accumulation in unusual areas, or increasingly common presentations in larger-bodied patients. Donning difficulties and therapist uncertainty or lack of confidence can further complicate prescription.

Navigating Patient Preferences and Clinical Judgement

Another area of concern is when therapists describe garment options that, in their clinical judgement, may not be suitable – such as offering circular knit swatches when flat knit would be more appropriate – then feel obligated to provide the patient’s choice. Similarly, choosing a complex garment as the first garment can sometimes hinder initial uptake. Starting with a simpler version, such as a below-knee option instead of pantyhose, can assist patient acceptance. It’s essential that patients understand this may be an interim step and that more comprehensive garments may follow.

Defaulting to Familiar Rather Than Fit-for-Purpose

There’s also a trend of selecting “safe” or familiar options rather than exploring whether another garment might be more appropriate. Sometimes, garments are chosen based on what’s been used before rather than what’s best for the patient’s current stage of treatment. Compression classes are another area where mismatches occur – for example, prescribing a garment with a compression class that exceeds the patient’s ability to don or tolerate. Layering garments of a lower compression class may achieve a similar effect with better wearability.

Cost Assumptions and Missed Opportunities

Cost considerations can also lead to suboptimal choices. Therapists may hesitate to recommend higher-quality or custom garments due to concerns about the patient’s financial capacity. This can result in defaulting to lower-cost options without discussing best-in-class alternatives. While cost is a valid concern, assuming a patient cannot or will not invest in more effective solutions can unintentionally limit their care. It’s important to offer informed choices and explain the benefits and potential outcomes of each option.

What can you do?

  • Start with the patient: Consider goals, diagnosis, swelling pattern, and practical barriers like donning ability, dexterity, and comfort. Also previous experience with compression garments
  • Match garment complexity to readiness: If appropriate, begin with a simpler garment to support uptake, but clearly explain that more comprehensive options may be needed later.
  • Be intentional with options: Only present choices that align with your clinical judgement, especially regarding fabric types and knit structure.
  • Use supplier consults: Most offer free virtual or in-person support – draw on their product knowledge and clinical expertise. Especially when measuring custom made garments.
  • Check fabric types and features: Confirm suitability for the patient’s needs, especially when working with unfamiliar garments or presentations.
  • Revisit options: If something didn’t work well before, ask if updated or alternative products are available – don’t default to “safe” options.
  • Have open conversations about cost: Don’t assume a patient’s financial limits – discuss the full range of clinically appropriate options, including best-in-class garments. Where cost is a concern, work with the patient to prioritise needs or explore interim solutions, but ensure they understand the potential benefits of each option.

Common Mistakes in Garment Selection – and How to Avoid Them

Measurement Inaccuracies

A few common errors were highlighted by suppliers, many of which are easy to avoid with the right checks in place. One is measurement inaccuracies – sometimes due to rushed appointments, measuring over clothing, or not accounting for oedema fluctuations. Even small errors can significantly affect fit and comfort.

Incomplete Orders

Therapists may also omit key parts of the order, such as forgetting to indicate compression class, foot or leg length, or whether toes should be open or closed. These oversights can delay treatment and impact effectiveness.

Misunderstanding Compression Factors

Another frequent issue is misunderstanding the factors that influence compression prescription. This includes both garment-related factors (such as the impact of low stiffness in circular knit fabrics) and client-specific considerations (like the presence of soft pitting). In some cases, garments are prescribed that don’t provide adequate distal support – for example, omitting compression for the hand when addressing arm swelling.

Underestimating the Extent of Swelling

There’s also the risk of underestimating the extent of the swelling. For instance, prescribing a below-knee garment when swelling extends to the thigh, or choosing a thigh-high garment with grip top when swelling extends into the hip or groin area. While simpler garments may be appropriate as a starting point, it’s important to ensure the garment still meets the clinical need.

Cost-Based Assumptions

Defaulting to cheaper options first: A common mistake is recommending lower-cost garments initially, rather than starting with best-practice solutions. Often, therapists may assume that patients can’t afford more expensive products, leading them to offer cheaper options first. However, this can delay effective treatment and result in a less-than-optimal clinical outcome. Therapists should feel confident offering the most appropriate garment for the patient’s needs, regardless of cost, and clearly explain the benefits of each option.

Limited Brand Familiarity and Protocol Gaps

Limited brand familiarity: Therapists who primarily use one brand may not be familiar with the full range of options across multiple companies. This can limit the ability to select the best garment for the patient. It’s crucial to be aware of multiple brands and their unique offerings to meet the patient’s needs. Additionally, no universal measuring process across brands can lead to incorrect measurements if therapists don’t follow each brand’s specific protocols, creating misfits. Therapists should ensure they are aware of the correct measuring techniques for each brand they use.

What can you do?

  • Double-check measurements: Measure on bare skin and repeat if unsure. Avoid measuring over clothing and consider changes post-decongestion.
  • Measure when oedema is at its lowest. For example measure at the beginning of the day or if not possible account for the increase in measuring.
  • Include full order details: Don’t forget to specify compression class, garment length, toe/foot options, and distal support.
  • Understand what affects compression: Know how garment properties (like stiffness) and client factors (e.g., soft pitting) impact outcomes.
  • Cover the full extent of swelling: Choose garments that extend far enough to address all affected areas. Avoid stopping compression short of where swelling occurs, and ensure the hand is included when there is distal swelling or when compression is applied further up the limb.
  • Reduce compression: When fitting garments on older adults with oedema extending to the thigh, but starting with a below-knee garment, ensure it does not constrict at the knee. Consider starting with a lower level of compression and use flat-knit fabric to provide a more comfortable and effective fit.
  • Stay updated: Attend supplier education sessions or webinars to stay familiar with evolving products and clinical considerations.
  • Ask questions: If you’re unsure whether a product suits your patient, supplier reps can help match options to needs.
  • Document feedback: Capture what worked or didn’t for each patient to support better future decisions and learning.
  • Consider cost-effectiveness without compromising quality: Don’t automatically opt for lower-cost garments first. Always prioritize the clinical needs of the patient and start with the best-suited garment.
  • Familiarize yourself with multiple brands: Don’t limit yourself to one brand. Be aware of each brand’s range and fit to choose the best garment for your patient.
  • Ensure correct measurement protocols across brands: When switching between brands, follow the brand-specific measurement guidelines to ensure a proper fit and avoid misfits.

Support and Resources for Clinicians

In addition to identifying areas for improvement, suppliers outlined the support and education they provide to assist therapists in selecting and prescribing compression garments effectively. Click the tabs for support and resource information.

Support:

Essity provides extensive clinical and educational support through:

  • Clinical sales specialists in every state (with backgrounds in allied health/nursing and Level 1 lymphoedema training)
  • In-clinic and remote support for troubleshooting, garment fitting, and product trials
  • 1:1 assistance via their Clinical Concierge (book a Teams session at a convenient time)
  • Dedicated customer service for garment orders and queries: jobst.au@essity.com
    www.jobst.com.au

Resources:

  • Professional Portal: access to e-learning and training videos
  • Compression prescription tools and dedicated product website: RTW and custom measuring guides, product information, measuring resources
  • eShop for custom compression options, instant quoting, and ordering
  • Education events including study days, roadshows, and measuring workshops for all experience levels
  • Webinar program delivered by experienced lymphoedema clinicians

Support:

Haddenham offers access to clinical advisors to support decision-making around their range of compression garments. Appointments can be booked for virtual or phone consultations. In addition, Haddenham runs regular online and in-person events throughout the year, providing education on their product range and sharing the latest updates.

Resources:

Support:

Jobskin offers a range of support services including:

  • Measuring videos for all body parts: jobskin.com/how-to-videos
  • Webinars on multiple topics: Jobskin ANZ YouTube
  • Telehealth clinical support (some in-person visits available)
  • In-person workshops and training (available on request)

Resources:

Support:
Support is offered through in-person and remote appointments (e.g., FaceTime). They provide detailed measuring forms and will soon launch a new Lymphology Guide to MTM Flat Knit Solutions, helping therapists select appropriate solutions by garment type.

Resources:

  • Product catalogues
  • Lymphology Guide to MTM Flat Knit Solutions (launching May)
  • Educational posters
    www.lymphoedemasc.com.au

Support:

medi Australia provides a variety of support options to assist clinicians and patients:

  • Online education including virtual fitting sessions, webinars, and access to the medi Academy portal featuring product information, recordings, and practical tips
  • Made to Measure Monday – regular microlearning emails designed to build knowledge in bite-sized, easy-to-retain segments
  • Clinical educators with lymphoedema training available to support clinicians and patients in selecting and using compression garments

www.mediaustralia.com.au

Resources:

  • Print and online educational resources covering product ranges and clinical guidance (available via the medi Australia website and medi Academy)
  • Clinical educators available for in-clinic or virtual visits
  • Workshops and webinars designed to enhance clinical knowledge and application

Support:
OPC Health offers support via multiple avenues, including in-person and video-based garment measuring guidance, depending on location.

  • Juzo queries and measuring advice: jsayle@opchealth.com.au
  • General garment queries: garments@opchealth.com.au
  • Clinical and measuring advice: nhadley@opchealth.com.au
    OPC Health website

Resources:

  • OPEDucate: an online education platform offering courses including Juzo Compression Garments and Lower Limb Oedema Management
  • Custom measuring forms and compression catalogues:
    o Juzo
    o Jobst

Top Tips from the Field

Alongside sharing resources and support tools, suppliers were invited to contribute one piece of advice they regularly offer to clinicians. These insights reflect their on-the-ground experience supporting therapists and patients with garment selection and compression therapy.

“Keep knowledge up to date and keep in regular contact with your local industry partners. Utilize the free training provided to maintain your skills and offer gold standard options to your patient group. Never be embarrassed to ask that question—chances are, if you’re thinking it, someone else will be too.”

— Michelle Richardson, Essity Health and Medical

“Compression doesn’t have to be complicated – we are here with practical support, training, and time-saving tools to help you deliver the best care to your patients.”

— Jennifer Ritossa, Essity Health and Medical

“Always double check your prescription before submitting/sending off for manufacture and have a systematic approach to check nothing is left off the order. When ordering custom made, order only one garment as the first, not multiples, until the nuances of fit have been established for that client.”

— Jane Phillips Haddenham Healthcare

“Don’t base your garment prescription on habit or brand loyalty—really think about the clinical need and look for a garment that gives you (or has modifications that can give you) what you want.”

— Rosemary Kendell, Jobskin

“Work closely with the manufacturer to ensure they have a total understanding of your expectations for the garment. They can confirm what is possible to achieve.”

— Leigh Esposito, Lymphoedema Supply Company

“Attend as many workshops as possible to increase the skill levels around garment prescription. Lobby governments to maximise funding so that cost is no longer a barrier to correct and best in class garment prescription”

— Adriana Popovic, medi Australia

“Listen to your client and design compression to meet their needs. There is no point prescribing best practice prescription if the client will not wear it and it will sit in the cupboard. Work with your client to find the right solution for them.”

— Natalie Hadley, OPC Health

Final thoughts

Compression therapy works best when therapists have the right tools, knowledge, and support to make informed decisions. This article has highlighted some of the common challenges in garment selection, along with practical strategies to help avoid them.

Thank you to the suppliers who contributed insights and shared information about the clinical support and resources available. Their input adds to a broader understanding of how we can strengthen outcomes through better garment selection and ongoing collaboration.

By staying informed and drawing on available support, therapists can continue to improve the care they provide and help ensure garments are well matched to each patient’s needs.

👉 What challenges have you encountered when prescribing compression garments, and how have you worked through them? Are there strategies or insights you’ve found helpful in navigating these common pitfalls? Share your thoughts in the comments.