Variability in compression pressure of multi-layer bandaging applied by lymphedema therapists
Hisako Hara & Nobumitsu Hamanaka & Maki Yoshida& Noriko Ikehata & Shigeko Tachibana & Katsura Nakakawaji & Makoto Mihara. Supportive Care in Cancer (2019) 27:959–963
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Variability in compression pressure of multi-layer bandaging applied by lymphedema therapists
Hisako Hara & Nobumitsu Hamanaka & Maki Yoshida& Noriko Ikehata & Shigeko Tachibana & Katsura Nakakawaji & Makoto Mihara. Supportive Care in Cancer (2019) 27:959–963
Background The success in multi-layer bandaging (MLB) relies on the technique of the therapists. The purpose of this study was to elucidate the compression pressure of MLB by lymphedema therapists. Methods We investigated the pressure of MLB applied by 48 lymphedema therapists. The average age was 43.5 (range 23–66) years old. Seventeen (35.4%) of the therapists had the clinical experience of MLB. We prepared ordinary compression materials and asked them to apply MLB to the whole lower limb of healthy volunteers, presuming moderate lymphedema. We attached the probe of Picopress at the Achilles tendon-muscle junction and measured the pressure three times: phase 1, resting condition; phase 2, after ankle exercise; and phase 3, after knee bend. Results The average pressure in phases 1–3 was 51.9, 48.9, and 45.5 mmHg, respectively. Only 13 (27.1%) of the therapists achieved50–59mmHg which is suitable for lymphedema treatment and the pressure varied by the training courses. The pressure decreased as the blank period got longer after finishing training courses (R=−0.39). Conclusions The pressure of MLB varied in different therapists and different training courses. This fact indicated the necessity of uniform curriculum in training courses including measurement of the bandaging pressure.
Main findings
- This study only considers traditional multilayer bandaging and not 2 layer systems. It also only considers the optimal compression in regards to mmHg and doesn’t take into account the stiffness of the bandaging system.
- The authors state the pressure was different for different therapists and different training course. About 70% of the therapists did not set a target pressure, though applying proper pressure is essential in multi-layer bandaging. From these results, the necessity of a unified training program is suggested.
- In the current study, the average pressure soon after applying bandages was 51.9 mmHg, and it decreased after exercising to 45.5 mmHg.
- The authors conclude achieving the appropriate pressure is the key in successful bandaging for lymphedema. Bandaging with too low pressure is ineffective despite time and effort. On the contrary, bandaging with too high pressure may lead to circulatory deficit or nerve damage. To maintain the bandaging pressure and ensure the quality of the therapists, review of the educational system for lymphedema therapist is essential.
