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                             Veins and Lymphatics 2018; volume 7:7633

[page 78]                                                          [Veins and Lymphatics 2018; 7:7633]

Keys to enhance patients’ad-
herence to compression therapy
Joseph N. Harfouche
Thoracic, Cardiac and Vascular Surgery
Centre, CHIREC, Delta Hospital,
Brussels, Belgium

Introduction
Many studies have demonstrated the

effectiveness of compression therapy (CT)
in the treatment of veno-lymphatic insuffi-
ciency.1-4
In daily practice, therapists are often

faced with a lack of patients’ adherence to
treatment and especially regarding CT.5
The causes are multiple and it is up to

the therapist to understand them, to provide
personalised solutions for their patient, and
thus boost the wearing of the compression
depending on the stage of the illness, in
addition to other aspects of treatment.

Materials and Methods
This preliminary study was conducted

over 16 months on patients with venous
and/or lymphatic insufficiency whose treat-
ment consisted, among other things, in the
wearing of a compression garment.
The 17 subjects matching the criteria of

inclusions were patients: i) admitted to the
hospital for venous or lymphatic insuffi-
ciencies; ii) suffering from their pathology
for at least 3 years; iii) reluctant to CT
(decided to stop it or never accepted it).
The observations resulting from the

methodology chosen for this analysis are of
a more qualitative than quantitative nature,
since its objective is to understand the
mechanisms of non-adherence to the wear-
ing of the compression, in order to find
appropriate responses and thus optimise the
CT. 
The next phase of this study will consist

in quantifying and classifying the results
with tests that are currently under develop-
ment.
It will also include a decisional tree to

support the therapist in the choice of the
most appropriate compression garment
according to the patient’s profile.

Results
It appears that the primary causes of

non-adherence with the CT are: i) the lack
of understanding by the patient concerning
the importance and therapeutic value of the
CT, because of the lack of explanation by
the therapists; ii) the high pressures applied
by the compression garment; iii) the dis-
comfort associated to compression garment;
iv) the irritation of the skin; v) the wrong
size of the garment because of erroneous
circumferential measurements; vi) the diffi-
culty to put on and take off the garments;
vii) the psychosocial reasons that often dis-
courage the patient from following the rec-
ommended treatment play an important
role.
After analysing the reasons of non-

adherence to CT, corrective actions were
put in place in order to enhance the compli-
ance and by consequence the therapeutic
benefits of the treatment. After accepting to
follow the procedure, 13 patients complied
with the CT.

Discussion
This preliminary study has shown that

most of the non-adherent patients are scep-
tical because of the lack of understanding
and trust in the CT therefore, to avoid isola-
tion of the patient it is essential to establish
the confidence.
The most effective and fastest way to

win the trust of the patient is to demonstrate
the effectiveness of the therapeutic means
put in place. Manual lymphatic drainage
(MLD) if done by experts is part of the
holistic treatment of veno-lymphatic insuf-
ficiency. When the patient with oedema, at
the end of the MLD session, notes a visible
volume reduction as well as a shape
enhancement, he will be convinced of the
usefulness of the treatment put in place.
This will positively impact his acceptance
of other aspects of treatment, including the
CT.
To solve the inconvenience and discom-

fort experienced by the patient that are
related to the high pressures applied by the
compression garment, we found that these
high pressure prescribed were not necessary
for all the patients, especially when the
whole treatment is respected (MLD, exer-
cises, hygiene/lifestyle tips, …).  Less pres-
sure is much better than no pressure.
Decreasing the pressure of the compres-

sion garment will help solve at the same
time the discomfort that patients experi-
enced and will facilitate the putting on and
taking off of the garment.
If the non-adherence is due to skin irri-

tation (e.g. in case of Urticaria Factitia), the
physician after assessment can prescribe

anti histaminic.
When the non-adherence comes from

erroneous circumferential measurements.
The solution, in this case, was the use of the
PerKit a reproducible e and accurate tech-
nic6 and give the measurement the impor-
tance it deserves in treatment, not only in
order to bring the patient a garment, perfect-
ly adapted to their morphology and mea-
surements but also to follow-up the changes
in the limb volume and thus to encourage
the patient with convincing results and to
adjust the treatment according to the results
obtained.
When the psychosocial reasons are

responsible of the non-adherence, the cost-
effectiveness must be systematically high-
lighted by the therapist in order to propose
to the patient the most appropriate treat-
ment, taking into account the therapeutic
objective, the duration of the treatment, the
financial means, etc. An effort is done by
some companies to enhance the aesthetic of
the current garments.
Compression bandages are preferred in

the phase of decongestion, because they are
effective7 and economical due to their abili-
ty to adjust. So bandages or adjustable gar-
ments must be privileged in this phase.
Because a premature choice of a made-to-
measure compression garment, while the
limb volume is still reducible, will lead to
inefficiency of the treatment and at the same
time it will be of high cost for the patient.
When the therapist estimates that the

limb volume is stabilized, the choice of a
compression garment will be preferred to
promote comfort and autonomy and self-
management of the patient.

Correspondence: Joseph N. Harfouche,
Thoracic, Cardiac and Vascular Surgery
Centre, CHIREC, Delta Hospital, Brussels, 
Belgium

E-mail: joseph.harfouche@yahoo.com

Conference presentation: International
Compression Club (ICC) Meeting, Paris,
2017. 

This work is licensed under a Creative
Commons Attribution 4.0 License (by-nc 4.0).

©Copyright J.N. Harfouche, 2018
Licensee PAGEPress, Italy
Veins and Lymphatics 2018; 7:7633
doi:10.4081/vl.2018.7633

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                                                                                          Conference Presentation

                                       [Veins and Lymphatics 2018; 7:7633]                                                         [page 79]

Conclusions
The therapist is responsible for choos-

ing the most appropriate treatment for the
patient but also for ensuring the patient’s
self-adherence to the therapeutic means put
in place. A personalised and multidisci-
plinary approach makes it possible to
involve all the therapeutic team to optimise
the results of the treatment. A crucial point
is that the patient must understand that he is
not a spectator, but he is one of the active
members of his therapeutic team.
Applying this protocol means: saving

patients’ money and giving him a better
result within an optimal time.
These observations, when validated by

an upcoming study, might allow a different
approach to current standards by combining
treatment efficacy and patient compliance.

References
1. Motykie GD, Caprini JA, Arcelus JI, et
al. Evaluation of therapeutic compres-
sion stockings in the treatment of chron-
ic venous insufficiency. Dermatol Surg
1999;25:116-20.

2. Mauck KF, Asi N, Elraiyah TA, et al.
Comparative systematic review and
meta-analysis of compression modali-
ties for the promotion of venous ulcer
healing and reducing ulcer recurrence. J
Vasc Surg 2014;60:71S-90S.

3. Blair SD, Wright DD, Backhouse CM,
et al. Sustained compression and heal-
ing of chronic venous ulcers. BMJ
1988;297:1159-61.

4. Partsch H, Menzinger G, Mostbeck A.
Inelastic leg compression is more effec-
tive to reduce deep venous refluxes than
elastic bandages. Dermatol Surg
1999;25:695-700.

5. BrownJC, ChevilleAL, Tchou JC, et al.
Prescription and adherence to lym-
phedema self-care modalities among
women with breast cancer-related lym-
phedema. Support Care Cancer 2015
Jan 1.

6. Harfouche, Joseph. The PeriKit: an
innovative connected portable device
with high level of accuracy and reliabil-
ity in taking circumferential limb meas-
urements. Veins and Lymphatics, [S.l.],
mar. 2017. ISSN 2279-7483.

7. King M, Deveaux A, White H, et al.
Compression garments versus compres-
sion bandaging in decongestive lym-
phatic therapy for breast cancer-related
lymphedema: a randomized controlled
trial. Support Care Cancer 2012;20:
1031-6.

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