Compression garments: Why are they necessary?

Home healthcare and hospice agencies (HHAs) work with diverse groups of people, from older adults living with multiple chronic conditions to children and younger adults recovering from surgery or acute illnesses. Depending on these patients' ailments or injuries, they may spend a significant amount of time sitting or lying down, which can restrict blood flow and lead to additional health problems. To help treat or prevent vascular illnesses, physicians often recommend or prescribe compression garments.

Compression therapy is an effective, noninvasive, inexpensive way to improve outcomes for people with venous conditions and edemas. But compression garments only work when worn consistently, and patient adherence rates typically range from 12% to 52%.

The HHA clinicians who care for these patients can play a major role in improving compliance by helping them understand why compression therapy is important and ensuring they have the right compression garments and the support they need to use them correctly.

How compression therapy works

Compression therapy is the use of elastic stockings, wraps, or inflatable devices to improve blood flow in a patient's extremities — areas of the body where blood tends to pool. A compression garment puts pressure on the wearer's lower legs, ankles, or feet, helping the veins return blood to the heart more efficiently.

By improving circulation, these products reduce pain and swelling caused by blood pooling, which can help to manage certain conditions and prevent others. Depending on the patient's condition, physicians might recommend compression therapy alone or combined with other treatments.

Types of compression therapy

There are a number of types of compression garments including:

Compression stockings, socks, or tights

Knee-length stockings are the most common compression garment for medical use. People with ankle pain and swelling might use compression socks that go up to the calf, while patients with swelling that extends above the knee might need longer stockings or tights.

Compression socks are rated based on the amount of pressure (mmHg, or millimeters of mercury) they provide:

• Low (less than 20 mmHg)

• Medium (20 to 30 mmHg)

• High (greater than 30 mmHg)

The amount of pressure a patient needs depends on their condition. Too little pressure may render the therapy ineffective, while too much pressure can be dangerous. Low compression stockings can be purchased over the counter, but those rated 20 mmHg or higher require a prescription.

Bandages and wraps

People who have difficulty putting on compression stockings might use Velcro wraps or elastic bandages applied in multiple layers.

Inflatable devices

Known as intermittent pneumatic compression (IPC) devices, these plastic cuffs fully cover the legs and are attached to a machine that inflates the cuffs at regular intervals to provide pressure. They're mostly used in hospitals or by athletes.

Compression therapy use cases

Physicians prescribe compression therapy for many reasons, including to treat and/or prevent:

Deep vein thrombosis (DVT)

Compression therapy is often recommended for people at risk for DVT blood clots, including patients who are overweight, physically inactive or immobile, and those who are undergoing chemotherapy or recently had certain surgeries.

Chronic venous insufficiency (CVI)

CVI is caused by weak leg veins and valves and leads to blood pooling. It can be the result of a DVT, prolonged sitting or standing, or simply aging. Compression therapy can help reduce symptoms, including pain, swelling, and varicose veins.

Edema (swelling) of the feet, ankles, or legs

Compression therapy may reduce swelling caused by CVI, congestive heart failure, lymphedema, pregnancy, or prologued sitting or standing.

Ulcers and wounds

Compression therapy can help to heal leg ulcers and wounds caused by diabetes, varicose veins, and immobility.

Orthostatic hypotension

Caused by poor blood return from the legs to the heart upon standing, orthostatic hypotension increases fall risk in vulnerable patients. Compression therapy can aid blood flow.

Scar management

Compression garments are the first-line therapy for patients following a severe burn. It can help relieve the pain and swelling associated with hypertrophic scars and may speed the healing process by improving blood flow and oxygen supply near the wound.

How HHA clinicians can support patient compliance

Consistency is key for compression therapy. Physicians typically recommend that patients wear compression socks or stockings during waking hours. Compression bandages for wounds or ulcers may need to be worn around the clock. Either way, it's important for patients to follow their provider's instructions. Yet, many patients don't wear them as recommended.

Many studies have surveyed patients to determine why they don't comply, and the reasons for nonadherence fall into five categories:

• Pain and discomfort

• Physical limitations, including difficulty applying compression garments

• Knowledge deficit, including a lack of understanding about why they should wear them

• Psychosocial issues, such as depression and isolation

• Financial issues

HHA clinicians typically see patients more often than their physicians and are more likely to know if patients are wearing their prescribed garments. Home care clinicians can help encourage compliance by discussing the importance of compression therapy, asking why patients aren't using them, and helping them overcome those barriers. For instance, if a patient is struggling with application, clinicians can assist them or suggest tools that might help. If the garment is too uncomfortable, they can ask the physician about alternative products.

These conversations can go a long way toward improving patient compliance with compression therapy, helping them get the full benefit of this noninvasive, often-effective treatment.
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