Compliance and satisfaction with foot compression devices: an orthopaedic perspective

Abstract

Although mechanical methods of thromboembolic prophylaxis have proven efficacy, relatively little is known about levels of patient compliance in the usage of these devices. Based on anecdotal evidence, we hypothesised that levels of compliance are sometimes insufficient to provide adequate thromboprophylaxis in the clinical setting. We prospectively analysed the use of foot pumps in 30 orthopaedic patients undergoing lower limb arthroplasty in order to assess levels of both patient compliance and satisfaction. The study was carried out over a 5-month period. Levels of compliance were measured by using a system of random "spot checks". Each patient completed a questionnaire before discharge. Parameters investigated included comfort levels while using the device and identification of factors about the device which the patients disliked. Three hundred and ninety-one measurements were made. The utilisation of the device was found to be effective in 40.2% of measurements. We detected an overall progressive decline in the level of compliance as post-operative time increased [P < 0.001, Chi-square (chi(2)) test]. The average level of patient "comfort" was 7.1 on a visual analogue scale of 0-10. Sleep disturbance was reported by 57% of patients, while 43% complained of "heat intolerance". We have also shown that compliance is significantly reduced in those who complained of "sleep disturbance" while using the foot pumps (t-test, P < 0.05). These findings suggest that satisfactory levels of compliance can be difficult to achieve in the clinical setting despite the proven efficacy in clinical trials of this device. Greater emphasis on patient education may help improve compliance. Unless compliance can be strictly enforced, it appears advisable to only use foot pumps in combination with other forms of pharmacological prophylaxis.