Effect Of Intermittent Pneumatic Compression Research Articles

Effect of intermittent pneumatic compression on preventing deep vein thrombosis using microfluidic vein chip.

Background: Deep Vein Thrombosis (DVT) is a common disease, frequently afflicting the lower limb veins of bedridden patients. Intermittent Pneumatic Compression (IPC) is often employed as an effective solution for this problem. In our study, a random selection of 264 patients underwent IPC treatment for either one or 8hours daily. The rate of severe venous thrombosis was substantially reduced in the IPC-treated group compared to the control group. However, real-time monitoring of blood flow during IPC operation periods remains a challenge, leading to rare awareness of IPC working mechanism on thrombosis prevention. Methods: Here, microfluidic chip methodology is used to create an in vitro vein-mimicking platform integrating venous valves in a deformable channel. Whole blood of patients after knee surgery was perfused into the venous channel at a controlled flow rate obtained from patients with IPC treatment clinically. Results: According to the numerical simulations results, both of an increase in compressive pressure and a decrease in time interval of IPC device can accelarete blood flow rate and the shear stress within the vein. The vein chip experiments also reveal that the fibrin accumulation can be greatly lowered in IPC treated group, indicating less thrombosis formation in future. A time interval of 24 seconds and a maximum contraction pressure of 40mmHg were proved to be the most effective parameters for the IPC device adopted in our clinical trail. Conclusion: This vein chip presents a novel method for observing the functional mechanisms of IPC device for DVT prevention. It provides crucial data for further standardization and optimization of IPC devices in clinical usage.

Effectiveness of manual lymphatic drainage and intermittent pneumatic compression in lymphedema maintenance therapy.

Background: To compare the effectiveness of intermittent pneumatic compression (IPC) and/or manual lymphatic drainage (MLD) associated to compression stockings in the maintenance treatment of lymphedema. Patients and methods: Patients in the maintenance phase of lymphedema therapy with MLD and compression since more than a year with stable values for weight and circumferences of ankle and calf were asked to participate in a study: Compression had to be worn daily, (1) 4 weeks IPC+MLD, (2) 4 weeks MLD alone, (3) 4 Weeks IPC alone (Order 1 and 3 was randomized). At the beginning and after each 4 weeks, circumference measurements (by hand and by machine: BT600®, Bauerfeind) were documented, pain and discomfort were assessed, and quality-of-life questionnaires were completed. Results: Of 20 participants, 18 (14 female, 4 male), mean age 59.6 years (48-89) could be evaluated. 11 subjects had bilateral, 7 unilateral, 5 primary, 13 secondary lymphedema since 2-20 years (mean 7.7), the subjects had received MLD and compression for 2-14 years (mean 6.4), 1-3 times per week (mean 1.5). The BMI ranged between 21 and 47 (mean 33.7). No differences between any phases were found for: Calf and thigh volume, circumference of calf. Only the ankle circumference was significant less (-0.22cm) when using "both" (IPC+MLD). Compared to before the study, quality of life was better in all three phases, but with a significantly higher improvement in the phases with IPC than in the phases without. Conclusions: There were no differences in objective measurement between MLD alone, IPC alone or both, excepting the minimal significant difference in ankle circumference after IPC+MLD. QOL favored IPC application. Considering the economic consequences of these results, a change of maintenance therapy with MLD weekly over years in favor of permanent care with IPC and few appointments of MLD per year should be considered and further investigated.

Effects of intermittent pneumatic compression on the recovery of cardiovascular parameters after repeated sprint exercise

PurposeIntermittent pneumatic compression (IPC) applies gradual pressure to facilitate lymph and blood flow movement to reduce exercise-induced tissue fluid accumulation and plasma volume loss. This study aimed to evaluate the cardiovascular system response during the recovery with IPC compared with passive recovery (Sham).MethodsSixteen volunteers (7 females and 9 males) executed a cycling-based exhausting sprint interval exercise (8 × 20 s all out), followed by a 30-min IPC or Sham condition. Participants performed two trials in a randomised, counterbalanced, and crossover design. Several cardiovascular parameters (blood pressure, heart function, and peripheral vascular resistance) were recorded at baseline (5ʹ), through the recovery protocol (30ʹ), and afterwards (5ʹ).ResultsThe use of IPC during the recovery phase led to a faster recovery, stated in relative values to pre-exercise, in mean blood pressure (102.5 ± 19.3% vs. 92.7 ± 12.5%; P < 0.001), and cardiac output (139.8 ± 30.0% vs. 146.2 ± 40.2%; P < 0.05) in comparison to Sham condition. Furthermore, during the IPC-based recovery, there was a slower recovery in cardiac pressure change over time (92.5 ± 25.8% vs. 100.5 ± 48.9%; P < 0.05), and a faster return to pre-exercise values in the peripheral vascular resistance (75.2 ± 25.5% vs. 64.8 ± 17.4%; P < 0.001) compared to Sham.ConclusionThe application of IPC after high-intensity exercise promotes the recovery of the cardiovascular system, reducing cardiovascular strain. Future investigations should consider the effects on the sympathetic-parasympathetic balance, such as heart rate variability, to assess further bonds between the use of IPC and autonomous control.

Cost-effectiveness of mechanical thromboprophylaxis for cesarean deliveries in Brazil.

To evaluate the cost-effectiveness of using mechanical thromboprophylaxis for patients undergoing a cesarean delivery in Brazil. A decision-analytic model built in TreeAge software was used to compare the cost and effectiveness of intermittent pneumatic compression to prophylaxis with low-molecular-weight heparin or no prophylaxis from the perspective of the hospital. Related adverse events were venous thromboembolism, minor bleeding, and major bleeding. Model data were sourced from peer-reviewed studies through a structured literature search. A willingness-to-pay threshold of R$15,000 per avoided adverse event was adopted. Scenario, one-way, and probabilistic sensitivity analyses were performed to evaluate the impact of uncertainties on the results. The costs of care related to venous thromboembolism prophylaxis and associated adverse events ranged from R$914 for no prophylaxis to R$1,301 for low-molecular-weight heparin. With an incremental cost-effectiveness ratio of R$7,843 per adverse event avoided. Intermittent pneumatic compression was cost-effective compared to no prophylaxis. With lower costs and improved effectiveness, intermittent pneumatic compression dominated low-molecular-weight heparin. The probabilistic sensitivity analyses showed that the probability of being cost-effective was comparable for intermittent pneumatic compression and no prophylaxis, with low-molecular-weight heparin unlikely to be considered cost-effective (0.07). Intermittent pneumatic compression could be a cost-effective option and is likely to be more appropriate than low-molecular-weight heparin when used for venous thromboembolism prophylaxis for cesarean delivery in Brazil. Use of thromboprophylaxis should be a risk-stratified, individualized approach.

Effects of different intermittent pneumatic compression stimuli on ankle dorsiflexion range of motion.

Despite substantial evidence of the effectiveness of intermittent pneumatic compression (IPC) treatments for range of motion (ROM) improvement, little evidence is available regarding how different IPC stimuli affect ankle dorsiflexion (DF) ROM. This study aimed to investigate the effects of different IPC stimuli on the ankle DF ROM. Fourteen, university intermittent team sport male athletes (age: 21 ± 1 year, height: 1.74 ± 0.05 m, body mass: 70.9 ± 7.7 kg, body fat percentage: 14.2 ± 3.6%, body mass index: 23.5 ± 2.5kg/m2; mean ± standard deviation) completed four experimental trials in a random order: 1) no compression with wearing IPC devices (SHAM), 2) the sequential compression at approximately 80mmHg (SQUEE80), 3) the uniform compression at approximately 80mmHg (BOOST80), and 4) the uniform compression at approximately 135mmHg (BOOST135). For the experimental trials, the participants were initially at rest for 10min and then assigned to either a 30-min SHAM, SQUEE80, BOOST80, or BOOST135. Participants rested for 20min after IPC treatment. The Weight-Bearing Lunge Test (WBLT), popliteal artery blood flow, pressure-to-pain threshold (PPT), muscle hardness, heart rate variability, and perceived relaxation were measured before (Pre) and immediately after IPC treatment (Post-0) and 20min after IPC treatment (Post-20), and the changes in all variables from Pre (Δ) were calculated. ΔWBLT performance, ΔPPT, and Δperceived relaxation in all IPC treatments were significantly higher than those in SHAM at Post-0 and Post-20 (p < 0.05). ΔPopliteal artery blood flow in BOOST80 and BOOST135 was significantly higher than that in SHAM and SQUEE80 at Post-0 (p < 0.05). ΔMuscle hardness and Δheart rate variability did not differ significantly between trials. In conclusion, IPC treatments, irrespective of applied pressure and mode of compression, increased ankle DF ROM. This resulted from decreased pain sensitivity (i.e., increased PPT). In addition, high inflation pressure and frequency did not provide additional benefits in increasing ankle DF ROM.

Effect of Intermittent Pneumatic Compression in Addition to Pharmacologic Prophylaxis for Thromboprophylaxis in Hospitalized Adult Patients: A Systematic Review and Meta-Analysis.

OBJECTIVES:Venous thromboembolic events (VTE) are frequent complications in hospitalized patients and a leading cause of preventable death in hospital. Pharmacologic prophylaxis is a standard of care to prevent VTE in patients at risk, the additional value of intermittent pneumatic compression (IPC) is uncertain. We aimed to evaluate the efficacy of adding IPC to pharmacologic prophylaxis to prevent VTE in hospitalized adults.DATA SOURCES:We searched the Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and the International Clinical Trials Registry Platform from inception to July 2022.STUDY SELECTION:We included randomized controlled trials comparing the use of IPC in addition to pharmacological thromboprophylaxis to pharmacological thromboprophylaxis alone in hospitalized adults.DATA EXTRACTION:Meta-analyses were performed to calculate risk ratio (RR) of VTE, deep venous thrombosis (DVT), and pulmonary embolism (PE). We assessed the risk of bias using the Cochrane Risk of Bias Tool for Randomized Trials, Version 2 and the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.DATA SYNTHESIS:We included 17 trials enrolling 8,796 participants. The IPC was mostly applied up to the thigh and pharmacological thromboprophylaxis was primarily low-molecular-weight heparin. Adjunctive IPC was associated with a decreased risk of VTE (15 trials, RR = 0.53; 95% CI [0.35–0.81]) and DVT (14 trials, RR = 0.52; 95% CI [0.33–0.81]) but not PE (seven trials, RR = 0.73; 95% CI [0.32–1.68]). The quality of evidence was graded low, downgraded by risk of bias and inconsistency. Moderate and very low-quality evidence, respectively, suggests that adjunctive IPC is unlikely to change the risk of all-cause mortality or adverse events. Subgroup analyses indicate a more evident apparent benefit in industry-funded trials.CONCLUSIONS:Results indicate low-quality evidence underpinning the additional use of IPC to pharmacological thromboprophylaxis for prevention of VTE and DVT. Further large high-quality randomized trials are warranted to support its use and to identify patient subgroups for whom it could be beneficial.

Noninvasive mechanical auxiliary circulation (NMAC): A general concept and the technological trends

A series of noninvasive mechanical auxiliary circulation (NMAC) technologies, such as intermittent pneumatic compression (IPC), external counterpulsation (ECP), and anti-G suit, had been widely used to realize noninvasive intervention of human cardiovascular system for different purposes, such as treatments of cardiovascular diseases and protecting pilot from G-induced loss of consciousness (G-LOC) during exposure to sustained accelerations. There are lots of similarities among these NMAC technologies, especially on aspects of hardware constitutions and their physiological effects. However, these technologies were almost independently developed in the past few decades. The similarities and differences were summarized on aspects of hardware constitutions and physiological effects of IPC, ECP and anti-G suit in this paper, and a general concept for NMAC technologies was proposed. This concept did not include a restrict definition, but generally focused on the physiological benefits, while any non-invasive mechanical methods that can achieve such benefits are welcomed. Trends for these typical NMAC technologies, especially about the strategies to realize personalized therapy or to meet new challenges, are discussed. This paper provided a unified perspective for non-invasive mechanical technologies aiming at cardiovascular benefits, and might inspire new technologies to be introduced in.

Pilot Study of Effects of Intermittent Pneumatic Compression in the Immediate Peri-Operative Period on Hemodynamic Parameters in Patients After Laparoscopic Gynecologic Surgery.

The randomized controlled study investigated the impacts of immediate peri-operative Intermittent pneumatic compression (IPC) on hemodynamic indicators in patients undergoing laparoscopic gynecologic surgery. Patients scheduled for elective laparoscopic gynecologic surgery were randomized to control (IPC not used), pre-operative IPC, post-operative IPC, and peri-operative IPC (performed both before and after surgery) groups. Systolic blood pressure (SBP), mean blood pressure (MBP) cardiac output (CO), heart rate (HR) and systemic vascular resistance (SVR) were measured at different time points. The results showed that SBP changes not obviously over time in the control and peri-operative IPC group. Compared with values before surgery, the pre-operative IPC group had a lower SBP (P < 0.01) at the end of PACU stay, whereas the post-operative IPC group had a higher SBP (P < 0.01) after surgery. All groups exhibited little or no variation in HR, CO and SVR. Conclusion is peri-operative IPC has no major adverse effects on hemodynamic parameters.

The Effectiveness of Intermittent Pneumatic Compression for Delayed Onset Muscle Soreness in Active People: A Literature Review

Introduction: When the exercises we perform exceed the muscle endurance threshold, Delayed Onset Muscle Soreness (DOMS) often occurs. DOMS is pain that a person feels 24 to 48 hours after strenuous physical activity or heavy and intense physical activity that can lead to damage to muscles and other connective tissues in the form of small tears in the muscles, muscle spasms, overstretching, and can cause tendon and connective tissue tears. Symptoms produced by DOMS conditions are certainly alarming for daily activities. This literature review will discuss ways to reduce DOMS conditions by using Intermittent Pneumatic Compression to overcome these conditions.&#x0D; Methods: The method in this study used a literature review based on the study results of data sources (including PubMed, ScienceDirect, NCBI, and Google Scholar) database with a publication period from 2017 to 2022. Keywords used in the search: [“Delayed Onset Muscle Soreness,” “DOMS” or “Muscle Soreness”] and [“Intermittent Pneumatic Compression” or “Recovery Pump”].&#x0D; Results: We found three related articles: two randomized controlled trials and one cross-over design based on the search result. The studies examined the effectiveness of Intermittent Pneumatic Compression on Delayed Onset Muscle Soreness. In the results of the three studies, Intermittent Pneumatic Compression offered little to no benefit in the recovery of DOMS inactive people.&#x0D; Conclusion: All studies concluded Intermittent Pneumatic Compression was not effective in reducing Delayed Onset Muscle Soreness.

Effects of intermittent pneumatic compression on serum HMGB1 levels of deep venous thrombosis of lower extremity in severe traumatic brain injury patients

Objective: To investigate the efficacy of intermittent pneumatic compression (IPC) in prevention of deep venous thrombosis (DVT) in severe traumatic brain injury (TBI) patients and to observe the effects of IPC on hemorheological and coagulation indices, as well as high-mobility group box 1 (HMGB1) in severe TBI patients. Methods: The present prospective open randomized controlled research recruited 332 severe TBI cases seen during May 2017~November 2019. All patients were randomly divided into two groups, with 166 cases in the control group and 166 cases in the IPC group. The serum levels of HMGB1 were determined using an enzyme linked immunosorbent assay (ELISA). The flow velocity of common femoral vein was also evaluated using Doppler ultrasound before treatment, as well as at 1 d, 3 d, 7 d and 14 d after admission. Levels of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and D-Dimer (D-D) were also evaluated before treatment, as well as at 7 d and 14 d after admission. Results: DVT occurred in a total of 35 (10.54%) cases of all patients, with 6 (3.61%) cases in IPC group, which was significantly lower than 29 (17.47%) cases in the control group. Serum FIB levels were significantly lower in the IPC group at 7 d and 14 d after treatment compared with the control. At 3 d, 7 d and 14 d after treatment, the levels of flow velocity of common femoral vein were markedly higher in IPC group compared with the control and after 3 d treatment, the levels of HMGB1 at 1 d, 3 d, 7 d and 14 d were all markedly lower in IPC group than the control. After admission, the serum levels of HMGB1 were markedly higher in DVT patients compared with the non-DVT patients at 1 d, 3 d, 7 d and 14 d and were negatively correlated with the flow velocity of common femoral vein at 3 d, 7 d and 14 d. Conclusion: IPC treatment could prevent DVT in severe TBI patients, which was associated with increased velocity of common femoral vein and decreased FIB and HMGB1 levels. HMGB1 may be useful as a potential biomarker for DVT in severe TBI patients.

The effect of intermittent pneumatic compression on deep-vein thrombosis and ventilation-free days in critically ill patients with heart failure

There are contradictory data regarding the effect of intermittent pneumatic compression (IPC) on the incidence of deep-vein thrombosis (DVT) and heart failure (HF) decompensation in critically ill patients. This study evaluated the effect of adjunctive use of IPC on the rate of incident DVT and ventilation-free days among critically ill patients with HF. In this pre-specified secondary analysis of the PREVENT trial (N = 2003), we compared the effect of adjunctive IPC added to pharmacologic thromboprophylaxis (IPC group), with pharmacologic thromboprophylaxis alone (control group) in critically ill patients with HF. The presence of HF was determined by the treating teams according to local practices. Patients were stratified according to preserved (≥ 40%) versus reduced (< 40%) left ventricular ejection fraction, and by the New York Heart Association (NYHA) classification. The primary outcome was incident proximal lower-limb DVT, determined with twice weekly venous Doppler ultrasonography. As a co-primary outcome, we evaluated ventilation-free days as a surrogate for clinically important HF decompensation. Among 275 patients with HF, 18 (6.5%) patients had prevalent proximal lower-limb DVT (detected on trial day 1 to 3). Of 257 patients with no prevalent DVT, 11/125 (8.8%) patients in the IPC group developed incident proximal lower-limb DVT compared to 6/132 (4.5%) patients in the control group (relative risk, 1.94; 95% confidence interval, 0.74–5.08, p = 0.17). There was no significant difference in ventilator-free days between the IPC and control groups (median 21 days versus 25 days respectively, p = 0.17). The incidence of DVT with IPC versus control was not different across NYHA classes (p value for interaction = 0.18), nor across patients with reduced and preserved ejection fraction (p value for interaction = 0.15). Ventilator-free days with IPC versus control were also not different across NYHA classes nor across patients with reduced or preserved ejection fraction. In conclsuion, the use of adjunctive IPC compared with control was associated with similar rate of incident proximal lower-limb DVT and ventilator-free days in critically ill patients with HF.Trial registration: The PREVENT trial is registered at ClinicalTrials.gov, ID: NCT02040103 (registered on 3 November 2013, https://clinicaltrials.gov/ct2/show/study/NCT02040103) and Current controlled trials, ID: ISRCTN44653506 (registered on 30 October 2013).

Intraoperative IPC combined with 3M warming instrument to prevent lower extremity deep venous thrombosis in patients undergoing proximal femoral anti rotation intramedullary nailing

To explore the effect of intermittent pneumatic compression(IPC) combined with 3M thermometer on the prevention of deep venous thrombosis(DVT) in patients with femoral intertrochanteric fracture. From March 2016 to August 2019, 127 patients with femoral intertrochanteric fractures who underwent proximal femoral nail antirotation(PFNA) were retrospectively analyzed. They were divided into two groups according to different methods of thrombus prevention and treatment. Among them, 63 patients in group A did not use IPC and 3M thermometer;64 cases in group B were treated with IPC combined with 3M thermometer. Color Doppler ultrasound was used to dynamically monitor the DVT and changes of lower limbs during perioperative period. The venous thrombosis of lower limbs was monitored at 0, 24, 72 h and > 72 h after operation(recheck every 3 days until discharge). Occurrence of DVT of lower limbs after PFNA operation in two groups:there were 5 cases (7.8%) in group B and 20 cases (31.7%) in group A, there was significant difference between two groups (P=0.001). There was no significant difference in lower limb DVT between two groups at 0, 72 and > 72 h after operation(P>0.05), but the formation rate of group A was significantly higher than that of group B at 24 h after operation (P=0.049). There was no significant difference in DVT formation between group A and group B(P>0.05). However, the formation of DVT in group A was significantly higher than that in group B(P=0.012). Intraoperative IPC combined with 3M thermostat can effectively prevent DVT of lower limbs in patients undergoing PFNA surgery.

Outcomes Comparison between Low Molecular-Weight Heparin with Mechanical Prophylaxis versus Mechanical Prophylaxis Alone for Perioperative Venous Thromboembolism Prevention in Abdominopelvic Surgery: A Randomized Controlled Trial

Background: Pharmaco-mechanical prophylaxis has been recommended for venous thromboembolism (VTE) prevention in surgical patients. The rate of receiving pharmacological prophylaxis was low due to the bleeding concern. The mechanical prophylaxis; either intermittent pneumatic compression (IPC) or graduated compressive stocking (GCS), becomes a preferred method, although its VTE incidence was higher than pharmaco-mechanical prophylaxis. The combination of IPC and GCS had a lower risk of DVT than GCS alone. We examined the efficacy of combining mechanical prophylactic methods; IPC and GCS, in VTE prophylaxis. Objective: The present study aimed to compare the pharmaco-mechanical method with combining mechanical method in VTE prophylactic effectiveness and adverse events for elective abdominopelvic surgery. Materials and Methods: A randomized controlled trial was conducted in elective abdominopelvic surgical patients. The control group received low molecular weight heparin, IPC, and GCS, whereas the study group received IPC and GCS. Results: We enrolled 76 elective abdominopelvic surgical patients, 39 patients in the control group, and 37 patients in the study group. Surgery for cancer was accounted for 64 (84.2%) and Caprini score was 8.4 (&plusmn;1.95). The incidence of perioperative VTE was 5 (6.58%). All VTE cases were asymptomatic DVT. In the present study group, 1 (2.7%) of proximal DVT and 3 (8.1%) of calf vein DVT occurred. Only 1 (2.6%) of proximal DVT occurred in the control group. The incidence of VTE tended to be higher in the present study group than in the control group; 4 (10.8%) vs. 1 (2.6%); RR 4.22, 95% CI 0.49 to 36.00, p-value=0.194). The adverse event such as symptomatic pulmonary embolism (PE), bleeding complication, and readmission rate was not found. Conclusion: The effectiveness of IPC combined with GCS was not superior to pharmaco-mechanical thromboprophylaxis for VTE prevention in high-risk surgical patients. Keywords: VTE cancer surgery, DVT prophylaxis, VTE prophylaxis, DVT, PE, Deep vein thrombosis, Pulmonary embolism, mechanical thromboprophylaxis, Intermittent pneumatic compression (IPC), Graduated compression stockings (GCS)

Effect of Intermittent Pneumatic Compression in Combination with Kinesiotape on Post Mastectomy Lymphedema

Background: Lymphedema caused by breast cancer is one of the side effects of therapy. It is defined as arm edema in breast cancer patients caused by surgery or radiation therapy interrupting the flow of the axillary lymphatic system, resulting in fluid accumulation in the subcutaneous tissue of the arm, decreased tissue distensibility around the joints, and increased weight of the extremity. Objective: This study was conducted to detect the effect of combination of intermittent pneumatic compression and kinesiotape on post mastectomy lymphedema. Patients and methods: Thirty females diagnosed with post mastectomy lymphedema were assigned randomly into two equal groups. Group A (Study group)received intermittent pneumatic compression (IPC) with kinesiotape (KT) in addition to complete decongestive therapy (manual lymphatic drainage-compression bandage-medical exercises-skin care) three times per week for 4 weeks. While, Group B (Control group) received only complete decongestive therapy 3 times per week for 4 weeks. Assessment of lymphedema and shoulder range of motion (flexion-abduction-external rotation) were done by tape measurement and goniometer respectively before and after 4 weeks. Results: There was no significant difference in lymphedema size and shoulder range of motion (ROM) between groups pre-treatment (p > 0.05). Comparison between groups post treatment revealed a significant decrease in lymphedema size and a significant increase in shoulder ROM of the study group compared with that of the control group (p > 0.05). Conclusion: The results suggested that IPC in combination with KT was an effective method in post mastectomy lymphedema more than complete decongestive therapy only.

Effects of Intermittent Pneumatic Compression on Lower Limb Lymphedema in Patients with Type 2 Diabetes Mellitus: A Pilot Randomized Controlled Trial

Background and Objectives: Diabetes mellitus type 2 (T2DM) is a chronic disease associated with fluid accumulation in the interstitial tissue. Manual lymphatic drainage (MLD) plays a role in reducing lymphoedema, like intermittent pneumatic compression (IPC). By the present pilot study, we aimed to evaluate the efficacy of a synergistic treatment with MLD and IPC in reducing lower limb lymphedema in T2DM patients. Materials and Methods: Adults with a clinical diagnosis of T2DM and lower limb lymphedema (stage II–IV) were recruited from July to December 2020. Study participants were randomized into two groups: experimental group, undergoing a 1-month rehabilitative program consisting of MLD and IPC (with a compression of 60 to 80 mmHg); control group, undergoing MLD and a sham IPC (with compression of <30 mmHg). The primary outcome was the lower limb lymphedema reduction, assessed by the circumferential method (CM). Secondary outcomes were: passive range of motion (pROM) of hip, knee, and ankle; quality of life; laboratory exams as fasting plasma glucose and HbA1c. At baseline (T0) and at the end of the 1-month rehabilitative treatment (T1), all the outcome measures were assessed, except for the Hb1Ac evaluated after three months. Results: Out of 66 T2DM patients recruited, only 30 respected the eligibility criteria and were randomly allocated into 2 groups: experimental group (n = 15; mean age: 54.2 ± 4.9 years) and control group (n = 15; mean age: 54.0 ± 5.5 years). At the intra-group analysis, the experimental group showed a statistically significant improvement of all outcome measures (p < 0.05). The between-group analysis showed a statistically significant improvement in pROM of the hip, knee, ankle, EQ-VAS, and EQ5D3L index at T1. Conclusions: A multimodal approach consisting of IPC and MLD showed to play a role in reducing lower limb lymphedema, with an increase of pROM and HRQoL. Since these are preliminary data, further studies are needed.

Effect of intermittent pneumatic compression with different inflation pressures on the distal microvascular responses of the foot in people with type 2 diabetes mellitus.

Intermittent pneumatic compression (IPC) is commonly used to improve peripheral circulation of the lower extremity. However, its therapeutic dosage for people with type 2 diabetes mellitus (DM) at risk for ulcers is not well established. This study explored the effect of IPC with different inflation pressures on the distal microvascular responses of the foot in people with type 2 DM. Twenty‐four subjects with and without DM were recruited. Three IPC protocols with inflation pressures of 60, 90, and 120 mmHg were applied to the foot. The foot skin blood flow (SBF) responses were measured by laser Doppler flowmetry during and after IPC interventions. Results show that all three IPC interventions significantly increased foot SBF of IPC stage in healthy subjects, but only 90 and 120 mmHg IPC significantly improved SBF in diabetic subjects. IPC with 90 and 120 mmHg showed a greater effect than 60 mmHg in both groups, but 120 mmHg IPC was more effective for diabetic subjects. This study demonstrates that 90 and 120 mmHg are effective dosages of IPC for improving blood flow in healthy people, and 120 mmHg IPC may be more suitable for people with type 2 DM.

Intermittent pneumatic compression for prolonged standing workers with leg edema and pain.

Even healthy individuals often encounter leg venous symptoms such as heaviness, pain, and swelling especially after prolonged standing work. Intermittent pneumatic compression (IPC) is a widely used simple therapy for preventing deep vein thrombosis and for treating lymphedema and chronic venous insufficiency. However, IPC has not been evaluated for its effect in relieving venous symptoms of healthy people.This was single center, cross-over study to investigate the effect of IPC for 20 healthy volunteers who usually stand on duty and complain of leg pain and swelling. The primary outcome was pain (measured using a visual analogue scale) and secondary outcomes were leg circumference and volume. Three different interventions included natural rest, sequential mode of IPC, and circular mode of IPC. Outcomes were measured before work and immediately after work (T1), after 30 minutes of intervention (T2), and 30 minutes of rest after intervention (T3).Pain and leg circumferences were significantly improved at T2 and T3 compared with those at T1. Sequential and circular IPC led to significantly greater improvement in pain and leg circumferences than just natural rest, but there was no difference in its effect according to the 2 modes of IPC. Leg volume was reduced significantly at T2 and T3 as compared with T1 in all 3 interventions, but effects did not differ among 3 intervention groups.IPC is effective for reducing leg pain and circumferences more than natural rest in healthy adults with prolonged standing work, without causing adverse events.

Long-Term Effectiveness of Combined Intermittent Pneumatic Compression Plus Low-Level Laser Therapy in Patients with Postmastectomy Lymphedema: A Randomized Controlled Trial.

Background: Upper limb lymphedema may be revealed after breast cancer and its treatment. Among different treatment approaches, intermittent pneumatic compression (IPC) therapy and low-level laser therapy (LLLT) are reported as effective modalities in the treatment of postmastectomy upper limb lymphedema (PML). The aim of the current study is to investigate the long-term effectiveness of combined IPC plus LLLT versus IPC therapy alone in patients with PML. Methods and Results: The patients were allocated into two groups in this single-blinded, controlled clinical trial. Group I received combined treatment with IPC plus LLLT (n = 21) and group II received only IPC (n = 21). IPC treatment was given 5 sessions per week for 4 weeks (20 sessions). LLLT was also performed 5 sessions per week for 4 weeks (20 sessions). Clinical evaluations were performed before and after the treatment at the 3, 6, and 12-month follow-up visits. According to within-group analysis, statistically significant improvements in the circumference difference (Cdiff) and grip strength were observed in both groups (for Cdiff, p = 0.018 and p = 0.032, respectively; for grip strength, p = 0.001 and p = 0.046, respectively). Visual analog scale values for arm pain and shoulder pain during motion were decreased only in group I. Conclusion: Both interventions have positive effects on lymphedema, grip strength, and pain. Long-term effects of combined therapy, especially on pain, are slightly superior to the pneumatic compression alone.

The Effects of Intermittent Pneumatic Compression on the Reduction of Exercise-Induced Muscle Damage in Endurance Athletes: A Critically Appraised Topic.

Clinical Scenario: Endurance sports require a great deal of physical training to perform well. Endurance training and racing stress the skeletal muscle, resulting in exercise-induced muscle damage (EIMD). Athletes attempt to aid their recovery in various ways, one of which is through compression. Dynamic compression consists of intermittent pneumatic compression (IPC) devices, such as the NormaTec Recovery System and Recovery Pump. Clinical Question: What are the effects of IPC on the reduction of EIMD in endurance athletes following prolonged exercise? Summary of Key Findings: The current literature was searched to identify the effects of IPC, and 3 studies were selected: 2 randomized controlled trials and 1 randomized cross-over study. Two studies investigated the effect of IPC on delayed onset muscle soreness and plasma creatine kinase in ultramarathoners. The other looked at the impact of IPC on delayed onset muscle soreness in marathoners, ultramarathoners, triathletes, and cyclists. All studies concluded IPC was not an effective means of improving the reduction of EIMD in endurance-trained athletes. Clinical Bottom Line: While IPC may provide short-term relief of delayed onset muscle soreness, this device does not provide continued relief from EIMD. Strength of Recommendation: In accordance with the Strength of Recommendation Taxonomy, the grade of B is recommended based on consistent evidence from 2 high-quality randomized controlled trials and 1 randomized cross-over study.

Effect of Intermittent Pneumatic Compression on Functional Level and Quality of Life in Community-Dwelling Older Adults with Limited Ambulation Due to Leg Pain: A Randomized Controlled Trial

Background and Purpose: Walking difficulties are defined as any reduction in speed, balance, or change of gait, causing limited ambulation. These difficulties are a common problem in older adults and may greatly affect their quality of life (QOL) and restrict their personal independence and participation. This study aimed to determine the effect of intermittent pneumatic compression (IPC) on lower leg pain, walking capacity, functional mobility, ankle range of motion (AROM), and QOL of community-dwelling older people with walking difficulties. Methods: In this randomized controlled trial, 34 eligible participants with self-reported lower limb pain and limited ambulation were randomized either to the intermittent pneumatic compression intervention group (IPCIG) or static compression control group (SCCG). The IPCIG and SCCG were trained to receive IPC and SC respectively for both lower legs and instructed to continue the application independently at home for 15 minutes per session, 2 sessions a day, 7 days per week for 4 weeks independently at the home. Outcome measures of lower leg pain, AROM, walking capacity, and functional mobility were assessed at baseline and at the first, second, third, and fourth weeks after randomization. Quality of life was assessed at baseline and immediately after the intervention. Results and Discussion: IPCIG showed a more significant improvement compared to the SCCG at the post-interventional stage for QOL and all the subscales. The findings show that “80% improved QOL” is 53% higher with the application of IPC than with SC for 4 weeks. The IPCIG showed a more significant improvement in the 6-minute walk test (6 MWT) at the third and fourth weeks compared to the SCCG. A pairwise comparison of mean values of 6 MWT over 4 weeks within the IPCIG showed a significant difference between all the weeks. Pairwise comparisons between groups at each time point showed that the IPCIG showed a more significant improvement in the timed up and go (TUG) test at the third and fourth weeks compared to the SCCG. Pairwise comparison of mean values of TUG test within the IPCIG showed a significant difference over 4 weeks, except between the second and third weeks, fourth week, and third and fourth weeks. The IPCIG showed a more significant improvement in lower leg pain between all weeks except the first week compared to the SCCG. Pairwise comparison of mean values of lower leg pain over 4 weeks within the IPCIG showed a significant difference among all weekly outcomes except between 1 and 2 weeks. The IPCIG showed a more significant improvement in left and right ankle dorsiflexion ROM at the third and fourth weeks compared to the SCCG. Conclusions: The IPC was effective in reducing lower leg pain and increasing the AROM and improving the walking capacity, functional mobility level, and QOL of community-dwelling older people with walking disabilities. Walking disability in old age is a common condition requiring physical therapy. Intermittent pneumatic compression can be used as a physical therapy modality for this patient group.