Compression Stockings Research Articles

Severe Post-COVID-19 dysautonomia: a case report

BackgroundThe emergence of dysautonomia as a consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; or COVID-19) is becoming more prevalent. We have seen evidence in several post-COVID patients and in the literature of varying degrees of autonomic dysfunction. Symptoms, among others, include inappropriate tachycardia, sweating, anxiety, insomnia and blood pressure variability from the effects of excessive catecholamine, as well as cognitive impairment, fatigue, headaches and orthostatic intolerance from decreased brain perfusion.Case presentationWe present a case of severe dysautonomia in a previously healthy 27-year-old runner. About five weeks after her initial mild COVID-19 infection, the patient began to develop weakness, which progressed into severe post-exertional fatigue, slowed cognition, headaches, blurred vision and generalized body aches. She also endorsed palpitations, especially when getting up from a seated or lying position as well as with mild exertion. She became reliant on her husband for help with her activities of daily living. Exam was significant for orthostasis; laboratory workup unremarkable. Over the following months, the patient’s symptoms have improved slowly with fluid and sodium intake, compression stockings and participating in a graduated exercise program.ConclusionsDysautonomia as a consequence of infection with COVID-19 is becoming increasingly discussed, especially as more patients recover from COVID-19. This is a case of a non-hospitalized patient with a mild initial presentation and significant, debilitating dysautonomia symptoms. More research on its pathophysiology, especially in relation to a precedent viral insult, as well as its treatment, is needed.

Fabricated leg mannequin for the pressure measurement of compression stockings

Different lower limbs and devices used for the contact pressure measurement of the compression stocking make a significant difference to the precise contact pressure value. This study aimed to fabricate a novel soft leg mannequin based on the standard-sized wooden leg mannequin, but closer to the human leg with soft tissue and bones and to evaluate further the performance of the fabricated leg mannequin. The contact pressure exerted by the graduated compression stocking was measured by the fabricated leg mannequin at four different locations along six different cross-sections. Comparing the contact pressure measured by the fabricated leg mannequin, the standard-sized wooden leg mannequin and human legs, the fabricated leg mannequin has a similar pattern to human legs, and contact pressure exerted by the wooden leg mannequin was far higher than that of human legs. In addition, the local contact pressure measured by the fabricated leg mannequin also has a remarkable agreement with that of human legs. Moreover, there was a significant Spearman rank correlation between the contact pressure measured by the fabricated leg mannequin and the human leg. Therefore, the performance of the fabricated leg mannequin can be consistent with the human leg, which enables the fabricated leg mannequin to replace the standard-sized wooden leg mannequin for standard tests.

Healing outcomes and predictors among patients with venous leg ulcers treated with compression therapy.

This study aimed to compare the healing outcomes between three types of compression therapy-two-layer bandage (2LB), four-layer bandage (4LB), and compression stockings, and to identify the predictors of venous leg ulcer (VLU) healing. A retrospective review of the medical records of patients diagnosed with VLU between 2011 and 2016 in Singapore was conducted. Univariate and multivariate analyses were done between healed and unhealed VLU patients at three and six months, based on potential factors, ranging from demographic profile to comorbidities and treatment-related variables. Data from 377 patients' medical records were analysed. The healing rates with the three types of compression system, 4LB, 2LB and compression stockings, were 22.3%, 34.9% and 8.7% respectively at three months; at six months they were 44.2%, 41.9% and 34.8% respectively. Patients on 2LB reported a significantly higher proportion of healed ulcers at three months (p=0.003) but at six months there was no difference in healing rates between the three types of therapy. At three and six months, the duration of compression therapy was found to be an independent predictor of healing (p<0.001). In this study, the 2LB appeared to show the most favourable healing outcome in the short-term but as VLUs persisted beyond the months, the type of compression system used did not make a difference in the healing outcome. Our findings suggested that, as the duration became more prolonged, VLUs became more resistant to healing despite compression therapy. Therefore, it may be necessary for clinicians to consider adjuvant therapies for hard-to-heal ulcers at an earlier stage.

Compression stockings for recurrent cellulitis.

Do compression stockings help patients with chronic lower limb edema decrease cellulitis recurrence? In patients with chronic leg edema, compression therapy reduced cellulitis recurrence to 15% versus 40% with education alone at 6 months. Compression stockings are a good option for patients

Prophylaxis for Venous Thromboembolic Events in Elective Total Hip and Total Knee Arthroplasty.

Venous thromboembolism (VTE) is a serious complication after major orthopaedic operations, such as a total hip (THA) and knee (TKA) arthroplasty. Therefore, perioperative VTE prophylaxis is recommended; a multitude of modern options are available, including both pharmacologic (aspirin, unfractionated and lowmolecular- weight heparin, vitamin K antagonists, and novel oral anticoagulants) and/or mechanical interventions (early mobilization, graduated compression stockings, intermittent pneumatic compression devices, and venous foot pumps). However, because of the abundance of these possibilities, it is crucial to understand the benefits and drawbacks of each VTE prophylaxis option to ensure that the optimal treatment plan is developed for each patient. The American College of Chest Physicians (AACP) and the American Academy of Orthopaedic Surgeons (AAOS) have both published individual guidelines on VTE prophylaxis regimens, alongside numerous studies evaluating the efficacy and outcomes of the different prophylaxis modalities. The purpose of this review is to provide a summary of the evidence on VTE prophylaxis after elective total hip and knee arthroplasty based on current guidelines and highlight the major concerns and potential complications.

Graducheck®-a novel device to measure sub-bandage pressures during application of compression.

Graduated compression, using bandaging or compression stockings, is the gold-standard treatment for the management of venous leg ulcers (VLUs) and preventing recurrence. However, achieving the required pressures on different parts of the leg is extremely difficult, even for experienced practitioners. Inappropriately applied compression can result in delayed healing and poor compliance. Graducheck® is a pressure sensor system that ensures that the prescribed level of compression is being applied accurately. This study aimed to determine if two experienced tissue viability nurses (TVNs) could achieve accurate pressures using four commonly used bandage systems, as measured using Graducheck sensor strips. Ideal pressures were not achieved, but in two systems, once the application pressure was adjusted according to the sensor level, ideal compression was achieved. In the remaining two systems, ideal pressures could not be produced, even after adjustments to application. Clinically, the Graducheck system could improve the standard of compression therapy, as real-time feedback ensures that corrections can be made. However, further work is required to determine why ideal pressures were not achieved in two of the tested systems.

The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology/Vascular Medicine Position Paper.

ImportanceThe post-thrombotic syndrome (PTS) is the most common long-term complication of deep vein thrombosis (DVT), occurring in up to 40–50% of cases. There are limited evidence-based approaches for PTS clinical management.ObjectiveTo provide an expert consensus for PTS diagnosis, prevention, and treatment.Evidence-ReviewMEDLINE, Cochrane Database review, and GOOGLE SCHOLAR were searched with the terms “post-thrombotic syndrome” and “post-phlebitic syndrome” used in titles and abstracts up to September 2020.Filters WereEnglish, Controlled Clinical Trial / Systematic Review / Meta-Analysis / Guideline. The relevant literature regarding PTS diagnosis, prevention and treatment was reviewed and summarized by the evidence synthesis team. On the basis of this review, a panel of 15 practicing angiology/vascular medicine specialists assessed the appropriateness of several items regarding PTS management on a Likert-9 point scale, according to the RAND/UCLA method, with a two-round modified Delphi method.FindingsThe panelists rated the following as appropriate for diagnosis: 1-the Villalta scale; 2- pre-existing venous insufficiency evaluation; 3-assessment 3–6 months after diagnosis of iliofemoral or femoro-popliteal DVT, and afterwards periodically, according to a personalized schedule depending on the presence or absence of clinically relevant PTS. The items rated as appropriate for symptom relief and prevention were: 1- graduated compression stockings (GCS) or elastic bandages for symptomatic relief in acute DVT, either iliofemoral, popliteal or calf; 2-thigh-length GCS (30–40 mmHg at the ankle) after ilio-femoral DVT; 3- knee-length GCS (30–40 mmHg at the ankle) after popliteal DVT; 4-GCS for different length of times according to the severity of periodically assessed PTS; 5-catheter-directed thrombolysis, with or without mechanical thrombectomy, in patients with iliofemoral obstruction, severe symptoms, and low risk of bleeding. The items rated as appropriate for treatment were: 1- thigh-length GCS (30–40 mmHg at the ankle) after iliofemoral DVT; 2-compression therapy for ulcer treatment; 3- exercise training. The role of endovascular treatment (angioplasty and/or stenting) was rated as uncertain, but it could be considered for severe PTS only in case of stenosis or occlusion above the inguinal ligament, followed by oral anticoagulation.Conclusions and RelevanceThis position paper can help practicing clinicians in PTS management.

A single-center experience of anterior accessory saphenous vein endothermal ablation demonstrates safety and efficacy

ObjectiveEndothermal ablation is well-established for the treatment of the great and small saphenous veins. Data are lacking for treatment of the anterior accessory saphenous vein (AASV). The purpose of this study was to evaluate the safety and efficacy of AASV treatment using endothermal ablation. MethodsThis retrospective review included 314 limbs at a single academic institution from 2016 to 2018 using the institutional Vascular Quality Initiative database. All limbs had documented AASV reflux. Baseline characteristics were evaluated including age; sex; ethnicity; clinical, etiology, anatomy, pathophysiology classification; Venous Clinical Severity Score (VCSS); and vein diameter. Outcomes relating to procedure safety and efficacy included treatment modality and length, successful ablation on postoperative imaging, postprocedural clinical outcomes, incidence of endothermal heat-induced thrombosis (EHIT), and any postprocedural complication. ResultsA total of 314 consecutive limbs were identified from 2016 to 2018. The preprocedure VCSS scores were available for 312 limbs and averaged 6.13 ± 3.33. A history of varicose veins were reported in all limbs with 49.4% (n = 155) having previously undergone a procedure. The most common presenting symptom was mild edema in 52.5% (n = 165). Vein diameter and assessment of reflux were obtained by venous duplex ultrasound (DUS) examination. The largest AASV diameter was available for 304 limbs, averaging 7.93 ± 2.69 mm. Treatment modalities included radiofrequency ablation (RFA) in 59.2% (n = 186), endovenous laser ablation (EVLA) in 37.9% (n = 119), and isolated microphlebectomy in 2.9% (n = 9). In all, 38.5% (n = 121) of limbs underwent concomitant microphlebectomy at the time of EVLA. The total treatment length was obtained in 297 limbs, averaging 23.0 cm ± 12.0. Postoperatively, 94.6% of limbs (n = 297) were prescribed compression stockings. Postoperative DUS examination was performed in 312 limbs, revealing successful ablation in 96.5% (n = 303) with 2 limbs (0.6%) developing an EHIT, both treated with therapeutic enoxaparin for 1 week. Repeat DUS examination revealed thrombus resolution in one limb; the other patient was lost to follow-up. VCSS scores after the procedure were available for 145 limbs and averaged 4.45 ± 2.31. This was a statistically significant decrease from preprocedure VCSS scores (P < .01). Average duration of follow-up was 2.2 years, with two limbs lost to follow-up. Of the nine limbs (3.5%) whose initial procedure failed, five (56%) were treated using RFA and four (44%) were treated using EVLA. There were no other postoperative complications. ConclusionsOur experience over a 3-year period for treating the AASV shows it to be safe and effective in a broad range of disease severity with an improvement in VCSS and a low incidence of EHIT. Additionally, RFA and EVLA exhibit similar treatment efficacy. Long-term follow-up data are needed.

Effects of graduated compression socks on ankle inversion proprioception of half-marathon runners at different running distances

ObjectivesTo determine the effect of graduated compression socks on ankle proprioception and the relationship between fatigue and ankle proprioception measures in half-marathon runners at successive 7 km intervals during a 21-km run. DesignRepeated measures study. MethodsTwenty well-trained half-marathon runners (mean ± SD: age 38.6 ± 11.3 y, weekly volume 42.3 ± 21.1 km, training experience 4.7 ± 3.5 y) performed two 21 km running trials on a treadmill wearing either graduated compression socks or looser, standard non-compression running socks. Each running trial was divided into three self-paced 7 km blocks, repeated at the same pace for each trial, heart rate was not controlled, but after each block, heart rate, blood lactate, rating of perceived exertion, and ankle inversion proprioception were measured, the latter by using the active movement extent discrimination apparatus. ResultsThere was no differences between the graduated compression sock and non-compression running sock conditions in rating of perceived exertion scores (F = 0.524, p = 0.478), heart rate (F = 0.001, p = 0.975) and blood lactate (F = 0.004, p = 0.951). Overall, wearing graduated compression socks was associated with significantly better ankle proprioception after 21 km of running (p = 0.024, 95% CI = −0.066, −0.005). Heart rate, rating of perceived exertion and blood lactate were not correlated with ankle proprioception sensitivity in the graduated compression sock and non-compression running sock conditions at any point during the run (all p > 0.05). ConclusionsWearing graduated compression socks provides a positive effect on proprioceptive control of the ankle joint only after 21 km and may therefore reduce the possibility of injury associated with proprioceptive ability diminishing over time during exercise.

Evaluation and Management of Primary Varicose Veins of Lower Limb in A Tertiary Care Centre

Introduction: Incompetent valves of deep, superficial or perforating veins lead to varicose veins. Dilated, elongated or tortuous subcutaneous veins of lower legs are a manifestation of increase in venous pressure. This increase in venous pressure results from the reflux of blood due to incompetence. The diseased Great Saphenous Vein (GSV) is removed by High Saphenous Ligation and Stripping (HLS) surgery. Aims and Objectives: To study the clinical and socio-demographic profile, precipitating factors/ risk factors, complications and clinical outcomes of management of varicose veins. Material and Methods: Data collected from 150 patients with varicose veins by appropriate history taking and clinical examination, relevant radiological and laboratory investigations and follow-up of cases to study the clinical outcome. Results: Study was conducted with 150 patients. Most common age group affected with primary varicose veins was between 41-60 yrs of age with male predominance (64.7%). Most of the cases in present study were engaged in work involving long standing hours i.e. farming (34%) and housewives (28%). Most common presenting complaints were oedema (88%), dilated veins (74%) and pain (71.3%). Conservative management was tried in all cases while Trendelenburg operation and SPJ ligation was done in 26.7% and 9.3% cases. Stripping and PERF ligation was done in 28.7% and 25.3% cases respectively. A total of 24.7% were lost to follow up. By the end of 6 month, quality of life improved in 70% cases. By the end of 6 month, symptoms improved in 72.5% cases while it disappeared in 26.5% cases. Conclusion: Males have been found to have larger incidence than females. They are mostly affected in their fourth and fifth decade of life. Ulceration and pain are the frequent findings in this condition. Compression stocking has beneficial effects if prolonged standing cannot be avoided during work hours. Trendelenburg operation with flush ligation with subfascial or extra fascial stripping is the definitive management and shows significant clinical improvement.

DEEP VEIN THROMBOSIS – A SYSTEMATIC REVIEW

Deep vein thrombosis (DVT) is the formation of blood clots in deep veins, commonly the leg veins and the pelvic veins. DVT is a potentially fatal condition leading to increased mortality and morbidity if not diagnosed and treated promptly.Incidence is more prevalent in 60- 65 years of age because of increased pro-coagulant factors like factor VIII, factor VII, homocysteine, brinogen. With the increase in age the risk of DVT development increases exponentially.All bed ridden patients should receive sequential compression device therapy as primary DVT prophylaxis in the form of intermittent pneumatic compression device (IPCDs), graduated compression stocking (GCS), and the venous foot pump.The pharmacological agents used in the prophylaxis of DVT include low-molecular-weight heparins (LMWH), fondaparinux, Unfractionated heparin (UFH), new oral direct selective thrombin inhibitors and factor Xa inhibitors.The complications of DVT include development of Pulmonary embolism (PE) , Paradoxical emboli, Recurrent DVT, Post thrombotic syndrome. Approximately 4% individuals treated for DVT develop PE. It accounts for 10-12% mortality rate in hospitalized patients.The prevention and treatment must be upgraded continuously with evidence base strategies. This article aims at reviewing the clinical presentation, diagnostic and treatment modalities of DVT

Prevention of the Postthrombotic Syndrome with Anticoagulation: A Narrative Review.

The postthrombotic syndrome (PTS) is chronic venous insufficiency secondary to a prior deep vein thrombosis (DVT). It is the most common complication of venous thromboembolism (VTE) and, while not fatal, it can lead to chronic, unremitting symptoms as well as societal and economic consequences. The cornerstone of PTS treatment lies in its prevention after DVT. Specific PTS preventative measures include the use of elastic compression stockings and pharmacomechanical catheter-directed thrombolysis. However, the efficacy of these treatments has been questioned by large randomized controlled trials (RCTs). So far, anticoagulation, primarily prescribed to prevent DVT extension and recurrence, appears to be the only unquestionably effective treatment for the prevention of PTS. In this literature review we present pathophysiological, biological, radiological, and clinical data supporting the efficacy of anticoagulants to prevent PTS and the possible differential efficacy among available classes of anticoagulants (vitamin K antagonists [VKAs], low molecular weight heparins [LMWHs] and direct oral anticoagulants [DOACs]). Data suggest that LMWHs and DOACs are superior to VKAs, but no head-to-head comparison is available between DOACs and LMWHs. Owing to their potentially greater anti-inflammatory properties, LMWHs could be superior to DOACs. This finding may be of interest particularly in patients with extensive DVT at high risk of moderate to severe PTS, but needs to be confirmed by a dedicated RCT.

The effects of 72 h of dynamic ankle immobilization on neural excitability and lower extremity kinematics

BackgroundAnkle injuries can foster maladaptive changes in nervous system function that predisposes patients to subsequent injury. Patients are often placed in a dynamic boot immobilizer (BI) following injury; however, little is known about the effects of this treatment on neuromechanical function. Research questionWe aimed to determine the effect of 72 h of BI-use on neural excitability and lower extremity joint motion in a healthy cohort. MethodsTwelve uninjured individuals (20.8 ± 1.4 yrs, 1.7 ± 0.1 m, 75.2 ± 9.9 kg) participated in this crossover study. Neural excitability and lower extremity kinematics were assessed before and after 72 h of BI or compression sock (CS) use. Neural excitability was assessed via the Hoffmann (H) reflex and transcranial magnetic stimulation of the motor cortex by measuring muscle activation at the tibialis anterior, peroneus longus, and soleus of the immobilized extremity. Three-dimensional lower extremity joint angles were assessed while participants walked on a treadmill. Repeated-measures analyses of variance detected changes in neural excitability and peak joint angles across time-points and testing conditions, while statistical parametric mapping (SPM) was implemented to determine continuous joint angle changes (α = 0.05). ResultsPre-BI to post-BI, HMax:MMax ratio (F = 6.496; p = 0.031) significantly decreased. The BI did not alter resting motor threshold (F = 0.601; p = 0.468), or motor evoked potential amplitudes (F > 2.82; p > 0.608). Significant changes in peak knee and hip angles in the frontal and transverse planes were observed (p < 0.05), with no changes at the ankle. SPM analyses revealed significant hip and knee changes in range of motion (p < 0.05). SignificanceDecreased measures of reflex but not corticospinal excitability suggest that BI-use for 72 h unloaded the joint enough to generate peripheral changes, but not the CNS, as has been described in casting models. Further, kinematic changes were observed in proximal lower extremity joints, likely due to swing-phase adaptations while wearing the BI.

Thromboprophylaxis after knee arthroscopy does not decrease the risk of deep vein thrombosis: a network meta-analysis.

The primary aim of this network meta-analysis (NMA) is to compare the incidence of venous thromboembolisms (VTE) and bleeding risk following the use of pharmacological and non-pharmacological thromboprophylaxis for arthroscopic knee surgery (AKS). This study assumed the null hypothesis which was that there will be no difference in the incidence of VTE and bleeding risk when comparing no treatment, pharmacological treatment, and non-pharmacological treatment for preventing VTE events following AKS. A systematic electronic search of CENTRAL, Medline, Embase, and ClinicalTrials.gov was carried out. All English language prospective randomized clinical trials published from date of database inception to November 21, 2021 were eligible for inclusion. All papers addressing arthroscopic knee surgery were eligible for inclusion regardless of timing of surgery, operation, surgical technique, or rehabilitation. Multiple random effects NMAs were conducted to compare all treatments for each outcome. The primary outcome was the incidence of pulmonary embolism (PE) and secondary outcomes consisted of overall deep vein thrombosis (DVT), symptomatic DVT, asymptomatic DVT, and all-cause mortality. Adverse outcomes consisted of major and minor bleeding, as well as adverse events. A total of nine studies with 4526 patients were included for analysis. There were 1054 patients in the no treatment/placebo group (NT/Placebo), 1646 patients in the graduated compression stockings, 810 patients in the extended-duration (> 10days) low molecular weight heparin (Ext-LMWH) group, 650 patients in the short-duration (< 10days) LMWH group (Short-LMWH), and 356 patients in the rivaroxaban group. GCS, Ext-LMWH, Short-LMWH and rivaroxaban all demonstrated low risks of PE, symptomatic DVT, asymptomatic DVT, combined DVT and all-cause mortality. Similarly, all interventions demonstrated a low risk of major bleeding. There is no significant difference in the risk reduction of PEs, symptomatic DVTs, major/minor bleeding, and/or all-cause mortality when using LWMH (including short or extended regimens), rivaroxaban, graduated compression stockings or no treatment following arthroscopic knee surgery. Future primary research on the efficacy of thromboprophylaxis following arthroscopic knee surgery should stratify outcomes based on key patient (i.e., age, sex, comorbidities) and surgical (i.e., major vs. minor surgery) characteristics and should include acetylsalicylic acid as an intervention. I, network meta-analysis of Level I studies.

Management of chronic venous disease in general practice: a cross-sectional study of first line care in Belgium.

The aim of this observational study was to examine how general practitioners (GP) in Belgium treat patients with chronic venous disease (CVD). This cross-sectional study was carried out in Belgium by GPs who recruited 15 consecutive patients who were consulting them and suffered from CVD. By following a standardized questionnaire, they collected information on patient characteristics, risk factors, signs and symptoms, and how they were being managed. Two hundred fifty-three GPs recruited 3055 patients, who were predominantly female (75.6%), with a mean age of 62.7 (SD=14.6). 20.1% of the population suffered from CVD without clinical signs (C0s). 8.7% of the population had advanced disease (C5-C6). Most common symptoms were respectively "heavy legs" (43.7%), "swollen feeling" (28%) and "pain" (24.1%). The primary care physicians decided 95.3% of patients needed therapy of some sort. The most used treatment option used in 83.3% of subjects was the use of venoactive medication. Lifestyle advice was recommended in 64.5% of patients and recommendations regarding compression stockings were given in 46.9% of patients. Referral to a specialist was warranted for 24.5% of the population. Patients with a lower C Classification were more often treated conservatively compared to those with a higher C Classification. Most patients were treated conservatively, which includes lifestyle changes, medication, and compression. Only one in four patients is referred to a vascular specialist and this referral is significantly positively correlated with the C Classification.

Asymptomatic deep vein thrombosis following cytoreductive surgery and Hyperthermic intraperitoneal chemotherapy: Results of routine postoperative lower limb Doppler studies in 387 patients.

Background: It is estimated that up to 7% of patients with major surgery to have occult deep venous thrombosis (DVT) despite preventive measures such as prophylactic anticoagulation, physiotherapy and compression stockings.

Evaluating Research Grade Bioimpedance Hardware Using Textile Electrodes for Long-Term Fluid Status Monitoring

Fluid overload is a chronic medical condition that affects over six million Americans with conditions such as congestive heart failure, end-stage renal disease, and lymphedema. Remote management of fluid overload continues to be a leading clinical challenge. Bioimpedance is one technique that can be used to estimate the hydration of tissue and track it over time. However, commercially available bioimpedance measurement systems are bulky, expensive, and rely on Ag/AgCl electrodes that dry out and can irritate the skin. The use of bioimpedance today is therefore limited to clinical and research settings, with measurements performed at daily intervals or over short periods of time rather than continuously and long-term. This paper proposes using wearable calf bioimpedance measurements integrated into a compression sock for long-term fluid overload management. A PCB was developed using standard measurement techniques that measures the calf bioimpedance using a custom analog front-end built around an AD8302 gain-phase detection chip. Data is transmitted wirelessly via Bluetooth Low Energy to an iOS device using a custom iOS app. Bioimpedance data were collected both from the wearable system and a commercial measurement system (ImpediMed SFB7) using RRC networks, Ag/AgCl electrodes, and the textile compression sock. Bioimpedance data collected from the wearable system showed close agreement with data from the SFB7 when using RRC networks and in five healthy human subjects with Ag/AgCl electrodes. However, when using the textile compression sock the wearable system had worse precision than the SFB7 (4% run to run compared to &lt;1% run to run) and there were larger differences between the two systems than when using the RRC networks and the Ag/AgCl electrodes. Wearable system precision and agreement with the SFB7 was improved by pressure or light wetting of the current electrodes on the sock. Future research should focus on reliable elimination of low-frequency artifacts in research grade hardware to enable long-term calf bioimpedance measurements for fluid overload management.

Patient Education in Spa Resorts: Experience from a French National Program for Patients with Chronic Venous Insufficiency.

The prognosis of chronic venous insufficiency (CVI) is greatly depending upon the ability of the patients to optimize their health-related behaviors (mainly compliance to compression stockings, physical activity and diet). As this is usually challenging for the patients, we developed a therapeutic education program (TEP) aiming at helping them to achieve these optimizations. We report here the preliminary results obtained with this program. This structured TEP was developed by a working group of 15 health professionals to be used during the regular French spa 3-week treatment course for CVI patients. The program included three interactive workshops aiming at improving the patients’ knowledge, skills and motivation, two educational consultations allowing to set and follow-up their personal action plans and a built-in evaluation. It was implemented in spa resorts specialized in CVI. Among the first 150 patients (116 women and 34 men, mean age 69 years old (SD 8 years), 49% had post-thrombotic disease. Compliance to the education workshops was 98%. After a 3-month follow-up, 83% of the patients fully achieved at least one behavioral objective. Quality of life, as assessed by the CIVIQ 2 auto-questionnaire, improved at 3 months (p = 0.0024) and 9 months (p = 0.018). These results demonstrate the feasibility of a TEP for CVI patients and its ability to improve their health-related behaviors, opening the way for the development of similar programs for other chronic diseases in the setting of spa resorts.

No Benefit of Wearing Compression Stockings after Endovenous Thermal Ablation of Varicose Veins: A Systematic Review and Meta-Analysis

No Benefit of Wearing Compression Stockings after Endovenous Thermal Ablation of Varicose Veins: A Systematic Review and Meta-Analysis

Physiological parameters and the use of compression stockings in individuals with spinal cord injuries: a scoping review.

Scoping review. To summarize information on the physiological effects of compression stockings (CS) in individuals with spinal cord injuries (SCI) and suggest areas for future research. We asked, "What are the physiological effects of CS use in individuals with SCI?" Original studies of patients with SCI regardless of sex and age that focused on SCI and CS were included. Five biomedical databases were searched. Studies were selected by three researchers in two stages, starting with an abstract and title screening and continuing with a full text review for application of the inclusion and exclusion criteria. A narrative synthesis was then performed. An initial search yielded 283 titles, of which five met the inclusion criteria and were subjected to the full text review. Among them, there were 78 individuals with SCI. The studies found that the use of CS at rest reduced deep vein thrombosis (DVT) and vascular capacitance but increased systolic blood pressure and norepinephrine level., three studies tested the use of CS During exercise; one found that time of the last lap in a standard court test was negatively affected; however, the greatest benefits were observed after exercises, such as reduced blood lactate level, improved autonomic function, and increased blood flow to the upper limbs. We conclude that future research should examine the physiological effects and relationship of CS with: (a) pharmacological interventions, (b) body position changes, (c) physical fitness level, (d) wheelchair use duration, (e) exercise-induced thermal stress, (f) thermal stress mitigation, and (g) edema reduction.