Sequential Pneumatic Compression Research Articles

Intermittent sequential pneumatic compression reduces post-exercise hemodilution and enhances perceptual recovery without improving subsequent cycling performance

Abstract Purpose The present study aims to evaluate the effects of intermittent sequential pneumatic compression (ISPC) in the short-term recovery of a repeated sprint interval exercise, including the assessment of power output performance, hematocrit, legs water, and perceptual recovery. Methods A randomized, counterbalanced, crossover design was conducted. Sixteen healthy trained individuals (F=7, M=9; 27.7 ± 9.4 years; BMI 22.3 ± 2.9) performed two trials of a cycling fatiguing exercise, followed by a recovery phase (ISPC or Sham), and a subsequent performance assessment exercise to evaluate the effects of ISPC in post-exercise recovery. Results There were no significant differences in cycling performance comparing both recovery modes. However, the decrease in the hematocrit levels after the recovery phase was less exacerbated in the ISPC condition compared to Sham (44.03 ± 1.33 vs. 42.38 ± 1.33 %; p = 0.047; d = 0.310). Likewise, the total quality recovery (TQR) was higher after the recovery in the ISPC condition (15.94 ± 0.16 vs. 14.75 ± 0.12 points; p = 0.045; d = 2.125), although no differences were shown previously in power output performance (371.8 ± 22.2 [46.5] vs. 372.4 ± 21.8 [47.2] W; p = 0.986) and rating of perceived exertion (RPE) (17.69 ± 0.41 vs. 17.56 ± 0.31; p = 0.700). Conclusions Contrary to our hypothesis, the application of intermittent sequential pneumatic compression after high-intensity exercise reduces the post-exercise hemodilution response and increases perceptual recovery. However, power output was similar between conditions, challenging the effectiveness of this recovery method in a short-term intervention.

The American Venous Forum, American Vein and Lymphatic Society and the Society for Vascular Medicine expert opinion consensus on lymphedema diagnosis and treatment.

BackgroundLymphedema imposes a significant economic and social burden in modern societies. Controversies about its risk factors, diagnosis, and treatment permeate the literature. The goal of this study was to assess experts’ opinions on the available literature on lymphedema while following the Delphi methodology.MethodsIn December of 2019, the American Venous Forum created a working group tasked to develop a consensus statement regarding current practices for the diagnosis and treatment of lymphedema. A panel of experts was identified by the working group. The working group then compiled a list of clinical questions, risk factors, diagnosis and evaluation, and treatment of lymphedema. Fifteen questions that met the criteria for consensus were included in the list. Using a modified Delphi methodology, six questions that received between 60% and 80% of the votes were included in the list for the second round of analysis. Consensus was reached whenever >70% agreement was achieved.ResultsThe panel of experts reached consensus that cancer, infection, chronic venous disease, and surgery are risk factors for secondary lymphedema. Consensus was also reached that clinical examination is adequate for diagnosing lymphedema and that all patients with chronic venous insufficiency (C3–C6) should be treated as lymphedema patients. No consensus was reached regarding routine clinical practice use of radionuclide lymphoscintigraphy as a mandatory diagnostic tool. However, the panel came to consensus regarding the importance of quantifying edema in all patients (93.6% in favor). In terms of treatment, consensus was reached favoring the regular use of compression garments to reduce lymphedema progression (89.4% in favor, 10.6% against; mean score of 79), but the use of Velcro devices as the first line of compression therapy did not reach consensus (59.6% in favor vs 40.4% against; total score of 15). There was agreement that sequential pneumatic compression should be considered as adjuvant therapy in the maintenance phase of treatment (91.5% in favor vs. 8.5% against; mean score of 85), but less so in its initial phases (61.7% in favor vs. 38.3% against; mean score of 27). Most of the panel agreed that manual lymphatic drainage should be a mandatory treatment modality (70.2% in favor), but the panel was split in half regarding the proposal that reductive surgery should be considered for patients with failed conservative treatment.ConclusionThis consensus process demonstrated that lymphedema experts agree on the majority of the statements related to risk factors for lymphedema, and the diagnostic workup for lymphedema patients. Less agreement was demonstrated on statements related to treatment of lymphedema. This consensus suggests that variability in lymphedema care is high even among the experts. Developers of future practice guidelines for lymphedema should consider this information, especially in cases of low-level evidence that supports practice patterns with which the majority of experts disagree.

Intermittent Sequential Pneumatic Compression Improves Coupling between Cerebral Oxyhaemoglobin and Arterial Blood Pressure in Patients with Cerebral Infarction.

Simple SummaryCerebral autoregulation is a homeostatic feedback mechanism that maintains a relatively constant cerebral blood flow despite changes in blood pressure. Impaired cerebral autoregulation results in unstable cerebral blood flow and is detrimental to the outcome of neurological diseases. Therefore, metrics of cerebral autoregulation were increasingly used to assess cerebrovascular health or to guide hemodynamic management. Intermittent sequential pneumatic compression (ISPC) is an effective physiotherapy technique that could improve motor deficits in patients with acute cerebral infarction. The present study focuses on the coupling relationships between arterial blood pressure and changes in oxygenated hemoglobin in the cerebral cortex to investigate the effect of ISPC on cerebral autoregulation in patients with cerebral infarction, as compared with the healthy controls. This study may help to advance the understanding of the physiological mechanisms of ISPC intervention and can provide a basis for evaluating the efficacy of ISPC interventions in patients with cerebral infarction.This study aims to explore the effect of intermittent sequential pneumatic compression (ISPC) intervention on the coupling relationship between arterial blood pressure (ABP) and changes in oxyhaemoglobin (Δ [O2Hb]). The coupling strength between the two physiological systems was estimated using a coupling function based on dynamic Bayesian inference. The participants were 22 cerebral infarction patients and 20 age- and sex-matched healthy controls. Compared with resting state, the coupling strength from ABP to Δ [O2Hb] oscillations was significantly lower in the bilateral prefrontal cortex (PFC), sensorimotor cortex (SMC), and temporal lobe cortex (TLC) during the ISPC intervention in cerebral infarction patients in interval II. Additionally, the coupling strength was significantly lower in the bilateral SMC in both groups in interval III. These findings indicate that ISPC intervention may facilitate cerebral circulation in the bilateral PFC, SMC, and TLC in cerebral infarction patients. ISPC may promote motor function recovery through its positive influences on motor-related networks. Furthermore, the coupling between Δ [O2Hb] and ABP allows non-invasive assessments of autoregulatory function to quantitatively assess the effect of rehabilitation tasks and to guide therapy in clinical situations.

Brain Function Changes Induced by Intermittent Sequential Pneumatic Compression in Patients With Stroke as Assessed by Functional Near-Infrared Spectroscopy.

Intermittent sequential pneumatic compression (ISPC) can effectively promote cerebral perfusion and collateral blood supply in patients with stroke. However, the effects of ISPC on cerebral oscillations are still unclear. The tissue concentration of oxyhemoglobin and deoxyhemoglobin oscillations were measured by functional near-infrared spectroscopy under resting and ISPC conditions in 27 right-handed adult patients with stroke. Five characteristic frequency signals (I, 0.6-2Hz; II, 0.145-0.6Hz; III, 0.052-0.145Hz; IV, 0.021-0.052Hz; and V, 0.0095-0.021Hz) were identified using the wavelet method. The wavelet amplitude (WA) and laterality index (LI) were calculated to describe the frequency-specific cortical activities. The ISPC state of patients with ischemic stroke showed significantly increased WA values of the ipsilesional motor cortex (MC) in the frequency intervals III (F37 = 8.017), IV (F37 = 6.347), and V (F37 = 5.538). There was no significant difference in the WA values in the ISPC state compared with the resting state in patients with hemorrhagic stroke. Also, the LI values of the prefrontal cortex and MC in patients decreased more obviously in the ISPC state than in the resting state despite no significant difference. The significantly increased WA values in the frequency intervals III, IV, and V in the MC of patients with ischemic stroke might be related to cortical activity in the MC in addition to increased cerebral perfusion. The decreased LI values in the prefrontal cortex and MC indicated that the ISPC may have had a positive effect on the functional rehabilitation of these regions. This study provides a method for assessing the effects of ISPC on cerebral oscillations, and the results benefit the optimization of ISPC parameters in personalized treatment for the functional recovery of patients with stroke.

Revisión bibliográfica de las recomendaciones de las Guías de Práctica Clínica para la prescripción de Medias de Compresión Médica

La terapia de compresión se puede aplicar con diversos dispositivos, entre los que se incluyen vendajes, sistemas de compresión neumática secuencial, dispositivos de velcro autoajustables, medias de compresión y los sistemas 2 en 1 compuestos por dos calcetines. Las principales indicaciones clínicas de las medias de compresión son la prevención y/o el tratamiento de los síntomas de la insuficiencia venosa primaria y el síndrome postrombótico, así como el linfedema y el lipedema. Tan solo a una minoría de los pacientes que necesitaría terapia de compresión a largo plazo se les llegan a prescribir. La inexperiencia, la falta de formación y la gran cantidad de materiales diferentes son consideradas como obstáculos por el profesional para la recomendación de medias. Por otro lado, también existe una escasa adherencia terapéutica por parte de los pacientes. El objetivo de este trabajo fue identificar y analizar las recomendaciones que ofrecen las principales guías y documentos basados en evidencias científicas para ayudar a los profesionales sanitarios a prescribir la media más adecuada para cada persona y conseguir los mejores resultados. Para ello, se han consultado 7 documentos basados en evidencias científicas. Las lagunas de conocimiento detectadas, sumadas a la confusión que se deriva de la variedad de tipos de medias disponibles, de la diversidad de condiciones clínicas que pueden requerir sus uso y de la variabilidad de situaciones personales que puede presentar cada paciente, hacen que las recomendaciones de las guías actualmente vigentes resulten insuficientes para resolver las dudas que surgen a la hora de prescribir medias de compresión.

The Use of Upper-Body Intermittent Sequential Pneumatic Compression Arm Sleeves on Recovery From Exercise in Wheelchair Athletes.

The aim of the current study was to investigate the efficacy of an upper-body intermittent sequential pneumatic compression device on recovery after wheelchair team sport activity. Eleven well-trained wheelchair basketball and rugby athletes (male, 8; female, 3; mean ± SD age = 33 ± 10 yrs) performed a series of performance measures pre-exercise, postexercise, and postrecovery (grip strength, pressure-to-pain threshold, medicine ball throw, wheelchair sprints, repeated sprints). Subjective muscle soreness and fatigue measurements were taken at the same time points as performance tests, with an additional 24-hr postrecovery measure. Participants completed two recovery trials, separated by 1 wk, of either passive recovery (control) or 20 mins of wearing recovery arm sleeves (intermittent sequential pneumatic compression) applied to both arms. No statistically significant differences were found between trials for any of the performance or perceptual measures (P > 0.05). However, effect size analysis revealed a moderate decrease (d = -0.67) from postexercise to postrecovery for muscle fatigue in favor of intermittent sequential pneumatic compression. A large decrease (d = -0.96) in muscle soreness was also found after exercise to 24 hrs after recovery in favor of intermittent sequential pneumatic compression over control. Intermittent sequential pneumatic compression may provide some benefit for perceptual recovery measures immediately after and 24 hrs after a high-intensity wheelchair activity with negligible effects on performance recovery.

Investigating the Use of an Intermittent Sequential Pneumatic Compression Arm Sleeve for Recovery After Upper-Body Exercise

Cranston, AW and Driller, MW. Investigating the use of an intermittent sequential pneumatic compression arm sleeve for recovery after upper-body exercise. J Strength Cond Res 36(6): 1548-1553, 2022-The current study aimed to investigate the efficacy of an intermittent sequential pneumatic compression (ISPC) device placed on the arm after a fatiguing upper-body exercise circuit. Fifty resistance-trained athletes (37 males/13 females, mean ± SD; age = 27 ± 4 years) performed 3 physical performance tests (grip strength dynamometer, single-arm medicine ball throw, and preacher bench bicep curls to failure) before and after exercise, following a 30-minute recovery period. During the recovery period, subjects were randomly assigned an experimental arm, which was placed in the ISPC device, and a control arm (no device). Subjects completed a perceptual muscle soreness rating through palpation of 4 muscle groups in the upper body at the same time points and also 24 hours after recovery. There was a statistically significant interaction between conditions for the single-arm medicine ball throw (p < 0.01) in favor of the ISPC after the recovery period; however, the effect size was deemed trivial. There was a small but not statistically significant effect (d = 0.22, p > 0.05) for the bicep curls in favor of the ISPC and no significant difference for the grip strength (d = 0.09, p > 0.05). The perceptual muscle soreness scales resulted in significant differences between conditions immediately after and 24 hours after exercise across all muscle groups (p < 0.05), all in favor of the ISPC condition. This study supports the use of an upper-body ISPC device to reduce perceived muscle soreness for up to 24 hours after exercise, with negligible effects on physical performance when compared with a control trial.

Intermittent sequential pneumatic compression does not enhance whole-body heat loss in elderly adults during extreme heat exposure.

Lower-limb intermittent sequential pneumatic compression (ISPC) improves circulation and vascular function in elderly adults. We evaluated the hypothesis that ISPC would also augment whole-body heat loss (WBHL) in elderly adults (aged 69 ± 4 years) resting in extreme heat (40 °C). While ISPC increased mean arterial pressure (91 ± 9 mm Hg) relative to no-ISPC (83 ± 5 mm Hg; P = 0.013) at the end of the exposure, no influence on WBHL was observed (81 ± 7 and 86 ± 11 W for ISPC and no-ISPC, respectively, P = 0.310). Novelty When assessed in elderly adults during an extreme heat exposure, intermittent sequential pneumatic compression augmented mean arterial pressure but did not enhance whole-body heat loss.

Sequential Pneumatic Compression in the Arm in Neurocritical Patients with a Peripherally Inserted Central Venous Catheter: A Randomized Trial.

Peripherally inserted central venous catheters (PICCs) are increasingly used for parenteral access in critically ill hospitalized patients, but they increase the incidence of upper extremity deep venous thrombosis (UE DVT). Sequential compression devices (SCDs) applied to the legs effectively reduce lower extremity DVT, but have not been tested in the arms. Our objective was to determine whether SCDs applied to the arm may reduce the risk of PICC-associated UE DVT. This was a retrospective study of randomized, single-center, controlled clinical trial on patients hospitalized in the intensive care unit with critical neurological illness who had a PICC and were not receiving anticoagulants. Between January 2014 and October 2016, patients were randomized 1:1 to an intervention group having a custom SCD applied to the arm harboring the PICC or to a control group. The primary endpoint was ultrasound-detected UE DVT. Following randomization of 77 subjects, the study was terminated due to excess DVT in the treatment arm. UE DVT was detected in 18 subjects (29.0%), and it was more frequent among those in the SCD group (13/31 [41.9%] vs. the control group 5/31 [16.1%]; p = 0.049). After accounting for crossovers, the difference was still significant (12/28 [43.0%] vs. 6/34 [17.6%]; p = 0.048). Yet, symptomatic UE DVT (n = 3) and pulmonary embolism without evidence of lower extremity DVT (n = 2) were only observed in patients who were not wearing the SCD on the arm. Although UE DVT is commonly associated with PICC use, the results of this trial do not support the use of SCD on the arm for DVT prevention. Further research on this strategy may nonetheless be justified. This trial was registered in ClinicalTrials.gov under the identifier NCT01670188.

Risk of Thromboembolic Disease With Cost Estimates in Patients Undergoing Robotic Assisted Surgery for Endometrial Cancer and Review of the Literature

This study sought to evaluate the incidence, risk factors, and estimated cost associated with venous thromboembolism (VTE) following robotic surgery for endometrial cancer. The study included all consecutive patients with newly diagnosed endometrial cancer who underwent robotic surgery, excluding patients with a previous history of VTE (3%), those taking long-term warfarin (3%), and patients with conversions to laparotomy (3%). The incidence of postoperative symptomatic VTE within 90 days was analyzed. Direct and indirect medical costs were estimated using a linked billing database for standardized, inflation-adjusted costs. A total of 558 cases were identified. Median BMI was 29 kg/m2 (range, 17-85 kg/m2), median operative time was 227 minutes (range, 75-419 minutes), and median blood loss was 30 mL (range, 3-400 mL). All patients received thromboprophylaxis with intraoperative subcutaneous heparin and sequential pneumatic compression devices. Extended postoperative prophylaxis for 28 days was administered to 88 (17.2%) patients with high-risk factors. A total of eight patients (1.6%) developed symptomatic VTE, and all eight were in the group that did not receive extended prophylaxis. The number needed to treat to prevent one VTE was 52.8, with an absolute risk reduction 1.89% (95% CI 0.59% to 3.19%). The average cost for treatment of a VTE was $7653 (range, $4396-$12 211), equivalent to the cost of treating 21 patients with extended prophylaxis ($356 per patient). The incidence of VTE in patients with endometrial cancer who underwent robotic-assisted surgery was low (1.6%), and none of the VTEs occurred in the cohort of high-risk patients who received extended thromboprophylaxis.

Venous Thromboembolism Incidence After Craniofacial Surgery.

Current protocols for venous thromboembolism (VTE) prophylaxis after craniofacial surgery (CFS) vary widely with substantial disagreements in both indications and managements. An evidence-based approach to this issue requires the following: the incidence of postoperative VTE, comorbidities associated with coagulopathy, risk reduction after VTE prophylaxis, and complications attributable to prophylaxis. This study addresses the first two. Retrospective cross-sectional study. Discharge data from 64,170 patients undergoing CFS between 2008 and 2013 extracted from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample were analyzed. The outcome measures extracted were: deep venous thrombosis, pulmonary embolism, demographic data, common comorbidities, length of stay, total cost, and discharge outcome. Diagnoses of deep venous thrombosis or pulmonary embolism, collectively classified as VTE, were observed in 355 (0.55%) of 64,170 patients discharged after CFS. Other surgeries exhibited a VTE rate of 1.17%. Men exhibited nearly double the incidence of VTE relative to women (0.69% compared with 0.37% respectively, P < 0.001), and the risk factors of adulthood, advanced age, cardiovascular disease, obesity, and malignancy were associated with increased VTE incidence with odds ratios of 9.93, 3.66, 1.80, 2.02, and 2.02, respectively (P < 0.005). Tobacco use did not exhibit any significant association (odds ratio, 0.94; P = 0.679). Afflicted patients experienced 4.60 times longer hospital stays averaging 23.8 days (95% confidence interval, 21.4-26.2; P < 0.001) compared the average of 5.2 days experienced by CFS patients without VTE. They incurred an average cost of US $298,228 (95% confidence interval, 262,726 to 333,731; P < 0.001) which was 4.17 times the US $72,376 expense of treating other CFS patients. The likelihood for a CFS patient to experience a poor outcome at the time of discharge was 54.6% higher after VTE. The risk of postoperative VTE after CFS is significantly increased in adults, patients with advanced age, cardiovascular disease, obesity, and malignancy. However even in those high-risk cases, postoperative VTE incidence remains relatively low after CFS. These findings in conjunction with further study regarding the risk associated with the addition of VTE chemoprophylaxis compared against mechanical VTE prophylaxis, such as sequential pneumatic compression stockings, may determine whether routine use of VTE chemoprophylaxis is appropriate.

Hemodynamic effects of different types of pneumatic compression of the lower extremities during anesthesia induction: a prospective randomized controlled trial.

BackgroundThe current study evaluated the hemodynamic effects of different types of pneumatic compressions of the lower extremities during anesthesia induction. In addition, the hemodynamic effects were compared between patients older than 65 age years and those aged 65 years or younger.MethodsOne hundred and eighty patients (90: > 65 years and 90: ≤ 65 years) were enrolled. Each age group of patients was randomly assigned to one of three groups; Group 1 (no compression), Group 2 (sequential pneumatic compression), and Group 3 (sustained pneumatic compression without decompression). Invasive blood pressure, cardiac index (CI), and stroke volume variation (SVV) were measured.ResultsIn patients aged ≤ 65 years, mean arterial pressure (MAP) and CI were significantly higher and SVV was lower in Group 3 compared to Group 1 before tracheal intubation, but there were no differences between Groups 1 and 2. However, there were no differences in MAP, CI, and SVV among the three groups in patients aged > 65 years. The number of patients who showed a MAP < 60 mmHg was less in Group 3 than Group 1 in patients aged ≤ 65 years, but not in patients aged > 65 years.ConclusionsSustained pneumatic compression of the lower extremities has more hemodynamic stabilizing effects compared to sequential compression during anesthesia induction in patients aged 65 years or younger. However, no difference between methods of compression was observed in patients older than 65 years.

Deep Vein Thrombosis in Acute Stroke - A Systemic Review of the Literature.

We present a systemic review of available literature on the complications of deep venous thrombosis that develops in patients presenting with acute stroke. There are several pharmacological and physical treatment options available and used. We aim to summarize the management plans currently used at different centers. In conclusion, low-dose anticoagulant therapy for ischemic stroke is recommended. In the case of intracerebral hemorrhage, pneumatic sequential compression devices should be placed initially, followed by the administration of ultra-fractioned heparin on the next day, and then oral anticoagulant therapy to replace the heparin after a week in high-risk patients. Similar prophylactic treatment recommendations are used for subarachnoid hemorrhage.

Use of Sequential Pneumatic Compression Devices to Facilitate Propagation of Contrast during Intranodal Lymphangiography

PurposeTo examine effects of lower extremity sequential compression devices (SCDs) on lymphatic transit during intranodal lymphangiography (IL) and thoracic duct interventions. Materials and MethodsA retrospective review of 19 SCD-assisted IL (IL-SCD) procedures was performed. The control group comprised 18 consecutive IL-guided procedures performed in the immediately preceding time period. For IL-SCD procedures, SCDs were placed onto patients’ calves before sterile preparation. Total procedure time and lymphatic transit time were measured. Mean age was 52 years in the IL-SCD group and 64 years in the control group. In the control group, 100% (18/18) of patients had a chylous leak, whereas only 74% (14/19) of patients in the IL-SCD group had a leak. ResultsIn the IL-SCD group, mean total procedure time was 75 minutes (range, 34–126 min), and mean lymphatic transit time was 29 minutes (range, 8–63 min). In the control group, mean total procedure time was 105 minutes (range, 51–203 min), and mean lymphatic transit time was 56 minutes (range, 28–117 min). Lymphatic transit time and procedure time were significantly reduced in the IL-SCD group (P < .01 and P < .05, respectively). ConclusionsUse of lower extremity SCDs reduces lymphatic transit time and IL-dependent procedure time.

Pneumatic Compression Fails to Improve Performance Recovery in Trained Cyclists.

To examine the efficacy of intermittent sequential pneumatic compression (ISPC) on exercise recovery and subsequent performance, when implemented between a 20-min cycling bout (simulated scratch race) and a 4-min cycling test (simulated individual pursuit), as experienced during an Omnium track cycling competition. Twenty-one (13 male and 8 female, mean [SD]: age = 36 [14] y) trained cyclists completed a familiarization trial followed by 2 experimental trials in a counterbalanced, cross-over design. Participants performed a fixed-intensity 20-min cycling bout on a Wattbike cycle ergometer, followed by a 30-min recovery period where ISPC recovery boots or passive recovery was implemented. At the conclusion of the recovery period, participants performed a 4-min maximal cycling bout (4-min time trial [TT]). Average power (watts) for the 4-min TT, blood lactate concentration, and perceived total quality recovery (TQR) during the recovery period were used to examine the influence of ISPC. There were no significant differences between trials for the 4-min TT (P = .08), with the effect deemed to be trivial (d = -0.08). There was an unclear effect (d [±90% confidence interval] = 0.26 [±0.78], P = .57) for ISPC vs passive recovery in the clearance of blood lactate during the recovery period. There was a small but not significant difference for perceived TQR in favor of ISPC (d [±90% confidence interval] = 0.27 [±0.27], P = .07). There was little additional benefit associated with the use of ISPC to enhance recovery and subsequent performance when used during the recovery period between 2 events in a simulated Omnium track cycling competition.

3:27 PMAbstract No. 306 - Use of sequential pneumatic compression devices to reduce thoracic duct catheterization procedure time

3:27 PMAbstract No. 306 - Use of sequential pneumatic compression devices to reduce thoracic duct catheterization procedure time

A Randomized Controlled Trial of Massage and Pneumatic Compression for Ultramarathon Recovery.

Study Design Randomized controlled trial. Background Postexercise recovery techniques are widely used, but little research has examined their effectiveness. Objectives To examine the effectiveness of massage and pneumatic compression on recovery from a 161-km ultramarathon. Methods Participants in the 2015 161-km Western States Endurance Run were randomized to a 20-minute postrace intervention of massage, intermittent sequential pneumatic compression, or supine rest. Each subject completed two 400-m runs at maximum speed before the race and on days 3 and 5 after the race, and also provided muscle pain and soreness ratings and overall muscular fatigue scores before and for 7 days after the race. Results Among the 72 runners who finished the race and completed the study, comparison among intervention groups revealed no significant group or interaction effect on 400-m run time, but there was a significant (P<.0001) time effect. Immediately posttreatment, massage resulted in lower muscle pain and soreness ratings compared with the supine-rest control condition (P<.0001), while both massage (P<.0001) and pneumatic compression (P<.01) resulted in lower overall muscular fatigue scores compared with the control group. There were no significant differences between groups in any outcome 1 to 7 days after the race. Conclusion Single 20-minute sessions of postrace massage and intermittent sequential pneumatic compression provide some immediate subjective benefit. There is no evidence, however, that such treatments provide extended subjective or functional benefits of clinical importance. The trial was registered at www.clinicaltrials.gov (NCT02530190). Level of Evidence Therapy, level 1b. J Orthop Sports Phys Ther 2016;46(5):320-326. Epub 23 Mar 2016. doi:10.2519/jospt.2016.6455.

Risk-Stratified Venous Thromboembolism Prophylaxis After Total Joint Arthroplasty: Aspirin and Sequential Pneumatic Compression Devices vs Aggressive Chemoprophylaxis

BackgroundVenous thromboembolism (VTE) is a major concern after total joint arthroplasty (TJA). We evaluated a risk-stratified prophylaxis protocol for patients undergoing TJA. MethodsA total of 2611 TJA patients were retrospectively studied. Patients treated with an aggressive VTE chemoprophylaxis protocol were compared with patients treated with a risk-stratified protocol utilizing aspirin and sequential pneumatic compression devices (SPCDs) for standard-risk patients and targeted anticoagulation for high-risk patients. ResultsWe found equivalence in terms of VTE prevention between the 2 cohorts. There was a decrease in adverse events and readmissions among the risk-stratified cohort, although this did not reach statistical significance. A statistically significant reduction in costs (P < .001) was experienced with the use of aspirin/SPCDs compared with aggressive anticoagulation agents within the risk-stratified cohort. ConclusionThe use of aspirin/SPCDs in a risk-stratified TJA population is a safe and cost-effective method of VTE prophylaxis.

The Role of Sequential Pneumatic Compression in Limb Salvage in Non-reconstructable Critical Limb Ischemia

Critical limb ischemia (CLI) is an increasingly alarming presentation of advanced generalized circulatory failure. Most patients presenting with CLI have profound cardiovascular comorbidities that hinder surgical intervention. Moreover, some patients present with non-reconstructable arterial anatomy. For this vulnerable cohort, primary amputation is often the only available option. This study aims at answering the question: Can sequential pneumatic compression (SPC) preclude amputation? A retrospective analysis of 187 patients (262 limbs) prescribed the Artassist SPC compared outcomes between the group of patients who acquired the device and those who did not. The primary end point was limb salvage; secondary end points were amputation-free survival and improvement in toe pressures. The mean age was 74.78 years, the median follow-up was 16 months, and the median duration of usage was 4 months. 81.72% of the patient acquired the device and 18.28% did not. The mean toe pressure was 61.4 mmHg pre-application, and 65 mmHg after application (p = .071). Amputation-free survival was 98% and 96% for those who acquired the device and 90% and 84% for those who did not at 6 and 12 months, respectively. There was a non-significant association between limb salvage and device acquisition (p = .714); however, there was a significant improvement in rest pain (p < .0001), reduction in minor amputation (p = .023), and amputation-free survival associated with using the device (p = .01). Although limb salvage is the paramount ambition for patients referred to vascular services, some patients with CLI are better served with primary amputation. Although the mechanism of SPC action is still ambiguous, there is strong evidence to support its role in preventing minor amputation, prolonging amputation-free survival, and improving rest pain in patients with non-reconstructable CLI; nevertheless, its role in prevention of major amputation lacks statistical significance.

Effect of sequential pneumatic compression therapy on venous blood velocity, refilling time, pain and quality of life in women with varicose veins: a randomized control study.

[Purpose] The aim of this study was to investigate the effects of sequential pneumatic compression therapy on venous blood flow, refilling time, pain level, and quality of life in women with varicose veins. [Subjects and Methods] Twenty-eight females with varicose veins were selected and randomly allocated to a control group, and experimental group. Maximum and mean venous blood velocities, the refilling time, pain by visual analog scale and quality of life by Aberdeen Varicose Veins Questionnaire were measured in all patients before and after six weeks of treatment. Both groups received lower extremity exercises; in addition, patients in the experimental group received sequential pneumatic compression therapy for 30 minutes daily, five days a week for six weeks. [Results] All measured parameters improved significantly in both groups, comparison of post treatment measurements between groups showed that the maximum and mean blood flow velocity, the pain level, and quality of life were significantly higher in the experimental group compared with the control group. On the other hand there was no significant difference between groups for refilling time. [Conclusion] Sequential pneumatic compression therapy with the applied parameters was an effective modality for increasing venous blood flow, reducing pain, and improving quality of women life with varicose veins.