Venous leg ulcers: patient concordance with compression therapy and its impact on healing and prevention of recurrence

Abstract

Moffatt Christine, Kommala Dheerendra, Dourdin Nathalie, Choe Yoonhee. Venous leg ulcers: patient concordance with compression therapy and its impact on healing and prevention of recurrence. ABSTRACT This study aimed to review available data on the reasons attributed to patient non concordance with compression therapy for the treatment of venous leg ulcers (VLUs), the frequency of non concordance and its effects on clinical outcomes. The biomedical literature was searched for publications on VLUs, compression therapy and concordance over the past 20 years. Physical, aesthetic and cosmetic factors, patient lack of education about VLUs, cost of therapy and issues with treatment by clinicians were all reported to influence concordance with compression therapy. The search identified 10 studies reporting patient concordance with compression stockings or bandages; while non concordance ranged from 2% to 42% of patients in three randomised controlled trials, it was generally higher in real-world studies, ranging from 9.7% to 80%. Another set of six studies indicated that the healing rate was half and the median time to complete healing was twice as long when patients were not concordant. Further, recurrence rates were 2-20 times greater when patients did not comply with the use of stockings following VLU healing. In conclusion, published biomedical literature has documented that non concordance with compression therapy negatively impacts the outcome of VLUs, highlighting the need to improve patient concordance to maximise therapeutic benefits.

Figure 1

Proportions of VLU patients non concordant with compression therapy. The percentage of patients non concordant with their prescribed compression therapy for VLU healing (filled bars) or prevention of recurrence (clear bars), or healing or recurrence not specified (hatched bars) are shown. Nelson (Class 3): patients treated with higher pressure stockings; Nelson (Class 2): patients treated with lower pressure stockings; Dereure: concordance was reported both by the physician and the patient; Heinen (LSB): patients treated with stockings or long‐stretch bandages; Heinen (SSB): patients treated with short‐stretch bandages.