Improving Adherence to Wearing Compression Stockings for Chronic Venous Insufficiency and Venous Leg Ulcers: A Scoping Review

Bar, Laila; Brandis, Susan; Marks, Darryn

doi:10.2147/ppa.s323766

Cited by 21 publications

(29 citation statements)

References 91 publications

(369 reference statements)

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“…However, further research on long-term adherence and health care outcomes after implementation of the improvements is necessary. Multidimensional interventions to improve adherence were found the show promising results [34], although further investigations with high-quality trials are required. Some weaknesses of our study have to be considered.…”

Section: Discussionmentioning

confidence: 99%

A realist evaluation to identify targets to improve the organization of compression therapy for deep venous thrombosis- and chronic venous disease patients

et al. 2022

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Background Although compression therapy is well established for patients with deep venous thrombosis (DVT) and chronic venous disease (CVD), considerable variation exists in its organization in clinical practice which may impact patient outcomes. The current study aims to deepen our understanding of the main drivers of the complex care organization for compression therapy and to identify targets for improvement. Methods This realist evaluation includes a mixed-method design consisting of semi-structured interviews with patients and health care professionals involved in compression therapy (n = 30), stakeholder meetings (n = 2) and surveys (n = 114). Data were collected to create the content of context-mechanism-outcome-configurations (CMOcs) important in compression therapy. Based on these CMOcs, targets for improvement to optimize the organization of compression care were identified. Results We identified overarching context factors and mechanisms targeting four optimal outcomes for the organization of compression therapy: selecting initial compression therapy types that support patient’s self-reliance (1), evidence based selection of elastic compression stocking type and class (2), patient-based selection of assistive devices (3), individualizing treatment duration for DVT patients (4a) and providing follow-up for CVD patients (4b). We found that increasing health care professionals’ knowledge of compression therapy, the availability of unambiguous protocols and guidelines, increasing patient involvement (and if applicable their informal care giver) in the decision making process, the accessible availability of resources, and increasing interdisciplinary consultation enhanced desirable outcomes. These targets triggered mechanisms such as increased health care professionals’ willingness, confidence and motivation to provide patient-based care and increased patients’ self-confidence and self-efficacy. Conclusions This study provides a detailed insight into what needs to be in place to optimize compression care and identified five main targets for improvement.

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Section: Discussionmentioning

confidence: 99%

A realist evaluation to identify targets to improve the organization of compression therapy for deep venous thrombosis- and chronic venous disease patients

et al. 2022

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“…Ein Review von Bar et al. berichtet Raten zwischen 20 und 95 %, wobei in den eingeschlossenen Studien teilweise Kriterien wie das Einlösen des MKS-Rezepts und die Durchführung empfohlener Übungen berücksichtigt wurden, die über übliche Adhärenzkriterien hinausgehen [ 42 ].…”

Section: Diskussionunclassified

“…Dabei sollte berücksichtigt werden, dass Patienten bei Interviews und in Studien ihre Adhärenz im Sinne einer sozialen Erwünschtheit ggf. zu positiv darstellen; dies fällt bei einem Abgleich mit Sensordaten auf, die in Studien-Settings in MKS integriert wurden [ 42 , 43 ].…”

Section: Diskussionunclassified

Medizinische Kompressionsstrümpfe bei chronischen venösen Erkrankungen und Lymphödem

Stücker

Rabe²

2022

Dermatologie

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Zusammenfassung Hintergrund und Ziele Medizinische Kompressionsstrümpfe (MKS) sind bei chronischer venöser Insuffizienz (CVI) aller Stadien indiziert und beim Lymphödem eine unverzichtbare Therapiekomponente; 8 % der deutschen Bevölkerung tragen vom Arzt verordnete MKS, Frauen häufiger als Männer (12 % vs. 5 %) und insbesondere Personen ab 60 Jahren (17 %). Die Adhärenz der Patienten ist relevant für eine erfolgreiche Behandlung mit MKS. Untersucht wurde die Versorgung mit MKS aus Patientensicht. Patienten und Methodik Die vorliegende Studie untersuchte 2019 die Versorgungsqualität durch strukturierte Interviews mit 414 repräsentativ ausgewählten Nutzern. Die Erkenntnisse werden vor dem Hintergrund wissenschaftlicher Evidenz zur Wirkung der MKS diskutiert. Ergebnisse Venenprobleme sind der häufigste Verordnungsgrund (44 %), gefolgt von Lymphödemen (22 %) bzw. Mehrfachindikationen (27 %). Patienten tragen MKS zumeist täglich und durchschnittlich 11 h/Tag; 89 % der Patienten waren zufrieden bzw. sehr zufrieden mit den MKS und berichteten je nach Indikation ein differenziertes Wirkprofil. Dieses reflektiert die umfangreiche wissenschaftliche Evidenz zur klinischen Wirksamkeit der MKS. Ein wichtiger Faktor für die Patientenadhärenz ist die ärztliche Schulung und Aufklärung. Schlussfolgerungen MKS werden von Patienten sehr gut akzeptiert. Bei der Verordnung sollen praktischen Aspekte wie An- und Ausziehen, empfohlene Tragedauer und -häufigkeit sowie der Wirkmechanismus der MKS vermittelt werden. Graphic abstract

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“…Unidimensional interventions that aim to improve behaviors associated with adherence to compression stockings have often been unsuccessful and none have demonstrated consistent superiority over others. 25 In contrast, research into improving adherence in other chronic health conditions including diabetes mellitus 26 and chronic kidney disease, 27 demonstrates more positive impacts from personalized and multidimensional approaches. A recent scoping review 25 of adherence to wearing compression stockings found that, while personalized and multi-dimensional interventions show promise, further high-quality research is required.…”

Section: Introductionmentioning

confidence: 99%

“… 25 In contrast, research into improving adherence in other chronic health conditions including diabetes mellitus 26 and chronic kidney disease, 27 demonstrates more positive impacts from personalized and multidimensional approaches. A recent scoping review 25 of adherence to wearing compression stockings found that, while personalized and multi-dimensional interventions show promise, further high-quality research is required. It recommended that the design of a multidimensional behavior change intervention to improve adherence with compression stockings, must accommodate the multitude of adherence barriers and be sufficiently flexible to deliver tailored personal interventions.…”

Section: Introductionmentioning

confidence: 99%

Developing a Suite of Resources to Improve Patient Adherence to Compression Stockings: Application of Behavior Change Theory

Bar

Marks

Brandis

2023

PPA

Self Cite

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Purpose Poor patient adherence to compression stockings remains a difficult and pervasive problem for clinicians, with costly repercussions for patients and health-care systems. The purpose of this paper was to describe the application of behavior change theory to the systematic development of a suite of resources, aimed at improving patient adherence to wearing compression stockings. Methods Employing a non-empirical approach, behavior-change theory was used to develop an innovative intervention as part of a multi-phase project. Target behaviors, barriers and potential enablers were identified in relation to stocking adherence. An impact-likelihood matrix for behavior prioritization was used to identify possible areas for intervention within occupational therapy outpatient clinics. Selection of suitable resources and their consequent development were based on a narrative and problem-solving process by a panel of clinical experts. Results Of 14 potential domains embedded in the Theoretical Domains Framework, the key target behaviors and barriers were associated with eight domains. Michie’s Behavior Change Wheel revealed recommendations in six subdivisions and of these, four intervention functions were selected by the panel, based on their potential impact and likelihood of adoption in clinical practice. Findings led to the development of a suite of resources comprising a new questionnaire, a clinical decision tree, augmented by clinical answer sheets corresponding to each of the barriers. Conclusion Application of behavior change theory informed the design of a behavior change intervention comprising an integrated suite of resources for novice and experienced clinicians. Practice Implications These novel resources have potential to improve patient adherence to compression stockings and consequently generate health-care savings through reduced need for wound care products, and medical interventions with translation to other settings and conditions requiring compression stockings. Patient outcomes will likely be improved with reduced pain, improved quality of life and earlier resumption of usual occupations.

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Improving Adherence to Wearing Compression Stockings for Chronic Venous Insufficiency and Venous Leg Ulcers: A Scoping Review

Cited by 21 publications

References 91 publications

A realist evaluation to identify targets to improve the organization of compression therapy for deep venous thrombosis- and chronic venous disease patients

A realist evaluation to identify targets to improve the organization of compression therapy for deep venous thrombosis- and chronic venous disease patients

Medizinische Kompressionsstrümpfe bei chronischen venösen Erkrankungen und Lymphödem

Developing a Suite of Resources to Improve Patient Adherence to Compression Stockings: Application of Behavior Change Theory

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