ELASTIC VERSUS INELASTIC COMPRESSION BANDAGING IN LYMPHOEDEMA MANAGEMENT; A COMPARATIVE ANALYTIC STUDY IN KORLE BU TEACHING HOSPITAL

Abstract

Background

Lymphoedema is a long-term chronic condition requiring a comprehensive multidisciplinary approach as there is no cure for it. Management is therefore aimed at reducing its symptoms and improving on the aesthetics and function of the body part involved. Currently the first line of lymphoedema management is the Complete Decongestive Therapy (CDT), which comprise of manual lymphatic drainage (MLD), compression bandaging, exercise and skin care. CDT is cumbersome, uncomfortable, inconvenient and time-consuming making compliance a big problem. Hence most institutions place emphasis on compression therapy. The prescription of the appropriate compression is a real challenge, since one must choose between inelastic and elastic bandages. It must be adapted to the patient and its pathology as well as provide comfort and ensure good compliance. The diversity of modalities of compression therapy is reflected by the different schools of compression within countries. In France, elastic compression is commonly prescribed whiles in Germany, Netherlands and Austria the standard treatment is inelastic compression. In UK the 4-layer system with an elastic bandage is the choice and in the USA a plaster type inelastic bandage (Unna’s boot) is favoured. The large discrepancies among treatment modalities underline the need of a research into what type of compression therapy is best suited for lymphoedema patients in our centre and to an extent in the Ghanaian population.

Aim The study aims to compare the clinical outcomes of treating lymphoedema of the limbs with elastic compression bandaging and inelastic compression bandaging in Ghanaian patients.

Methodology The study was a prospective randomized study involving 23 Ghanaian patients with lymphoedema of the upper or lower limbs. Using defined inclusion and exclusion criteria, patients with extremity lymphoedema seen at the Physiotherapy Unit of the National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, were selected by simple random sampling into two groups. (Group A – Inelastic bandage, Group B – Elastic bandage). Informed consent was obtained from each patient after clinical assessment. Measurements for both the affected and unaffected limbs were taken using a tape at specific parts of the limb. Manual lymphatic Drainage was done by the physiotherapist and then the appropriate bandage applied based on patient’s group. Limb measurements (affected limb) and Physiotherapy sessions were repeated every two weeks for eight weeks to complete the intensive phase of Compression Bandaging. Quality of life assessment score was taken before and after the 8 weeks of compression bandaging. Data was collected and analyzed using ANOVA to compare the percentage change in the total circumference and volume of the limb with lymphoedema in each of the groups. The quality of life score was compared before and after treatment for each group.

Results The mean age of the participants was 48.61 years. There was a statistical significant difference in the occupational status and level of education of the patients. 70% of patients had upper limb lymphoedema and the mean age at diagnosis was 46.26 years. 82.6% 0f patients had secondary lymphoedema with malignancy being the commonest cause. Both inelastic and elastic compression bandages were effective in reducing the circumference and volume of the affected limb. Compression bandaging in all resulted in a statistically significant difference in the quality of life before and after treatment (p< 0.0001).

Conclusion Compression bandaging using either elastic or inelastic compression bandages are effective in the treatment of limb lymphoedema with a better quality of life outcome. There is no statistical significant difference in the efficacy of both inelastic and elastic bandages. However inelastic compression bandage gives a better reduction in limb volume.