Shi C, Dumville JC, Cullum N, Connaughton E, Norman G, et al.
The Cochrane database of systematic reviews. Date of publication 2021 Jul 26;volume 7():CD013397.
1. Cochrane Database Syst Rev. 2021 Jul 26;7:CD013397. doi:
10.1002/14651858.CD013397.pub2.
Compression bandages or stockings versus no compression for treating venous leg
ulcers.
Shi C(1), Dumville JC(1), Cullum N(1), Connaughton E(2), Norman G(1).
Author information:
(1)Division of Nursing, Midwifery and Social Work, School of Health Sciences,
Faculty of Biology, Medicine and Health, University of Manchester, Manchester
Academic Health Science Centre, Manchester, UK.
(2)EMERGING Research, Manchester Foundation Trust, Manchester, UK.
BACKGROUND: Leg ulcers are open skin wounds on the lower leg that can last weeks,
months or even years. Most leg ulcers are the result of venous diseases.
First-line treatment options often include the use of compression bandages or
stockings.
OBJECTIVES: To assess the effects of using compression bandages or stockings,
compared with no compression, on the healing of venous leg ulcers in any setting
and population.
SEARCH METHODS: In June 2020 we searched the Cochrane Wounds Specialised
Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid
MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase and
EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and
unpublished studies, and scanned reference lists of relevant included studies as
well as reviews, meta-analyses and health technology reports to identify
additional studies. There were no restrictions by language, date of publication
or study setting.
SELECTION CRITERIA: We included randomised controlled trials that compared any
types of compression bandages or stockings with no compression in participants
with venous leg ulcers in any setting.
DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed
studies using predetermined inclusion criteria. We carried out data extraction,
and risk-of-bias assessment using the Cochrane risk-of-bias tool. We assessed the
certainty of the evidence according to GRADE methodology.
MAIN RESULTS: We included 14 studies (1391 participants) in the review. Most
studies were small (median study sample size: 51 participants). Participants were
recruited from acute-care settings, outpatient settings and community settings,
and a large proportion (65.9%; 917/1391) of participants had a confirmed history
or clinical evidence of chronic venous disease, a confirmed cause of chronic
venous insufficiency, or an ankle pressure/brachial pressure ratio of greater
than 0.8 or 0.9. The average age of participants ranged from 58.0 to 76.5 years
(median: 70.1 years). The average duration of their leg ulcers ranged from 9.0
weeks to 31.6 months (median: 22.0 months), and a large proportion of
participants (64.8%; 901/1391) had ulcers with an area between 5 and 20 cm2.
Studies had a median follow-up of 12 weeks. Compression bandages or stockings
applied included short-stretch bandage, four-layer compression bandage, and
Unna's boot (a type of inelastic gauze bandage impregnated with zinc oxide), and
comparator groups used included 'usual care', pharmacological treatment, a
variety of dressings, and a variety of treatments where some participants
received compression (but it was not the norm). Of the 14 included studies, 10
(71.4%) presented findings which we consider to be at high overall risk of bias.
Primary outcomes There is moderate-certainty evidence (downgraded once for risk
of bias) (1) that there is probably a shorter time to complete healing of venous
leg ulcers in people wearing compression bandages or stockings compared with
those not wearing compression (pooled hazard ratio for time-to-complete healing
2.17, 95% confidence interval (CI) 1.52 to 3.10; I2 = 59%; 5 studies, 733
participants); and (2) that people treated using compression bandages or
stockings are more likely to experience complete ulcer healing within 12 months
compared with people with no compression (10 studies, 1215 participants): risk
ratio for complete healing 1.77, 95% CI 1.41 to 2.21; I2 = 65% (8 studies with
analysable data, 1120 participants); synthesis without meta-analysis suggests
more completely-healed ulcers in compression bandages or stockings than in no
compression (2 studies without analysable data, 95 participants). It is uncertain
whether there is any difference in rates of adverse events between using
compression bandages or stockings and no compression (very low-certainty
evidence; 3 studies, 585 participants). Secondary outcomes Moderate-certainty
evidence suggests that people using compression bandages or stockings probably
have a lower mean pain score than those not using compression (four studies with
859 participants and another study with 69 ulcers): pooled mean difference -1.39,
95% CI -1.79 to -0.98; I2 = 65% (two studies with 426 participants and another
study with 69 ulcers having analysable data); synthesis without meta-analysis
suggests a reduction in leg ulcer pain in compression bandages or stockings,
compared with no compression (two studies without analysable data, 433
participants). Compression bandages or stockings versus no compression may
improve disease-specific quality of life, but not all aspects of general health
status during the follow-up of 12 weeks to 12 months (four studies with 859
participants; low-certainty evidence). It is uncertain if the use of compression
bandages or stockings is more cost-effective than not using them (three studies
with 486 participants; very low-certainty evidence).
AUTHORS' CONCLUSIONS: If using compression bandages or stockings, people with
venous leg ulcers probably experience complete wound healing more quickly, and
more people have wounds completely healed. The use of compression bandages or
stockings probably reduces pain and may improve disease-specific quality of life.
There is uncertainty about adverse effects, and cost effectiveness. Future
research should focus on comparing alternative bandages and stockings with the
primary endpoint of time to complete wound healing alongside adverse events
including pain score, and health-related quality of life, and should incorporate
cost-effectiveness analysis where possible. Future studies should adhere to
international standards of trial conduct and reporting.
Copyright © 2021 The Authors. Cochrane Database of Systematic Reviews published
by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.
DOI: 10.1002/14651858.CD013397.pub2
PMCID: PMC8407020
PMID: 34308565 [Indexed for MEDLINE]
