Results and finding

Venous leg ulcers are a common and recurring type of chronic wound that can significantly
impact a patient’s quality of life. The primary treatment for venous leg ulcers is compression
therapy, which increases blood flow in the leg by applying pressure to the area around the ulcer.
This therapy can be administered through compression hosiery or compression bandages. Both
methods have been found to be effective in healing venous leg ulcers, but there are differences in
terms of healing times, patient adherence to treatment, and cost-effectiveness.

In terms of healing times, studies have shown that they are similar for both treatments. For
instance, one study reported a median time to ulcer healing of 99 days in the hosiery group and
98 days in the bandage group. The proportion of ulcers healing was also found to be much the
same in the two groups (70.9% hosiery and 70.4% bandage). Further research suggests that a
monthly surface area reduction of 30% provides a baseline healing rate for venous leg ulcers
managed with compression therapy and advanced dressings. This indicates that both
compression hosiery and bandages can effectively reduce the size of the ulcer over time, leading
to eventual healing. Moreover, with appropriate treatment, venous leg ulcers often heal within 6
months. This healing time applies to both compression hosiery and bandages, further
emphasizing their similar effectiveness. However, it’s important to note that treatment should
always be carried out by a healthcare professional trained in compression therapy for leg ulcers.
This ensures the correct application and use of the compression method, whether it be hosiery or
bandages, to maximize healing potential.

In terms of patient comfort and adherence to treatment, several factors have been identified. One
study found that more hosiery participants changed their allocated treatment (38.3% hosiery vs
27.0% bandage; p=0.02). This suggests that while hosiery might be a viable alternative to
bandages, it might not be suitable for all patients. Further research has identified five determinant
themes regarding patients’ reasons for non-compliance with compression therapy: pain and
discomfort, psychosocial issues, knowledge deficit, physical limitations, and financial issues.
These factors can significantly influence a patient’s adherence to treatment and ultimately, the
effectiveness of the treatment.

Pain and discomfort are common reasons for non-compliance. Compression therapy can
sometimes cause discomfort, especially if the compression is too tight or if the patient has other
underlying conditions that make wearing compression garments uncomfortable. Psychosocial
issues also play a significant role. The appearance of compression garments can affect a patient’s
body image and self-esteem, which can lead to non-compliance. Additionally, the need to wear
these garments daily can interfere with the patient’s lifestyle and social activities. A knowledge
deficit about the importance of compression therapy and how to properly use the garments can
also lead to non-compliance. Patients who do not understand the purpose of the treatment or how
to correctly use the garments are less likely to adhere to the treatment. Physical limitations, such
as difficulty in putting on or taking off the garments, can also affect compliance. Elderly patients
or those with physical disabilities may find it challenging to use compression garments without
assistance. Lastly, financial issues can be a barrier to compliance. Compression garments can be
expensive, and not all patients can afford them. In some cases, insurance may not cover the cost
of these garments, further exacerbating the financial burden.

In terms of cost-effectiveness, one study found that the average mean costs were approximately
US$1.62 lower per participant per year in the hosiery group than in the bandage group. This
suggests that hosiery might be a more cost-effective option for the treatment of venous leg
ulcers.

Further research conducted compared the clinical and cost-effectiveness of compression hosiery
versus compression bandages in the treatment of venous leg ulcers, concluded that two-layer
compression hosiery is a feasible alternative to four-layer compression bandages and may be
cost-effective. The cost-effectiveness of compression hosiery can be attributed to several factors.
Firstly, the cost of hosiery is generally lower than that of bandages. Secondly, hosiery is easier to
apply and remove, which can reduce the time and resources required for healthcare professionals
to change dressings. This can result in significant savings in terms of healthcare resources.
However, it’s important to note that while hosiery may be more cost-effective on average,
individual patient circumstances can significantly influence the overall cost-effectiveness.
Factors such as the size and severity of the ulcer, the patient’s ability to apply and remove the
hosiery, and the patient’s personal preference can all impact the cost-effectiveness of hosiery
versus bandages.

Discussions
The results of the studies indicate that both compression hosiery and compression bandages are
effective in treating venous leg ulcers, with similar healing times. However, there are differences
in terms of patient adherence to treatment, recurrence of ulcers, and cost-effectiveness. These
findings have significant implications for clinical practice and warrant a critical discussion.

The median time to ulcer healing was found to be similar for both treatments, around 98-99 days.
This aligns with existing literature that suggests appropriate treatment often results in healing of
venous leg ulcers within 6 months. The proportion of ulcers healing was also found to be much
the same in the two groups (70.9% hosiery and 70.4% bandage). These findings suggest that both
compression hosiery and bandages are equally effective in promoting healing of venous leg
ulcers.

However, the recurrence of ulcers was found to be lower in the hosiery group. This is an
important finding as recurrence of venous leg ulcers is a common issue that can significantly
impact a patient’s quality of life and increase healthcare costs. Therefore, the use of compression
hosiery may provide added benefits in terms of preventing ulcer recurrence.

Patient adherence to treatment is crucial for the effectiveness of both compression hosiery and
bandages. However, more patients in the hosiery group changed their allocated treatment. This
suggests that while hosiery might be a viable alternative to bandages, it might not be suitable for
all patients. Factors such as pain and discomfort, psychosocial issues, knowledge deficit,
physical limitations, and financial issues can significantly influence a patient’s adherence to
treatment. Therefore, these factors should be considered when recommending a treatment
method for venous leg ulcers.

In terms of cost-effectiveness, hosiery was found to be a more cost-effective option for the
treatment of venous leg ulcers. The average mean costs were approximately US$1.62 lower per
participant per year in the hosiery group than in the bandage group. This is an important
consideration for healthcare systems, especially in resource-limited settings.

While the findings of the studies provide valuable insights, there are several limitations that
should be acknowledged. Firstly, the studies did not consider the severity of the ulcers, which
can significantly influence the effectiveness of the treatment. Secondly, the studies did not assess
the long-term outcomes of the treatments beyond the healing of the ulcers. Future research
should address these limitations and also explore the effectiveness of these treatments in
different patient populations and healthcare systems.

The findings of the studies have significant implications for clinical practice. They suggest that
both compression hosiery and bandages are effective in treating venous leg ulcers, but there are
differences in terms of patient adherence to treatment, recurrence of ulcers, and cost-
effectiveness. Therefore, healthcare professionals should consider these factors when choosing a
treatment method for venous leg ulcers. They should also provide education and support to
patients to improve adherence to treatment. Furthermore, healthcare systems should consider the
cost-effectiveness of the treatments when making decisions about resource allocation.