Over the past few years, it has been increasingly
recognised that the current recommendations
for compression therapy are not su cient to
ensure long-term maintenance that prevents rebound
oedema. Following intensive decongestive lymphatic
therapy (DLT), many patients experience a recurrence
of their swelling within one year (Quéré et al, 2014).
The reasons for this are often extremely complex and
di cult to unravel. However, one factor is the typical
recommendation that compression therapy should
be worn only during the day, rather than for 24 hours
(Vignes et al, 2011).
Further research is required to assess the e cacy
of products developed to address these issues. This
supplement contains cases studies describing patients’
and nurses’ clinical experience with an advance in
compression: JOBST® Relax, a garment that has been
specially designed to be worn at night. The outcomes
indicate that both health professionals and patients
found it bene cial.
Patients with lymphoedema are a highly heterogeneous
population, even when the underlying aetiology, such as
breast cancer treatment, is considered. As demonstrated
in the case studies in this supplement, they can experience
many comorbidities which, along with the underlying
disease process, will a ect their swelling. For example,
breast cancer-related lymphoedema is often described
as a minor problem that has been largely eradicated
due to improvements in surgical technique. Despite this,
approximately 25% of patients still develop lymphoedema
(Mo att et al, 2003), although early surveillance might
ensure they are identi ed early and o ered treatment
to prevent a deterioration. In addition, complex
postoperative complications, such as seroma and wound
infection, can occur, increasing the risk of swelling, as can
wider issues such as obesity and treatments including
radiotherapy, chemotherapy, reconstructive surgery and
repeated surgery (DiSipio et al, 2013; Paiva et al, 2013;
Rebegea et al, 2015).
Lymphoedema in the leg is more complex to manage
than arm oedema, and can have a greater impact on
quality of life, possibly owing to the e ect on mobility,
which in turn can cause social isolation (Tiwari et al, 2006).
As the case studies show, the main outcome that
facilitates adherence with treatment is patient comfort.
Lymphoedema is a life-long problem and there is a
need for garments that can address this issue. In some
cases, JOBST Relax was used in patients with brachial
plexopathy or who were receiving palliative care, where
garments are required that provide comfort as well as
compression. The patients’ symptoms improved, despite
the severity of their condition. In other cases, night-time
compression enhanced patients’ control of their swelling
and provided increased comfort and relief. They also
found it aesthetically pleasing.
The case studies also show that patients’ preferred
outcomes can di er to those of health professionals.
Traditionally, the outcome of lymphoedema treatment
has been de ned as the change in limb volume. While
this remains an important factor, given that uncontrolled
oedema is associated with pain, numbness, reduced
function and cellulitis, factors such as comfort, enhanced
wellbeing and improved self-management may be more
important to people managing a life-long condition.
The opportunity to use night-time compression to
increase the e ectiveness of treatment is an important
development. Further innovations, like JOBST Relax, are
likely in this area for many reasons, including the need
for better management and to reduce intensive DLT
treatments for recurrent swelling and cellulitis.
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