Intermittent pneumatic compression for treating venous leg ulcers

E Andrea Nelson, Raj Mani, Kate Thomas, Kathryn Vowden
Cochrane Database of Systematic Reviews 2011, (2): CD001899

BACKGROUND: Intermittent pneumatic compression (IPC) is a mechanical method of delivering compression to swollen limbs that can be used to treat venous leg ulcers and limb swelling due to lymphoedema.

OBJECTIVES: To determine whether IPC increases the healing of venous leg ulcers. To determine the effects of IPC on health related quality of life of venous leg ulcer patients.

SEARCH STRATEGY: For this update we searched the Cochrane Wounds Group Specialised Register (searched 10 December 2010); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4); Ovid MEDLINE  (2007 to November Week 3 2010); Ovid MEDLINE (In-Process & Other Non-Indexed Citations December 09, 2010); Ovid EMBASE (2007 to 2010 Week 48); and EBSCO CINAHL (2007 to 3 December 2010).

SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared the effects of IPC with control (sham IPC or no IPC) or made comparisons between IPC treatment regimens, in venous ulcer management.

DATA COLLECTION AND ANALYSIS: Both review authors reviewed titles and abstracts and agreed on full studies to be retrieved. One review author extracted data and assessed studies for risk of bias and this was checked by a second review author.

MAIN RESULTS: We identified seven randomised controlled trials (including 367 people in total). Only one trial was at low risk of bias having reported adequate randomisation, allocation concealment and blinded outcome assessment. In one trial (80 people) more ulcers healed with IPC than with dressings (62% vs 28%; p=0.002). Four trials compared IPC plus compression with compression alone. The first of these trials (45 people) found increased ulcer healing with IPC plus compression than with compression alone (risk ratio for healing 11.4, 95% Confidence Interval 1.6 to 82). The remaining three trials (122 people) found no evidence of a benefit for IPC plus compression compared with compression alone.One small trial (16 people) found no difference between IPC (without additional compression) and compression bandages alone. One trial (104 people) compared different ways of delivering IPC and found that rapid IPC healed more ulcers than slow IPC (86% vs 61%).

AUTHORS' CONCLUSIONS: IPC may increase healing compared with no compression, but it is not clear whether it increases healing when added to treatment with bandages, or if it can be used instead of compression bandages. Rapid IPC was better than slow IPC in one trial. Further trials are required to determine whether IPC increases the healing of venous leg ulcers when used in modern practice where compression therapy is widely used.

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