Layered compression bandages may be the "gold standard" in treatment of venous leg ulcers, but according to a new study, 2-layer hosiery is just as effective—and less costly. Rates of adherence, however, may mean that the approach is "not suitable" for all patients, according to researchers.
The study, which appears in the March 8 edition of The Lancet (abstract only available for free, but see note at the bottom of this story for additional access information), analyzed treatment results among 453 patients with venous leg ulcers at 34 facilities in England and Northern Ireland. The patients were divided evenly into 2 groups—1 receiving 4-layer compression bandage treatment that authors said is regarded as the "gold standard," and the other receiving 2-layer hosiery (understocking and overstocking). Each group was monitored to assess healing rates and proportions.
The results showed nearly identical rates of healing, with a 99-day median healing time in the bandage group and a 98-day median time in the hosiery group. Likewise, the overall proportion of patients whose ulcers healed through compression treatment was nearly the same for each cohort, at 70.4% for the bandage group and 70.9% for the hosiery group. "Our results indicate that 2-layer hosiery is as effective as 4-layer bandage for healing of venous leg ulcers," the authors write. The study also found a decreased chance of recurrence among the hosiery group.
The authors also looked at overall cost-effectiveness for each approach and found that at least for patients in the UK's National Health System, average mean costs were about $485 less per year for the hosiery participants, a savings realized mostly because of fewer nurse consultations.
After making additional adjustments for ulcer area and duration, participant mobility, and participating facilities, researchers also concluded that the hosiery group had "slightly more" quality adjusted life-years than the bandage group. "These findings suggest that hosiery is a dominant treatment—that is, on average it results in higher quality-adjusted life-years and lower costs than do bandages," the authors write.
Though outcomes were good for the hosiery group, researchers were surprised at compliance rates. Authors expected that because of the ease of application and greater mobility provided, the hosiery treatment would enjoy strong compliance. Instead, they noted, 38% of hosiery participants changed to a nontrial treatment before their ulcers had healed, compared with 28% of the bandage group (combined rate: 33%). "Our results suggest that participants had more complaints about discomfort with hosiery, which led many participants in this group to change to another treatment," they wrote.
The complete article will be available free to members in approximately 3 months via APTA's PTNow ArticleSearch, the association's research access tool. Check out ArticleSearch regularly, or e-mail APTA library staff to be notified when this article becomes available. For synthesized information on the management of venous leg ulcers, members can visit PTNow to access full-text clinical practice guidelines and 4 full-text Cochrane Reviews.
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