Table 1 TiDier table describing control and intervention group treatments
Name | Treatment as usual (TAU) | Trial treatment (TT) |
|---|---|---|
Why | Compression for hand oedema is usually achieved through Lycra gloves which exerts around 35 +/− 5 mmHg pressure on the tissues of the hand [10]. The garment acts as an external counter pressure [10, 11] which compensates for the inelasticity of oedematous tissues and therefore improves circulatory efficiency by facilitating venous and lymphatic flow [11, 13] Massage techniques are used to stimulate the lymphatic system [13]. Different methods are documented in the literature which employ various degrees of force or pressure on the skin directing the oedema towards regional lymph nodes. Traditional ‘retrograde massage’ uses a moderate force ‘milking’ action but is considered too aggressive for the delicate lymphatic system to cope with and has been questioned [8]. Instead, a lighter tractioning of the skin has been proposed in a longitudinal direction to produce a stretch reflex to the skin [11]. Both methods are used in clinical practice Elevation permits gravity to assist with the drainage of oedema from the distal limb [8]. Elevation alone [3] is not effective in reducing oedema but is recommended in combination with other modalities | Kinesiology tape is designed to mimic the elastic properties of the skin by lifting the skin to allow greater interstitial space and encourage lymphatic drainage. In contrast to the traditional compression method, it is designed to push the fluid proximally into the venous and lymphatic system [6]. The tape is said to be unique in that it mimics the elastic properties of the skin and its wave-like grain provides a pulling force to the skin creating more space by lifting the fascia and soft tissues under the areas where it is applied [18]. This multifunctional tape can be applied anywhere on the face or body. The benefit of using it in the hand, unlike an oedema glove or other form of compression, is that it leaves the majority of the skin surface free for sensory feedback which is essential for functional use. It can also be worn in water. As the tape is elastic and stretches up to 55–60% of its length, it also allows for unrestricted movement [18, 19] Massage: as per TAU Elevation: as per TAU |
What — materials |
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What — procedures | Standardised oedema management programmes designed through an Internet-mediated Delphi consensus method with 8 volunteer hand therapy experts. The standardised programme was then made into a patient instruction leaflet which was made accessible to patients during a process of meetings and reviews with a patient advisory committee | |
Who | Treatment was demonstrated to patients by members of the hand therapy team. These are occupational or physical therapists who specialise in hand therapy Hand therapists regularly advise patients about managing their oedema following injury or surgery and prescribe a combination of compression, elevation and massage as required All therapists involved in the trial were trained by the PI on the treatment protocol and method of implementing each treatment | |
How | All therapy sessions were delivered on a face-to-face individual basis. The therapist equipped the participant with the materials required to self-administer the programme unsupervised at home. This included the application of kinesiology tape and compression as advised by their therapist and supported by a written information sheet | |
When and how much | Wear for 20–24 h a day, removing for hygiene for up to 12 weeks | Applied to the skin full time for 3–5 days. No tension at the proximal anchor, 0–25% tension of the central tape |
Massage: 5–10 min, 3–6 times a day for at least 2 weeks or until the swelling has resolved Elevation: As much as possible during the day and night when the hand is not being used. Continued until the patient and therapist mutually agree the oedema has subsided | ||
Tailoring | Latex-free versions available | A 24-h rest period can be utilised between application but is not essential if there has been no issues |
Massage: Reduce frequency and duration if unable to tolerate massage or if a smaller area is affected Elevation: Active elevation or using Bradford sling in the day and Bradford sling or pillow day or night | ||
Modifications | Remove if vascularity compromised | Remove in cases of skin irritation |
Massage: Discontinue if pain or swelling increases Elevation: Discontinue if pain (in neck, shoulder or elbow), sensation or symptoms worsen or if vascularity compromised (colour changes to digits) | ||
How well | There were no planned or actual assessments of treatment fidelity. A patient adherence diary was used to record the extent to which treatments were adhered to on a weekly basis, either not at all, in part of as advised | |
