Page 177 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

152 Chapter 6. Treatment

Compression bandages need to feel firm, especially around
the ankle and patients need to be able to move the ankle and
foot freely, as a loss of range of motion at the ankle increases
an individual’s risk of developing ulceration and reduces
healing (Barwell et al. 2001 ). Indeed, it has been recom-
mended that people wear the highest level of compression
that is comfortable (Nelson 2012 ). However in some cases
it has been reported that this causes pain for the patient as
they are unable to move their toes (Stephen-Haynes 2006 ).
Furthermore, not all patients can tolerate high compression
bandages due to the pain and discomfort, and according
to some studies, compression bandages can cause pain for
patients that can result in poor concordance (Briggs and
Flemming 2007 ; Todd 2011 ; Weller et al. 2013 ). For instance,
Briggs et al. ( 2007 ) found that one participant they inter-
viewed indicated that compression bandages began to cause
excessive discomfort and pain that was intolerable and they
would contact their clinic immediately to be seen at the
earliest time available to review the situation. Furthermore,
failure of satisfactory pain relief for the patient caused non-
concordance of compression bandages, which resulted in
poor patient outcomes. Indeed, Miller et al. ( 2011 ) identified
that increased pain was a significant predictor of non-concor-
dance with compression bandages.
Additionally, it has been noted that adherence to treatment
depends on patient willingness to adapt to treatment regimes.
Annells et al. ( 2008 ) explored the willingness of patients to
comply with compression bandages reporting that one of the
reasons for low concordance was that pain caused by either
the tightness, or the resultant swelling, from bandages. As
well as this, bandages that were uncomfortable for the patient
and caused pain can be a constant reminder of the wound
and therefore affect the patient’s self-image, identity and
day-to-day life. Furthermore, Dereure et al. ( 2005 ) identified
that over 65 % of patients considered applying compression
very difficult and 23 % found wearing compression bandages
painful. Although multicomponent compression bandages
are reported to achieve the best healing rate without pain,