We Have Numbers Of Free Samples

Which method of compression is more effective for post-operative limb compression in patients who underwent varicose vein surgery?

PICO

Population (patients) – Patient who underwent varicose vein surgery

Intervention – Compression elastic stockings

Comparison – Compression elastic stockings versus other interventions, such as Compression bandages, sclerotherapy, surgery, radiofrequency ablation endovenous laser treatment

Outcome – Reduced thromboembolism or edema with decreased pain (primary)
Improved quality of life (secondary)

In medical domain, PICO framework is used for evidence based practice that further enables the medical professionals to construct an answerable clinical or healthcare related questions. PICO framework helps to develop literature search strategies (Ackley & Ladwig, 2010). Evidence-based practice recommends health professionals to formulate questions considering population, problem, intervention, comparison and consequences. These elements enable to make PICO framework. Any formulated question needs to be linked with patient population, or an identified problem and structure in a way that simplify the presentation of a relevant answer to the developed question. PICO framework makes this process easier and helps in developing clinical questions.

Linking PICO to clinical queries helps in effectual literature search. Jewell & Jewell, (2011) stated that PICO makes it easier and effective to answer a clinical-based question compare to those, which do not involve a PICO framework to develop a research question.

PICO represents:

P: population or patient or problem (what is the issue? / Most important population or patient characteristics? / co-existing conditions)

I: intervention (Major intervention identified)

C: /comparator/control/comparison (Major comparison intervention)

O: outcomes (Expected improvements, affects or measures or)

Rationale

Varicose veins are dilated superficial veins generally observed in the legs. The dilation range varies based on the causative factors and can range from less than 1mm to 1-3 mm. Literature show various causes behind the formation of varicose veins, among all, deep vein thrombosis and genetic link have majorly demonstrated strong association. Some literature suggest that degeneration of groin valve leads to varicose vein formation (Ashby, Gabe, & Ali, 2014). On the contrary, research conducted by Marsden et al., (2015) demonstrated that almost 40% affected individuals do not have sapheno-femoral junction. Ostler, Holdstock, Harrison, Fernandez-Hart, & Whiteley, (2014) in this regard have mentioned that affected individuals’ loss the elasticity of the tissue in the venous wall that leads to venous hypertension, total dilation and reflux. This situation is aggravated by ineffectiveness of the venous valves within the axial veins. All these situations combine and leads to varicosities. Limb compression after venous surgery is significant in order to prevent postoperative issues, for instance reduction of pain, venous thromboembolism, hemorrhage, related edema and so on. It has been identified that in Australia on an average almost 7% – 40% men and 25% – 39% women are affected with varicose veins. However, there is lack of information on the prevalence of varicose veins among the Australian population. This indicates a need to focus on the issue in order to improve the quality of life of the citizens (“Varicose Veins – Specialist Vein Care”, 2016).

A study by Mosti (2013), have demonstrated techniques and duration of post-treatment compression. It has been identified that compression therapies after varicose veins surgery range from no compression, compression bandaging to elastic stockings. However, there is a lack of information present in the literature on the duration of compression that need to be applied on the surgical site after surgery. The study has revealed during supine positon pressure of 10-15 mmHg and in standing position 40-50 mmHg is required to obstruct superficial veins within the thighs. It has also been explored that inelastic bandaging achieved 63 mmHg compression pressure and eccentric compression achieved 98 mmHg compression pressure during standing position. Post-surgery adverse effect was fewer among patients recommended with inelastic compression bandaging and fewest in eccentric population. Eccentric compression after ‘endovenous laser ablation’ of saphenous vein diminished pain after surgery. The study outcomes have informed that high level of compression is effective in reducing post-operative complications along with pain, where more compression is achieved by eccentric and inelastic bandaging.

Another study by Kapp, Miller, & Donohue, (2014) demonstrated the acceptability and application of metal or material frame devices for the application and removal of compression stockings, which reduces the chance of venous leg ulceration. The devices are majorly acceptable by the aged population, who strive to prevent venous leg ulceration. However, this does not indicates that the aged population are prone to develop venous leg ulceration. The devices are user-friendly with stocking characteristics that also promote the adherence to wear stockings. Health care professionals and service users demonstrated confidence about such devices, as it promoted self-management among the aged population, especially who are living alone in their residences and have less financial investment capacity. However, this study did not indicate whether the same devices are equally beneficial for other population and thus hold certain limitation.

Another study by Bakker, Schieven, Bruins, van den Berg, & Hissink, (2013) demonstrated effectiveness of duration of applying compression stocking following endovenous laser ablation (EVLA) on saphenous vein that reduced pain and improves quality of life. The researchers have carried out a randomised controlled trial, where divided the sample population into two groups: one used compression stocking for 7 days and the other for 48 hours. Pain and quality of life were evaluated after therapy and ultrasound imaging have been performed after three months treatments to assess the rate of venous occlusion. Ultrasound result revealed no venous occlusion and deep venous thrombosis. It has been revealed that wearing compression stockings for more than 48hours after EVLA reduces pain, improve mobility, physical functioning and thus enhance the quality of life of the affected individuals. However, another question that could be raised in this regard that whether wearing compression stockings more than 48hours would also be beneficial.

Affected patients are recommended with various management options: compression therapies, surgical treatment and endovenous therapy that includes sclerotherapy, which considers applying foam or liquid or foam and could be ultrasound guided, UGFS); endovenous laser therapy (EVLT); radiofrequency ablation (RFA) and mechanical, which involves application of rotating catheter or steam. The treatment choice is depends upon general health, symptomatology and age of the affected patients. However, limited evidences are available on the most effective compression therapy among the recommended treatment options. Hirai et al., (2011) stated that compression stockings are majorly used for compression therapy. However, there is a lack of information available on the other available treatment options. This indicates a need to review already available literature to recognize the most beneficial compression therapy for the individuals, who underwent varicose vein surgery.

Literature Search Strategy

To derive appropriate information on the selected research topic, effectiveness of post-operative limb compression, the databases maintaining authentic journal articles are searched. As opined by Machi & McEvoy, (2009) obtaining data from authenticated sources eliminates the possibilities of errors and bias in research result. The articles providing thorough insights on post-operative limb compression in patients with varicose vein surgery are considered. Articles, reports and textbooks identifying various compression methods and their effectiveness, especially post-operative limb compression patients are recognised and chosen based on the reliability of the authors, publishers and publications date, as the most recent journals provides up-to-date information. Databases like PubMed, Science Direct, Google Scholar and Elsevier are searched, as these sources are reliable and authentic, contain good quality articles and provide specific information on selected topics. The key words used for the literature search to obtain relevant information on the selected topic are:

Key Words
Varicose vein	Compression therapy	Surgery
Compression stockings	Compression bandages	Elastic stockings
Post-operative limb compression	Limb compression	Effective compression therapy

 

While key words are provided in the search box of the reliable databases, on an average it has given rise to almost 20 articles per page. Thus, almost 100 of articles have been found which are relevant to the selected topic. Inclusive and exclusive criteria have accelerated the search process. The articles written in English and published within last 10years are selected to carry out this research, whereas, articles written in other languages and published beyond last 10years are discarded. This has further ensured the inclusion of most recent information in the present research. Research works which were carried out under strict ethical considerations have been selected for review to support the present research. Secondary data collected from such articles enhance the reliability, authenticity and replicability of the present research. Also, application of Boolean operators, such as ‘OR’, ‘NOT’, ‘AND’ enabled the researcher to combine key words that has given rise to more relevant papers, such as: varicose vein surgery and post-operative limb compression, compression and risk of venous thrombosis reduction. At the initial point of time, the population have not been selected, hence the literature search generated information on diverse population, which might have affected providing the justification of the selection. However, selection of study population as patients, who have undergone varicose vein surgery, enabled the researcher to justify the selection of the topic.

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