Lymphoedema Evidence Library › Topics › Compression
Compression
Compression: bandaging, garments, wraps and pneumatic devices
55 sources
Evidence in one minute
- Garments alone have strong trial support in early BCRL; highest tolerated class (~20–60 mmHg); no trials to choose flat- vs circular-knit. Executive Committee of the International Society of Lymphology 2023
- Intensive phase: inelastic multilayer short-stretch bandaging (high working, low resting pressure); bandages with static stiffness index ≥10 give effective compression. European Wound Management Association ; senior editorial advisor Moffatt CJ; consultant editors Mortimer P 2005 · Charles 2013
- Garment choice: circular-knit for regular shapes; flat-knit (custom, stiffer) for distorted limbs, skin folds and lipo-lymphoedema; wraps for self-management and adherence. Lymphoedema Framework ; senior editorial advisor Moffatt C 2006 · Fletcher 2024 · Keast 2025
- Arterial safety (legs): ABPI <0.5 — no compression, refer vascular; 0.5–0.8 — reduced compression (≤25 mmHg) under specialist supervision; SA statement uses <0.79. UK: ≤20 mmHg may start before ABPI if no red flags. Lymphoedema Framework 2006 · Davey 2014 · Davey 2018 · Wounds 2015
- Heart failure: not a contraindication once compensated; start 20 mmHg both legs and step up one leg at a time over ~2 weeks. Wounds 2023
- Pneumatic compression (IPC): multi-chamber sequential with root-of-limb/trunk coverage; avoid single-chamber pumps and a fibrotic ring at the limb root. An advanced device beat a simple pump at home in BCRL (very low certainty, revised 2026-10-08). Fife 2012 · National Lymphedema Network Medical Advisory Committee 2011
- Garment replacement: every ~6 months; two garments per 6 months is usual (useful for medical-aid motivation). Wounds UK / BSN medical unknown · Davey 2014
- SA reality: garments often made by occupational therapists with unmeasured pressures; long custom lead times; neoprene wraps may give only ~20 mmHg. Davey 2018 · Vivian 2019
Industry note: almost every compression guidance document held is manufacturer-sponsored (Sigvaris, BSN, Lohmann & Rauscher, medi, Essity, Activa, Haddenham, Juzo).
Update 2026-10-08 — downloaded evidence
- Prevention (revised 2026-10-08): a sleeve for 4–9% subclinical swelling was not shown to prevent BCRL (PLACE, inconclusive, low certainty); CALGB 70305 did not test prophylactic compression (activity-only sleeve). BIS-triggered sleeves led to less tape-defined chronic BCRL than tape-triggered sleeves (PREVENT, low certainty). Ridner 2022 Paskett 2021 · Bundred 2023 · Ridner 2019
- IPC: meta-analysis of 14 RCTs (many Chinese) — RR 0.36 for developing BCRL with early low-pressure IPC; little effect in established lymphoedema. Very low certainty (revised 2026-10-08: 5 small prevention trials, contradictory search dates, a subgroup estimate outside its own CI). Su 2025
Appraisal update 2026-10-09
- Manufacturer-linked material (BSN/JOBST leaflet, Wounds UK quick guides, Charles 2013 SSI article) is accurate on principles but brand-led; cite the ILF/ISL documents for recommendations. The LIPLEG critique arguing that compression was “underrepresented” was translated with compression-industry funding. Wounds UK / BSN medical unknown · Charles 2013 · Bertsch 2025
Update 2026-10-09 — open-access batch 1 (2020–2026 trials and reviews)
- Adjustable wraps v multilayer bandaging (Reisshauer 2025 RCT): self-applied wraps non-inferior for lower-leg volume over 10 days of intensive CDT (difference 9 mL, margin 50 mL), 8 minutes quicker and more comfortable — low certainty; funded by the wrap maker. Reisshauer 2025
- IPC for leg lymphoedema (O'Donnell 2026 guideline review): seven small RCTs; the review says moderate certainty, but by its own table only one sequentially allocated trial showed a volume difference v no IPC — low. O'Donnell TF Jr 2026
- Improvised compression in Africa (Chang 2022, Kenya): locally made zinc-paste bandages (~US$2 per leg per week) added to chemotherapy did not improve Kaposi sarcoma leg lymphoedema in a 30-patient pilot — very low. Chang 2022
Update 2026-10-09 — open-access batch 2
- Night-time compression: a night sleeve added to day garments reduced rebound after intensive therapy (LYMphoNIGHT, 56 women, Thuasne-funded) — low. Now supported by the independent McNeely 2022 RCT — see below. Borman 2026
- Garment-first for early BCRL not shown inferior to intensive bandaging (very low). Jeffs 2024
Update 2026-10-09 — papers supplied by Dr Weir
- Night-time compression (revised 2026-10-09): an independent Canadian RCT (LYNC, 120 women) found night compression added to a day sleeve reduced excess volume by 11–15 percentage points over 12 weeks; self-bandaging worked as well as a US$450 night garment — moderate (sustained benefit low). With LYMphoNIGHT, two trials now agree. McNeely 2022
- Sleeve at diagnosis of mild BCRL: a class 1 sleeve cut 6-month progression from 57% to 16% (Swedish RCT, 70 women, unblinded measurement) — low; 43% without a sleeve did not progress. Blom 2022
Update 2026-10-09 — open-access batch 3
- Prophylactic compression after node dissection: delays swelling while worn — arm (Paramanandam 2022, moderate for first year) and leg after groin dissection (Brown 2026: 11% v 45% at 3 months, but 39% v 55% at 24 months, NS — very low). Paramanandam 2022 · Brown 2026
- Garments first: Dayes 2013 — garments alone nearly as effective as intensive CDT for BCRL (low). Dayes 2013
Update 2026-10-09 — open-access batch 4
- Non-pneumatic active compression devices (Dayspring, Koya Medical): two crossover trials report large benefits over pneumatic pumps — arm (NILE, 64.6% v 27.7% edema reduction in 28 days) and leg (TEAYS, 370 v 83 mL over 90 days). Both are sponsor-run, unblinded, with self-reported adherence and (TEAYS) a completer analysis — very low. The AVF/AVLS position statement endorsing them relies on these trials only. Rockson 2022 · Barfield 2025 · Jacobowitz 2026
- Light hosiery in a self-care package after radical hysterectomy reduced 1-year leg lymphoedema (13.6% v 34.5%) — low. Wang 2020
- Social cost of a sleeve in mild BCRL: more embarrassment and practical burden with a garment (Blom 2023 QoL companion). Blom 2022
Update 2026-10-09 — open-access batch 5
- Bandage pressure: high pressure not shown better (very low). Duygu-Yildiz 2023
- Pump adherence: text reminders did not help (Tactile-funded, 29 women). Maingi 2023
Update 2026-10-09 — open-access batch 6
- Pump dosing: 1 hour daily is enough (Keeley 2023 pilot, very low). Garments during exercise: optional (Wittenkamp 2025). Keeley 2023 · Wittenkamp 2025
How the evidence points
| High | Mod. | Low | V. low | None | |
|---|---|---|---|---|---|
| Positive | 0 | 2 | 7 | 5 | 0 |
| Null or negative | 0 | 1 | 6 | 3 | 0 |
Sources on this page with a comparison, by the result of their primary outcome and the GRADE certainty of their main finding (Mod. = Moderate, V. low = Very low, None = not graded). Context sources are not counted. How direction is decided.
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