Elastic or inelastic compression? Reported evidence from clinical trials

Evidence for compression therapy found in literature mainly comes from clinical studies, preferably randomized controlled trials (RCTs) and systematic reviews (SR), which are often complemented by research data, expert opinion or by data from technology assessment or regularization documents. Differences between materials/methods/intervention in clinical trials can be partly explained by variability in focus, or due to country specific issues. Results from RCTs and SRs, and the interpretation of these results may vary depending on definitions used and the adequacy of data. In the first place, the baseline comparability of study groups depends very much on the accuracy of the diagnosis. Secondly, results will very much depend on the intervention used, whether compression is used alone, or whether it is part of a more complex management like decongestive treatment including other physical methods, surgery, or pharmacological treatment. A third consideration relates to the outcome parameters, the methods used to measure them, and the length of follow-up. Properties of compression materials have been redefined and standardized, and new insights in the physiological effects of compression treatment have shaken existing myths and dogmas in this field. RCTs using out-dated definitions and classifications of materials have led to systematic reviews and recommendations based on the same misunderstanding; it is left to the alert reader to interpret their results with caution.