Conflict of Interest Declaration
The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: none applicable.
The following Task Force members and other authors declared an intellectual conflict of interest and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees: none applicable.
CoSTR Citation
Borra V, Berry D, Djärv T, Hood N, Cassan P, Zideman D, Singletary E on behalf of the International Liaison Committee on Resuscitation First Aid Task Force.
Compression wrap for closed extremity joint injuries Consensus on Science with Treatment Recommendations [Internet] Brussels, Belgium: International Liaison Committee on Resuscitation (ILCOR) First Aid Task Force, 2019 December 9. Available from: http://ilcor.org
Methodological Preamble and Link to Published Systematic Review
The continuous evidence evaluation process for the production of Consensus on Science with Treatment Recommendations (CoSTR) started with a systematic review of compression bandages or wraps for closed extremity joint injuries (Borra, 2019 – PROSPERO CDRXXX - pending) conducted by the Centre for Evidence-Based Practice (CEBaP) at the Belgian Red Cross with involvement of clinical content experts of the ILCOR First Aid Task Force.
Systematic Review
Webmaster to insert the Systematic Review citation and link to PubMed using this format when it is available.
PICOST
The PICOST (Population, Intervention, Comparator, Outcome, Study Designs and Timeframe)
Population: Adults in the prehospital setting with a closed extremity joint injury.
Intervention: Compression wrap, elastic wrap.
Comparators: No compression wrap or elastic wrap.
Outcomes: Reduction of pain, reduction of swelling/edema (critical outcomes). Recovery time, range of motion, adverse effects (important outcomes).
Study Designs: Randomized controlled trials (RCTs) and non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies) are eligible for inclusion.
Timeframe: All years and all languages were included as long as there was an English abstract; unpublished studies (e.g., conference abstracts, trial protocols) were excluded. Literature search updated to November 3, 2019.
PROSPERO Registration CRD42020153123
Consensus on Science
For the critical outcome reduction of pain (measured by a visual analogue scale (VAS)), we have identified low-certainty evidence (downgraded for indirectness and imprecision) from 2 randomized trials (Boyce 2005 91; O’Connor 2011 255) and 1 non-randomized trial (Bilgic 2015 1496) enrolling 122 adult patients with ankle sprains, not showing benefit from the use of a compression bandage, when compared with not using a compression bandage, using a splint or using an Aircast® ankle brace (SMD, 0.34; 95%CI, -0.10–0.79; P=0.12).
For the critical outcome free from walking pain after 4 days and 8 days (measured as having pain during walking, yes or no), we have identified very-low-certainty evidence from 1 non-randomized trial (Linde 1984 177) enrolling 100 adult patients with ankle sprains, not showing benefit from the use of a compression bandage, when compared with not using a compression bandage (RR, 1.25; 95%CI, 0.78–2.11, P=0.33 and RR, 1.39; 95%CI, 0.98–1.95, P=0.06, respectively).
For the critical outcome pain at rest and pain at walking after 6-9 days (measured by a visual analogue scale (VAS)), we have identified very-low-certainty evidence from 1 non-randomized trial (Bendahou 2014 1005) enrolling 117 adult patients with ankle sprains, not showing benefit from the use of a compression bandage, when compared with use of a non-compressive stocking (MD, -4.4; 95%CI, -9.35–0.55; P=0.08 and MD, -3.30; 95%CI, -11.77–5.17; P=0.45, respectively).
For the critical outcome reduction of swelling/edema (measured by circumference measurement (cm) or ankle volume change (mL)), we have identified very-low-certainty evidence (downgraded for risk of bias, indirectness and imprecision) from 3 randomized trials (Bendahou 2014 1005; Boyce 2005 91; Rucinski 1991 65) enrolling 172 patients with ankle sprains and 1 non-randomized trial (Bilgic 2015 1496) enrolling 51 adult patients with ankle sprains, not showing benefit from the use of a compression bandage, when compared with not using a compression bandage, or using a non-compressive stocking, a splint or an Aircast® ankle brace (SMD, 0.54; 95%CI, -0.14–1.22; P=0.12).
For the important outcome ankle joint function (measured by Karlsson score), we have identified low-certainty evidence (downgraded for indirectness and imprecision) from 2 randomized trials (Boyce 2005 91; O’Connor 2011 255) enrolling 71 adult patients with ankle sprains not showing benefit from the use of a compression bandage after 10 days and 1 month, when compared with not using a compression bandage or using an Aircast® ankle brace (SMD, -0.34; 95%CI, -1.16–0.49; P=0.42 and SMD, -0.29; 95%CI, -1.11–0.53; P=0.49; respectively).
For the important outcome range of motion (ROM (% of the uninjured ankle range of motion)) after 3-5 days, 2 weeks and 4 weeks, we have identified very-low-certainty evidence (downgraded for risk of bias, indirectness and imprecision) from 1 randomized trial (Leanderson 1995 529) enrolling 73 patients with ankle sprains not showing benefit from the use of a compression bandage when compared with using an Air Stirrup® ankle brace (MD, -7 %; MD, 0 % and MD, 2 %, respectively, 95%CI could not be calculated; P>0.05).
For the important outcome recovery time (time to return to normal walking, time to return to stair climbing, time to return to walking with full weight-bearing in days) we have identified very-low-certainty evidence (downgraded for risk of bias, indirectness and imprecision) from 1 randomized trial (Beynnon 2006 1401) enrolling 142 patients with ankle sprains, not showing benefit from the use of a compression bandage when compared with using an Air Stirrup® ankle brace (only mean number of days reported; 95%CI could not be calculated; P>0.05 for all outcomes).
For the important outcome return to work, we have identified very-low-certainty evidence (downgraded for risk of bias, indirectness and imprecision) from 3 randomized trials (Bendahou 2014 1005; Leanderson 1995 529; O’Connor 2011 255) enrolling 226 patients with ankle sprains. One study (Leanderson 1995 529) showed less benefit for use of a compression bandage when compared with using an Air Stirrup® ankle brace (only median number of days reported; absolute effects could not be calculated; P<0.05). Two other studies (Bendahou 2014 1005, O’Connor 2011 255) did not show benefit for use of a compression bandage when compared with not using compression bandage (MD, -2.10 days; 95%CI, -4.97–0.77; P=0.15) or use of non-compressive stockings (only median number of days reported; 95%CI could not be calculated; P=0.20).
For the important outcome return to sports, we have identified very-low-certainty evidence (downgraded for risk of bias, indirectness and imprecision) from 1 randomized trial (Bendahou 2014 1005) enrolling 117 adult patients with ankle sprains, showing benefit for use of a compression bandage when compared with use of non-compressive stockings (only median number of days reported; 95%CI could not be calculated; P<0.02).
Treatment Recommendations
We suggest either application of a compression bandage or no application of a compression bandage for adults with an acute closed ankle joint injury (weak recommendation, very low certainty evidence).
Due to a lack of identified evidence, we are unable to recommend for or against use of a compression bandage for closed joint injuries besides the ankle.
Justification and Evidence to Decision Framework Highlights
- This topic was last reviewed in 2010 (Markenson 2010 S598) however, it did not lead to a treatment recommendation because of limited available evidence.
- All studies were performed in a hospital setting. We did not identify any evidence on closed extremity joint injuries in an out-of-hospital setting. All included evidence is therefore downgraded for indirectness.
- Studies including standard first aid for acute joint injuries, such as elevation of the injured extremity of application of cold packs, splints, braces or non-compressive stockings, as the control treatment were included in this review, as long as no compression was applied. The results may therefor suffer from confounding.
- The task force discussed that it may require training and/or practice for laypeople to apply a compression bandage correctly, which may impact feasibility as well as reduction of pain and swelling.
- The task force discussed that to apply a “compression bandage” correctly may require a commercial elastic bandage, which may impact access and health disparity.
- Most studies do not explain how much pressure is applied with the compression bandages, from what direction (proximal to distal or distal to proximal), whether they were applied with circumferential or sequential pressure nor do they say for how many days or how long per day the compression bandages were applied.
- We may not have identified some outcomes of importance, such as stakeholder satisfaction, i.e., patients with ankle sprains are unhappy if you do nothing for them; and caregivers feel like they are ‘doing something’ for an injury with application of a compression wrap.
Knowledge Gaps
- Only studies including patients with lateral ankle sprains were identified. Additional research is needed to determine whether if this recommendation can be applied to other acute closed joint injuries, such as to the wrist.
- Additional research is required in the out-of-hospital setting to confirm findings of the included studies.
- Additional research is required to determine if the intervention of application of a compression bandage compared with doing nothing/no compression bandage results in greater stakeholder satisfaction.
- It is unknown whether if a first aid provider can properly apply a compression wrap without training or with the use of simple video instructions currently available online.
- It is unsure of how much pressure is needed to produce physiological changes to the body.
- It is unsure whether lay providers can apply the compression bandage reliably over time to allow for changes in critical outcomes.
- We are unsure of the economic impact (direct and indirect medical cost, lost wages) of compression bandages related to closed joint injuries.
- We are unsure of the impact compression bandages play with other adjunct therapies administered in the prehospital setting.
Attachment
FA511-Compression-Bandage-Et D-FINAL_Revised
References
Bendahou M, Khiami F, Saidi K, Blanchard C, Scepi M, Riou B, Besch S and Hausfater P. Compression stockings in ankle sprain: a multicenter randomized study. The American journal of emergency medicine. 2014;32:1005-10.
Beynnon BD, Renstrom PA, Haugh L, Uh BS and Barker H. A prospective, randomized clinical investigation of the treatment of first-time ankle sprains. The American journal of sports medicine. 2006;34:1401-12.
Bilgic S, Durusu M, Aliyev B, Akpancar S, Ersen O, Mehmet Yasar S and Ardic S. Comparison of two main treatment modalities for acute ankle sprain. Pakistan journal of medical sciences. 2015;31:1496-1499.
Boyce SH, Quigley MA and Campbell S. Management of ankle sprains: a randomised controlled trial of the treatment of inversion injuries using an elastic support bandage or an Aircast ankle brace. British journal of sports medicine. 2005;39:91-6.
Leanderson J and Wredmark T. Treatment of acute ankle sprain. Comparison of a semi-rigid ankle brace and compression bandage in 73 patients. Acta orthopaedica Scandinavica. 1995;66:529-31.
Linde F, Hvass I, Jurgensen U and Madsen F. Compression bandage in the treatment of ankle sprains. A comparative prospective study. Scandinavian journal of rehabilitation medicine. 1984;16:177-9.
Markenson D, Ferguson JD, Chameides L, Cassan P, Chung KL, Epstein JL, Gonzales L, Hazinski MF, Herrington RA, Pellegrino JL, Ratcliff N, and Singer AJ. Part 13: First aid: 2010 American Heart Association and American Red Cross International Consensus on First Aid Science with Treatment Recommendations. Circulation. 2010 Oct 19;122(16 Suppl 2):S582-605.
O'Connor G and Martin AJ. Acute ankle sprain: is there a best support? European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 2011;18:225-30.
Rucinkski TJ, Hooker DN, Prentice WE, Shields EW and Cote-Murray DJ. The effects of intermittent compression on edema in postacute ankle sprains. Journal of orthopaedic and sports physical therapy. 1991;14:65-9.