Compression stockings·Ulcus Cruris Venosum

Increasing adherence through information

Study on patient education

From Bauerfeind Life Magazin on 17.06.2020

Story Check Kerstin Protz et al. conducted a study on what contribution can be made to patient education by a brochure about compression therapy for patients with venous leg ulcers (VLU).

  • The main issue with VLU patients is to develop awareness of the condition and the reasons behind its treatment.
  • Only an educated patient can be engaged in a meaningful way as an equal partner in the treatment process.
  • The study’s case group benefited considerably from the patient brochure. Compared with the control group, the case group gained significant knowledge in all specified areas.

When treating venous leg ulcers, the patient’s self-management plays an important role. Wound expert Kerstin Protz, whose tasks include being the project manager for wound research at Hamburg-Eppendorf University Hospital , Germany, investigated how patient brochures can contribute to this.

life: What is the main problem when treating patients with venous leg ulcers?

Kerstin Protz: It’s a major challenge to develop awareness of the condition itself. Those affected often believe that their leg wound was caused by a specific incident , such as bumping into a shopping cart or by an abrasion. They don’t know that the cause is an underlying vascular problem, such as chronic venous insufficiency in this case. We need to educate our patients to develop an understanding of the condition and, based on this, compliance with the treatment.

“Only an educated patient can be engaged in the treatment process in a meaningful way.”
Kerstin Protz

Kerstin Protz is, among other things, a member of the executive board at “Wundzentrum Hamburg e. V.” and a member of the advisory board at “Initiative Chronische Wunden (ICW) e. V.”.

In your opinion, how do patients respond to complying with compression therapy?

Kerstin Protz: A lot of patients find it difficult. Especially in the beginning during the decongestive phase, bandaging that is often quite thick, slips out of place easily and means shoe problems, is often rejected. Each carer also uses short-stretch bandages differently, which can cause patients to be irritated. You then hear statements like: “But yesterday, your colleague did it differently and with less pressure!” Compliance with medical compression stockings that are used during the maintenance phase and for prevention also needs to be improved.
The prerequisite for patient adherence is that the affected person understands the reasons, the benefits and the proper execution of the necessary treatment measures. Only an educated patient can be engaged in a meaningful way as an equal partner in the treatment process. In order to achieve this, patients should know the factors that contribute toward the condition, how compression therapy works, which self-care options are available, and much more. Patient brochures can help with this. If they are designed appropriately and convey the relevant topics and expert knowledge in a way that is easy to understand, brochures will improve patients’ satisfaction and treatment compliance. However, such brochures must never be used alone, but as a part of the educational process.

In a study1 published in 2019, you showed that patient brochures can support the work of treatment and nursing staff. Which topics were investigated in this study?

Kerstin Protz: In that study, we examined whether and how 136 German and Austrian patients with venous leg ulcers undergoing compression treatment would benefit from the use of a brochure. The case group completed a patient questionnaire after reading the brochure2, the control group answered the questions without having read the brochure. The patient questionnaire included six questions to assess their subjective knowledge related to compression therapy. This tested theoretical and practical knowledge about mode of action, products, and how they’re used. Thirteen pure knowledge questions followed about the impact of compression therapy, risk factors for venous disorders, self-care measures, options for self-management , use of donning and doffing aids, skin and material care and exercise to support vein function. The patients were also asked how long they had been suffering from venous leg ulcers.

What is your main conclusion?

Kerstin Protz: I’m pleased to report that , overall , patients gained significant knowledge in all specified areas by reading the brochure. 98.5 per cent of patients from the case group knew, for example, that compression therapy improves wound healing, whereas 56.9 per cent of control group patients didn’t know that. The fact that compression therapy prevents the recurrence of wounds was correctly stated by only 32.4 per cent from the control group. In the case group, however, four out of five people knew. Perhaps another example: most patients in the case group knew that people wearing compression stockings should regularly remove calluses on their feet (86.8 per cent) and cut their finger and toe nails (85.3 per cent), while 83.8 per cent from the control group didn’t find either of those particularly important. Given the fact that only one pair of medical compression stockings is reimbursed every six months in Germany, that’s quite an important factor.
The results of our study show that education using a brochure helps patients understand how necessary measures relate to treatment goals – in this case, compression therapy. If patients recognize these correlations, they will comply with treatment measures much more effectively.

Which findings surprise you?

Kerstin Protz: The numbers we obtained during the study relating to the duration of venous leg ulcers were shocking: more than 40 per cent of patients surveyed had their ulcers for more than seven months, more than 25 per cent even had them for seven to twelve months, and more than 13 per cent for over a year. These are relatively long durations that also restrict the quality of life of those affected as well as their compliance with the treatment. These figures suggest that a lot still needs to be done about the treatment of this condition. 

1  Protz, K. et al: Education in people with venous leg ulcers based on a brochure about compression therapy:
A quasi-randomised controlled trial. Int Wound J. 2019 Dec; 16(6): 1252-1262.
2  “Kompressionstherapie einfach – tragbar”, provided by Wundzentrum Hamburg e. V., 2018,
download at

Images: Kerstin Protz (Hamburg), Soares

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