NEW TOOL: the International Compression Club compression questionnaire (ICC-CQ) for evaluating the effect of compression and its acceptance by the patient
The prevalence rate of chronic lymphedema is estimated at 150 million people worldwide. In more advanced disease, there may be oedema, skin fibrosis and ulceration. Compression therapy is the mainstay of lymphedema treatment and of conservative measures in chronic venous disease. Compression therapy can be applied as bandages, compression garments and as intermittent pneumatic compression. To evaluate the effect of compression material and systems, often the pressure under the material or system (i.e. interface pressure) is measured. In addition, quality of life of the subject and disease-related symptoms can be evaluated using questionnaires such as the ULL-27, Lymph-ICF,[2, 3] LYMQOL, FLQA-l and LyQLI. Questionnaires specific to evaluate chronic venous disease are VEINES-QOL/Sym,[7, 8] CIVIQ, TLQ-CVI, VLU-Qol and Wound-Qol. However, none of these questionnaires specifically evaluate the effect of compression therapy and the experience of patients using the compression. Besides the pressure and quality of life and symptoms, it is necessary to evaluate other aspects related to compression, such as the ease of application and removing of compression and the comfort and complications of compression. To our knowledge, no reliable and valid compression-specific questionnaire existed, until now, to assess different aspects of compression materials and devices applied in patients with lymphedema or chronic venous disease.
Therefore, our research team contributed in conducting an international study with the aim to develop an assessment tool to evaluate the effect of different kinds of compression materials and devices applied in patients with lymphedema or chronic venous disease. A second aim was to investigate its reliability and validity, and a third aim was to translate the questionnaire into English.
To do so, 11 experts in applying compression and 51 Dutch patients with experience of using compression were involved in the construction process. One part of the ICC-CQ has to be completed by the patient (ICC-CQ-P) and evaluates seven domains. The other part has to be completed by the health care provider (ICC-CQ-H) and comprises three domains. Reliability and validity of the final version was investigated in a new group of 79 Dutch speaking patients with lymphedema or chronic venous disease, wearing compression garments (N=52) or bandages (N=27).
Except for one domain, the Intraclass Correlation Coefficients for test-rest/interrater reliability ranged from .55 to .93. Cronbach alpha for internal consistency ranged from .71 to .97. 89% of the patients fully understood the questionnaire indicating good face validity and 87% found it complete indicating good content validity. Construct validity was considered good since 10 out of 11 hypotheses were accepted.
So… what does this tool add to the currently existing knowledge and practice?
The ICC Compression Questionnaire is the first reliable and valid tool to evaluate different aspects related to compression that can be applied in clinical practice as well as in research. With this questionnaire, not only the pressure from the compression, the disease-related symptoms and the functionality while wearing the compression are being evaluated. Also the dosage of the compression, the ease of its application and removal, the comfort and complications related to compression are assessed. At this stage, the questionnaire is available in Dutch and English and accessible at pur website here.
By Tessa De Vrieze
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