Limitations of Daily Living Activities in Patients With Venous Stasis Ulcers Undergoing Compression Bandaging: Problems With the Concept of Self-bandaging.

Venous stasis ulcers (VSUs) represent both an enormous cost to the healthcare system and significant quality-of-life issue to patients. While certain high-technology products have shown promise, compression bandaging continues to be the gold standard of care. Recently, some regional Medicare carriers suggested that patients with VSUs should be able to perform self-bandaging in an effort to avoid reimbursing caregivers to provide this service. Using a database of 7251 patients from 29 wound care facilities maintained as part of an agreement under the Intellicure Research Consortium for users of Intellicure Inc's (The Woodlands, Tex) wound care software; activity of daily living (ADL) data was extracted for all patients with a VSU in whom this was collected (547 patients) to examine such an impact. Analysis showed that 55% of these patients required assistance with ADLs-the majority had issues with dressing and toileting. It is unlikely that patients who require assistance with dressing and toileting will be able to achieve adequate positioning to perform self-bandaging. Since it is possible that even patients who do not require assistance with ADLs might be unable to perform self-bandaging, the authors consider these results a conservative estimation. These results indicate that a significant number of patients are not capable of self-bandaging, thus placing their prognosis and quality-of-life at risk if they are unable to pay for the necessary professional services or do not have family members who are capable of bandaging.