Impact of Compression Therapy on Cellulitis

INTERVENTION: Participants in the control and intervention groups will receive education regarding the benefits of skin care and how to prevent cellulitis at an initial appointment. The initial appointment will take approximately 60‐90minutes and will conducted in individual format. Education will involve a handout (created for the study) and verbal education regarding how to maintain good skin integrity and prevent infection through moisturising regularly, minimising trauma to skin (long pants, closed shoes, insect repellent, sunscreen etc), managing minor wounds/abrasions/bites (using antiseptic creams and covering with dressings), minimising risk of tinea/fungal infections between toes (dry between toes, thongs in public pools/showers) and managing inflammatory skin conditions. The intervention group will be provided with skin care education but the initial appointment will also be used to plan appropriate compression therapy, which will then be provided in subsequent additional appointments. The treatment plan will be developed by a qualified level 1 lymphoedema physiotherapist (or physiotherapist supervised by a level 1 lymphoedema therapist) based on the participants requirements (e.g severity of swelling, functional capacity, and ability to do/doff compression garments). Compression therapy will consist of prescription of appropriate compression garments and where indicated provision of a period of compression bandaging to minimise swelling prior to measure for and fit of compression garments). The number of appointments necessary for provision of compression therapy will vary based on patient requirements. Patients may require between 1‐6 appointments per episode of care and appointments may range from 30‐90 minutes. Time per appointment and number of appointments will vary based on severity of oedema (patients with more severe oedema will require more compression bandages to reduce oedema), patient function and comorbidities, and number of legs affected). Compression garments will be selected from the current range available on the Australian market and may include ready to wear or custom made garments, including wrap systems. The initial garments provided to the patient free of charge will be from Haddenham Health Care, who have a range of ready to wear and custom made garments which are available on the Australian market. Following this, participants in both groups will be followed for up to three years at regular intervals (6 monthly) to have outcomes measures taken and to continue to receive the allocated treatment (skin care education with or without compression therapy). Compression garments with or without bandaging will be renewed regularly (every 6‐12 months). ‐ Clinicians who providing chronic oedema management and education to prevent cellulitis will be qualified level 1 Lymphoedema physiotherapists or be supervised by qualified level 1 lymphoedema physiotherapists. ‐ Participants will be seen at Calvary Public Hospital Bruce outpatient physiotherapy department Assessments will be done face to face where possible. Phone contact will be made at times to collect certain data for participants who cannot attend scheduled appointments ‐Compliance with treatment will be monitored at regular assessments CONDITION: Lower limb Chronic Oedema Lower Limb Recurrent Cellulitis ; SECONDARY OUTCOME: If participant was hospitalised for episode of cellulitis recurrence ; ; Hospitalisation will be based on patient self report and may be confirmed through medical record review or from General practitioner report when deemed necessary by the clinician. INCLUSION CRITERIA: 1. The patients is over 18 years of age 2. The patient is identified as having chronic oedema (oedema persisting more than 3 months) in one or both legs PRIMARY OUTCOME: Percent change in volume of leg circumferences (cm) and oedema (ml). Perometer will be used to assess leg volume. Tape measure will be used to measure leg circumferences. Quality of life using LYMQOL questionnaire Time to first episode of recurrent cellulitis (days) ; Diagnosis of cellulitis will be confirmed through patient report. Diagnosis may be confirmed through medical record review or from General practitioner report when deemed necessary by the clinician. 3. The patient has a history of 2 or more episodes of cellulitis in the past 2 years 4. The patient is able to understand their involvement in the study, as per the information sheet 5.The patient is able to give informed consent 6. The patient has a valid Medicare card 7. The patient is able to attend regular scheduled appointments