My name is Naz Wahab. I'm a wound care physician in Las Vegas, Nevada. 

Patients have difficulty adhering to compression many times because of pain, ill-fitting compression garments, sometimes heat, and itching or pruritus. There's a variety of reasons why patients complain, why they don't want to have compression garments on. 

Strategies to help promote adherence to compression garments or compression materials would be to address their diet. Many times they are having too high of a salt diet, it causes swelling and it definitely causes difficulty tolerating due to increased swelling. Also another aspect is to have them elevate, despite the fact that they are wearing a compression device or garment. Many times if their legs are dependent, it causes a lot more pain and difficulty for tolerance. So having a patient elevate their legs is definitely an important aspect. Another is heat or moisture. We live in a very hot environment here in Las Vegas. In the summertime, I'm sure many people have the same problem regardless of where you live. But if there is a time that the patient is constantly being compressed, it's difficult for them to tolerate the heat.

And so, perhaps taking the garment off, having them come into your office, taking the garment off, washing their legs, letting them sit with their legs not in a dependent position for a period of time before you actually reapply the garment or your device might be helpful as well. I think education is important for the patient on what to expect. Being able to also time the ability to have showers. Patients definitely want and we want them to have showers and to be able to clean themselves. And I think that will help with adherence. 

Also ensuring that that the physician and /or provider is also checking for any arterial disease. So screening with arterial ultrasounds or ABIs or TBIs are important to avoid their pain related to arterial compression. And also making sure that your staff is is either certified or has competencies in applying these devices and garments on the legs is important so that there's a standard of care in the application and there's not undue pain or distress to the patient with different people applying the device.