Garments: they are NOT consistent

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kira66715
kira66715 Member Posts: 4,681
edited June 2014 in Lymphedema

I know we have a long thread on all things garments, but I found this and wanted to document that what we've complained about--the variability of garments, is documented in the literature

http://www.ncbi.nlm.nih.gov/pubmed/22720662

Lymphat Res Biol. 2012 Jun;10(2):74-80. doi: 10.1089/lrb.2012.0003.

Development of a pressure-measuring device to optimize compression treatment of lymphedema and evaluation of change in garment pressure with simulated wear and tear.


Source

Department of Clinical Sciences, Lund University, Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden. hakan.brorson@med.lu.se


Abstract

The use of compression garments in treating lymphedema following treatment of genital (penis, testes, uterus, cervical) and breast cancer treatment is a well-established practice. Although compression garments are classified in compression classes, little is known about the actual subgarment pressure exerted along the extremity. The aims of this study were to establish an in vitro method for measuring subgarment pressure along the extremity and to analyze initial and over time subgarment pressure of compression garments from three manufacturers. The measurements were performed with I-scan(®) (Tekscan Inc.) pressure measuring equipment once a week during a period of 4 weeks. Wear and tear was simulated by washing and putting on the garments on plastic legs every day. There was a statistically significant difference between the garments of some of manufacturers. There was no difference between garments from the same manufacturer. No significant decrease of subgarment pressure was observed during the trial period. The study demonstrated that Tekscan pressure-measuring equipment could measure subgarment pressure in vitro. The results may indicate that there was a difference in subgarment pressure exerted by garments from different manufacturers and that there was no clear decrease in subgarment pressure during the first four weeks of usage.


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  • Binney4
    Binney4 Member Posts: 8,609
    edited July 2013

    Kira, thank you. This is sure interesting. I hope they'll begin to do some serious testing on real people. And among brands as well. Sure would be helpful to know which brands are most effective at creating gradient compression, and which last the longest. "Brands" is a broad category in itself, since many of them offer several options.

    It's an odd finding, because during those first couple of weeks of wearing new garments I always sense a big difference. First few times you wear them they're annoyingly tight, and then they start to get comfortable again. Maybe it's ME adjusting, not the garments!Laughing

    Be well,
    Binney

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  • kira66715
    kira66715 Member Posts: 4,681
    edited July 2013

    The things I find: here's a study that proves that padding is important:

    http://www.ncbi.nlm.nih.gov/pubmed/22902938

    Am J Phys Med Rehabil. 2012 Sep;91(9):768-73. doi: 10.1097/PHM.0b013e3182643c36.

    Pressure monitoring of multilayer inelastic bandaging and the effect of padding in breast cancer-related lymphedema patients.


    Source

    Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.


    Abstract

    OBJECTIVE:

    This study of pressure monitoring of multilayer inelastic bandaging and the effect of padding in breast cancer-related lymphedema patients aimed to measure the resting and working sub-bandage pressures in compression therapy for lymphedema patients and to determine whether applying additional padding has an additional effect in volume reduction of the limb.

    DESIGN:

    Forty-eight patients with breast cancer who were beginning complex decongestive therapy for lymphedema were included. In 24 patients, padding was added to the forearm. A short-stretch bandage with or without padding was applied to the affected arm. The working pressure was measured while the patients squeezed a rubber device. The forearm limb circumference was measured before and after 2 wks of treatment.

    RESULTS:

    The mean (SD) of the resting pressure was 36.3 (2.2) mm Hg without padding and 49.5 (3.2) mm Hg with padding. The mean (SD) of the working pressure was 9.5 (3.7) mm Hg without padding and 24.3 (9.1) mm Hg with padding (P < 0.05). The volume loss after treatment was significantly greater in the group with added padding (P < 0.05).

    CONCLUSIONS:

    The working pressure during exercising with a force of 50 Pa is approximately 10 mm Hg with a short-stretch bandage applied. Adding a pad increases both the resting and the working pressure and also seems to be effective in increasing volume reduction of the limb.


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  • kira66715
    kira66715 Member Posts: 4,681
    edited July 2013

    Binney, I totally agree about the breaking in of garments: sometimes I wash them to encourage some shrinkage...

    But we can use the first article when our fitters--who can just take a 4 hour course to be "certified"--like I'm a certified Jobst fitter, and I wouldn't dare order anything--try and tell us about interchangable products....

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited July 2013

    kira thanks for this. You are wonderful at "hoofing out info" This is really interesting.

    It is of particular interest to me right now because I've been having a number of flares for no particular reason. We (LEist and I) can't pin down anything in particular other than change of seasons. Well it's been changing seasons for a good 3 months now. UGH. I tripped over a pot plant and did a horizontal dive last week on the concrete and of course stuck my LE hand out to breeak the fall. I wasnt really hurt and in fact surprisingly didnt even have any bruises. My latest flare was after that.  Anyway Im having to wrap again and Ive found it MUCH better with this really nice padding like a sleeve which you do your 1/2 stretch bandaging over. Its soft and quite thick. DOnt know exactly what its called. The alternative for me has been gauze stocking then cotton bandage wrap then 1/2 stretch bandage. That combo has left indents galore in my arm where as the soft tubing has been infinitely better. With this combo I finally had some success (YES!!!) in getting the trouble spot just below the elbow down.  I feel like I just might be getting somewhere.

    Im about to be measured for my Jobst glove and sleeve in just over a week. Can't wait as I reckon my current one is puckarood. The challenge now is to get my arm down so it doesn't affect the measuring.

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  • KS1
    KS1 Member Posts: 632
    edited July 2013

    I've had 4 custom gloves made with exactly the same measurements, each made at a different time over the course of 9 months.  Two were indistinguishable from each other, one felt a bit loose overall but wasn't visibly different, and one had a ring finger that was grossly different from the other 3 gloves' ring fingers (barely touched the finger in places and provided no compression).  I've had 8 custom sleeves made by the same manufacturer, all with exactly the same length measurement.  Put them side by side and the longest is a good 2" longer than the shortest.  Others on the LE board have had similar experiences with custom and non-custom garments.  We find a garment that fits, and when we go to replace it with what is supposed to be an identical garment, the replacement is not the same.

    I have a hard time reconciling the board's experience with the statement  "there was no difference between garments from the same manufacturer."  Maybe two garments made by the same manufacturer at the same time are identical, but we need consistency over tme! KS1

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  • kira66715
    kira66715 Member Posts: 4,681
    edited July 2013

    KS1, had that identical issue with Juzo, and my LE therapist orders leg garments from them and has it also. My latest fitter who after three tries got a good if not amazing glove from Juzo, swears it's a translation issue, but when I had to go through 5 gloves and the Juzo rep got involved he said the machines were not that exact!

    come on. I've had bizarre gloves come from the same measurements. And same manufacturer.

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  • KS1
    KS1 Member Posts: 632
    edited July 2013

    I was told that the difference in lengths of the sleeves was the result of shrinkage/stretching.  I had 2 "identical" sleeves that were only 1 month different in age, and one was 34 cm and the other 36 cm.  Juzo said that this was within manufacturing "tolerance."  For the gloves, they admitted there was a manufacturing error.  KS1

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  • carol57
    carol57 Member Posts: 3,567
    edited July 2013

    I put a spankin' new sleeve under a 6-month old sleeve and the new one was a full inch wider at the top.  If the difference was cause by worn/shrinkage/stretching of the old sleeve, you'd sure think that the old sleeve would be the wider one.  An inch difference is crazy, and it happened with two Juzo sleeves.  

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited July 2013

    Carol, wow. Just goes to show we have to forever check everything. That inch is ridiculous.

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  • carol57
    carol57 Member Posts: 3,567
    edited July 2013

    Musical, I think it's time for another round of song lyrics, this time a blues number about the frustration of inconsistent garment sizing.

    I'll start, and then you, with your gift for rhyme, can write a better one:

    A garment that fits is such a treasure

    But sleeves and such just don't match from measure to measure

    I'm cryin' and wailin' about achin' and swellin'

    'Cause my new sleeve doesn't fit, to my great displeasure!

    (And somebody please poke their nose into cookiegal's igloo and suggest that singing campfire songs about bad garments would be a great way to pass the time while roasting marshmallows for the s'mores she's making in there!)

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  • kira66715
    kira66715 Member Posts: 4,681
    edited July 2013

    Hmmm. Juzo seems to be the culprit here right now.

    My LE therapist orders her leg garments from them and they have been having huge variations.

    KS1 wrote them a letter, with photos, after getting a massive run around, and got a new glove in a few days, that fit. Go figure

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  • sushanna1
    sushanna1 Member Posts: 764
    edited July 2013

    I have had problems with Jobst.  I don't understand why Jobst cannot make a glove to match the measurements submitted on the form.  This year, I had to return two Jobst custom seamless gloves and should have returned the third. After two returns, the Jobst regional rep insisted on remeasuring me before accepting another return.  I was furious since the original measurements were made by my P.T. (certified with years of experience whom I have seen for 8 years.).  Either the Jobst rep changed the measurements or it was mismade yet again.  Glove #3is is about 3 inches too long, fingers are shorter than usual and the thumb is so wide that it is worthless.    I hate the glove but this is the time of year that I need it and my old ones are too tight so . . . I am living with it.  Thanks for letting me sound off. 

    The company had all sorts of excuses for the first two gloves including, "it will shrink."  This said in response to fingers so long they covered my fingertips.  I washed it in hot water as per their recommendation but the fingers were still way too long.  I even took photos of last year's glove side by side with each of the new ones to show that anyone could see the difference.  Sigh.  

    Sue

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  • sushanna1
    sushanna1 Member Posts: 764
    edited July 2013

    How about a blues in the vein of "I'm a cross cut saw"? 

    1) I'm your glove baby. Aint' nobody else but yours. 

    I'm your handglove baby. And nothing else will do.

    Long as you got me girl. Ain't no reason to be blue.

    2) Slip me on your hand baby, Nobody else but yours.

    Slip me on your hand now baby, nothing else will do.

    Long as you got me girl, Ain't no reason to be blue

    3) I'm your sleeve baby, Ain't nobody else but yours.

    I'm your armsleeve baby, And nothing else will do

    Long as you got me girl. Aint' no reason to be blue.

    4) Pull me over your wrist bones baby.  Nobody else but yours

    Pull me over your wrist now baby, Nothing else will do

    Long as you got me girl. Ain't no reason to be blue

    5)  Cover up your elbow baby, etc.

    6)  On up to your shoulder baby, etc.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited July 2013

    Lol Carol.... youre kidding me right? Smile  ... you know where this might lead LOL

    Once I get on this track its real hard to get back
    to whatever is normal - formalities gone
    I'll be back pretty soon ... when the words fit the tune
    in the meantime I'll sing a melodious song.

    sushanna    Cool   LOL LOL .

    Purple are you looking in? I know you wrote a poem some wayz back and I it slipped me by to give you the thumbs up too. I cant remember what thread its in.

    Gotta look in on cookies thread, then do some jobs and I'll be back soon. Smile

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited July 2013

    Well here I am back with my thoughts black and white
    I think I might think hard-  to make the words right
    The trouble is is nothing is there that is blue
    So Come on now all ... I am lookin to you Wink


    And don't forget music - you must have that too
    The tune is the part where the words stick like glue
    theres also the rhythm thats fits in the rhyme
    Thinking caps on ... to have lines all in time.


    That said - its fun if you give it some thought
    ideas fly past you - more than they ought
    but you capture the moment as it comes around
    and its nice when it fits into sounds I have found   Smile     (YEAH!)

    Just noticed my wrapping is acting all weird
    It hasnt stayed up but has slipped down instead  (grrr)
    Is this black and white turning all shades of blue ?
    Im slightly off topic -Its all back to you !   Wink



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  • Estel
    Estel Member Posts: 3,353
    edited July 2013

    Ha! Love the songs and poems! :)



    Kira - Thanks for posting. I'm having serious fit issues. The Juzo Soft sleeve I ordered was HUGE! Like Carol, it was a good inch bigger at the top than my jobst sleeves that are two years old. When I called brightlife direct and asked for advice on which sleeves run small vs. ones that run large, the rep told me to check my measurements with the respective charts. :/ Grrrrrr. Not at all helpful.



    It shouldn't be this hard...glad to know it's not just me.

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  • carol57
    carol57 Member Posts: 3,567
    edited July 2013

    Sushanna and Musical, toooo funny!  

    Dawne-Hope, I find it amazing when a garment maker's size chart is identical for two of their sleeve models, but one of the 'same size' sleeves is an inch bigger than the other.  I think the garment makers should sell a very inexpensive sleeve sizing kit, which includes three or four non-gradient, very lightweight (i.e. cheap) sleeves meant not to wear for compression, but to correspond to their sleeve fits.  I would pay $10 to $15 for that, if I were sure that say, the medium in the sizing sleeve would correspond correctly to a medium compression sleeve.  There simply has to be a better way than using a tape measure to do DIY sleeve fitting.

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  • Dejaboo
    Dejaboo Member Posts: 2,916
    edited July 2013

    Shoot...I was FINALLY going to order my Juzo sleeves this week & Now I feel like they will all be different sizes.

    Not a sleeve but the sports bra that works best for me...I bought 4 more last month...Went to wear one of them the other day & it was tighter then my old one...Thought ok- so they old one is streched out.

    The next day I went to wear a different one- put it on the loosest hook- assuming it was going to be tight too.  it was very loose...even on the tightest hook it was loose...I compared it to the other new bra & it was 1 whole inch longer : (

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