Juxta CURES®: promoting quality of life, patient concordance and wellbeing10th July 2013
Juxta CURES™ is an inelastic, instantly adjustable compression device that offers a simple and effective alternative to bandaging for the treatment of venous leg ulceration. It provides accurate, measured application of pressure to the lower leg to aid healing of venous ulcers and, more importantly, enables patients to actively engage with their treatment regimen.
Why do we use compression for venous ulcer treatment?
The majority of lower leg ulceration has a venous component. Compression therapy, considered to be the ‘Gold Standard’ treatment, reverses venous hypertension and thus facilitates healing of venous ulceration. Where oedema is present, compression forces fluid from the tissue into the veins and lymph vessels. Valvular incompetence is also reduced as compression produces an increase in blood flow towards the heart and reduces venous reflux. Compression can both reduce oedema and pain in addition to aiding ulcer healing.
The Scottish Intercollegiate Guidelines Network (SIGN) recommends that ‘High-compression systems (including short-stretch regimens), capable of sustaining compression for at least a week, should be the first line of treatment for uncomplicated venous ulcers’ (SIGN, 2010). Inelastic (short-stretch) compression is based on the application of rigid compression around the leg. Inelastic compression improves calf muscle function and therefore venous return, especially when mobilising. It also enhances patient comfort when resting.
However, while approximately 1% of the population will suffer from leg ulceration at some point in their lives, 51% of these are non-compliant with multi-layer compression bandaging (Miller et al, 2011) due to pain, skin irritation, bandage slippage, malodour, inability to maintain hygiene and comfort/acceptability of the compression, particularly in relation to the lack of ability to wear normal footwear. In addition, patients do not always present with ‘text book’ legs; they have unusual limb shapes and altered skin consistency which can alter the effectiveness and safety of bandages (World Union of Wound Healing Societies [WUWHS], 2008). Non-concordance both increases treatment costs, as more dressing changes have to be undertaken, and affects patient quality of life.
Why Juxta CURES™?
Juxta CURES™ is a product that helps to ameliorate the reasons for non-concordance with compression therapy, as:
- It has a built-in pressure system that helps to ensure that consistent and measurable compression (20, 30, 40, or 50mmHg) is applied to the lower leg. This built-in pressure system (BPS™) guide enables patients to be involved in their own treatment, as they can check the pressure levels themselves throughout the day and make any readjustments needed to maintain compression levels (Bianchi et al, 2013).
- By providing effective and consistent compression, it aids ulcer healing and reduces exudate and odour, which improves patient comfort and thus concordance with compression therapy
- It is simple to size and fit for a wide variety of limb shapes.
- The latex-free, breathable, anti-odour and antimicrobial Breath-O-Prene® fabric is specifically designed to allow the skin to breathe, making it more comfortable. It is also long-lasting (guaranteed for up to six months of use) and machine washable (30–40degree wash).
- It is easy to don and doff, which again promotes self-care, such as bathing/washing/showering, this in turn promotes patient empowerment and concordance. Furthermore, its slim profile means that patients are not restricted in their choice of footwear by bulky bandaging, but can wear normal shoes and clothes, which again has a positive impact on quality of life and self-image (Bianchi et al, 2013).
Performance in clinical practice
A multi-centre product evaluation found that Juxta CURES delivered improved healing rates and faster healing compared to bandaging (Elson, 2012). The study compared the costs of treating venous leg ulcers with bandages and Juxta CURES, with a secondary parameter of assessment of patient comfort. Seventeen patients were included; average wound duration was seven years.
Data was collected over two six-month periods, and included the number of nurse visits, patient quality of life, the type and number of wound dressings used and the compression bandaging type and number used. This period included data on standard compression therapy, the second on Juxta CURES™. From this information, costs of the two treatment options were calculated.
In the six months using standard compression before introducing Juxta CURES™, ulcers remained static or deteriorated. After six months of treatment with Juxta CURES, all 17 patients saw an improvement in their ulcer. Patients and clinicians were happy with the product, as it reduced the number of dressing changes required and was in effect, an individualised treatment. Comments from patients and staff using Juxta CURES showed this:
Allowed me to take control of my life.
This treatment freed up the medical profession as my clinic appointments have reduced from an hour twice a week to 20 minutes once a week.
Its unique clinical advantage has to be that it can very quickly and easily be transformed from an “off-the-shelf” into a bespoke compression garment.
The author concluded that this was a cost-effective product compared with standard compression, as it improved the condition of the ulcer in a shorter time (Figure 1).
Figure 1: Average costs and cost-savings associated with leg ulcer treatment using standard compression bandaging and Juxta CURES™ compression treatment
A recent paper by Dowsett and Elson (2013) used two case studies to demonstrate that Juxta CURES can improve a patient’s quality of life and patient-centred outcomes, thus achieving the components of the Quality, Innovation, Productivity and Prevention (QIPP) and Any Qualified Provider (AQP) agendas. Care can be delivered by NHS providers, or by external providers under the AQP model, the suggestion being that this model provides a wider, quality-driven choice for the patient, which will improve access, address gaps and inequalities, and improve the quality of services.
In addition to service specifications, outcomes and tariffs, care pathways for both simple and complex leg ulceration have been issued for those providing services under AQP. Patients in the former group are expected to heal within 18 weeks, and in the latter, within 24 weeks on care pathway two.
Service providers will be expected to provide management information, including key performance indicators. For example, percentage of wounds healed in the required time, patient reported outcome measures [PROMS], and patient-reported experience measures [PREMs], num ber of assessments completed, number assessed who were found not to meet referral criteria, number going through each care pathway, and the rationale underpinning pathway decisions.
Case studies: The following case study shows how effective treatment can improve quality of life, realise cost-efficiencies and meet QIPP requirements.
Patient A was a 47-year-old gentleman with a 10-year history of bilateral venous ulceration. Previous bandage compression systems had proved ineffective, although the patient admitted to being non-compliant because of his work commitments. The wound was malodorous and he had extreme pain and depression. When not at work, he spent time lying on his bed elevating his legs, as instructed by the nurse. Mr A stated that during his long history of ulceration, he had ‘fought many battles, but never won the war’.
In order to achieve concordance, it was decided to trial Juxta CURES as this was an alternative, instantly adjustable compression device. His ulcer healed completely in eight months, after which he received made-to-measure flat-knit hosiery.
Patient A’s quality of life improved to the extent that he was able to take a holiday during this treatment. He no longer has depression and his social life has improved. He now feels that he has ‘won the war’.
Another study by Janice Bianchi et al (Bianchi et al 2013), presented a review of Juxta CURES in the treatment of venous leg ulceration and on patient quality of life. The importance of establishing the cause of ulceration before a treatment strategy is decided is emphasised, as is the importance of involving the patient in their own treatment plan. As the authors point out, patients with long-term conditions should be supported to self-manage if this is appropriate and they should be given a choice of compression system.
The article argues that using Juxta CURES will provide significant cost-savings by:
- Reducing the need for advanced dressings to cope with excessive exudate
- Reducing the amount of compression bandages used over six months
- Reducing the clinicians’ time needed, as patients will be able to manage their own treatment.
Cost-savings have been reported in a multi-centred study involving 17 patients, which also reported an improved quality of life (Elson 2013).
The authors use three case studies to prove their assertions. The first is of a 42-year-old woman who had been non-compliant with compression therapy in the past and has had recurrent ulceration. The switch to Juxta CURES allowed the patient to take control of her care and the wound rapidly reduced in size. She did not require frequent visits to the clinic or visits from community nurses, she found Juxta CURES to be easier to use and she was able to comply with therapy.
The second case study is presented to illustrate the way Juxta CURES fits in with the NHS’ Quality, Innovation, Productivity and Prevention (QIPP) strategy. A 48-year-old man who had a non-healing ulcer for 12 months, switched to Juxta CURES; the wound reduced by 50% in five weeks. The patient was reported to be very pleased with the therapy, had increased wellbeing, and reduced treatment costs were realised.
The third case involved a 65-year-old woman who had recurrent ulceration for many years, as well as other significant comorbidities. She had difficulties with compression therapy and had developed lympho-venous disease. She was given Juxta CURES so that she could manage her bandages while on holiday. She continued using Juxta CURES, and felt that the garment had transformed her life. Her pain levels reduced, she could bathe when she wanted, as she could redress the bandages. The time to dress her leg had reduced and her legs did not feel so weighed down.
Quotes from the patients also demonstrate how the product improved quality of life:
It has changed my life considerably. I no longer need to take pain killers and so I feel brighter on less medication and I have more energy.
The biggest impact was being able to take my grandson on holiday and my husband and I now visit him weekly.
I can bathe or shower when I want to and dress my own legs afterwards.
Bandages weighed my legs down dreadfully: the Juxta CURES feels light to wear.
It is brilliant to be able to wear shoes.
Juxta CURES is easy to put on and take off.
Dressing my legs used to take an hour with bandages, now it takes less than 30 minutes.
The article concludes that the Juxta CURES is compression system, that encourages self-management, can improve quality of life and help to heal simple and complex venous leg ulcers.
For more information read: http://woundcare-today.com/products-pyramid/compression/juxta-curestm
Bianchi J, Mahoney K, Nugent L, et al (2013) A fresh way to treat venous leg ulcers with measured compression. J Community Nurs 18(16 WCA supplement): S34–S40
Dowsett C, Elson D (2013) Meeting the challenges of delivering leg ulcer services. Wounds UK 9(1): 90–5
Elson D (2012) The 21st century approach to cost effective healing of venous leg ulcers. Poster presentation, at the Wounds UK conference, Harrogate
Miller C, Kapp S, Newall N, et al (2011) Predicting concordance with multi-layer compression bandaging. J Wound Care 20(3): 101–2
Scottish Intercollegiate Guidelines Network (SIGN) (2010) SIGN Guideline 120: The Care of Patients With Leg Ulcers. http://sign.ac.uk/guidelines/fulltext/120/references.html
World Union of Wound Healing Societies (WUWHS). (2013) Principles of best practice: Compression in venous leg ulcers. A consensus document. London: MEP Ltd