Intermittent Pneumatic Compression

Intermittent Pneumatic Compression

IPC is a modality that is used widely in physical therapy. It is a form of mechanical device that has sleeves that are wrapped around the legs of a patient, then attached to a pump via a tube and deflated and inflated periodically (Greenall & Davis, 2020). This paper specifically aims to explore deeply the pathological disorders that benefit from IPC use, discussing causes, populations primarily affected, absolute contraindications, and primary indications. Furthermore, the effect of IPC on a patient’s functional abilities will be evaluated and supported by research-based practice in physical therapy. Also, the paper will look into the various IPC applications in sports recovery as opposed to the cardiovascular prevention methods in the inpatient setting.

IPC Profile

The use of IPC can be back-dated to the 1800s when vasculature was compressed for therapeutic objectives. Currently, compression devices deliver vasopneumatic compression, also referred to as IPC, using a sleeve and a mechanical pump and are used for patients with circulatory disorders (Bellew & Jr, 2022). IPC is used in conditions like edema, peripheral arterial disease, and lymphedema. Edema involves abnormal fluid accumulation in the interstitial space. It is a common symptom in patients with cardiac conditions; IPC compresses the tissues, elevating the fluid pressure in interstitial spaces higher than that of lymph and blood vessels. A shift in the pressure gradient may force the fluid to flow out into the lymphatic and venous vessels for drainage, causing the edema to resolve. IPC is contraindicated in case of severe insufficiency and unmanaged congestive heart failure (Bellew & Jr, 2022).

In lymphedema, the tissue swells due to the accumulation of fluid rich in protein that is normally drained through the lymphatic system of the body. The population primarily affected includes cancer survivors, specifically those who have undergone lymph node dissection (Bellew & Jr, 2022). IPC helps in the drainage of the lymphatic system, decreasing swelling and improving overall function. IPC is, however, contraindicated in deep vein thrombus and acute infections. Lastly, peripheral arterial disease is caused by atherosclerosis, which causes reduced blood flow to the extremities. The most affected population is older adults with a history of diabetes or smoking. Nonetheless, IPC is indicated to improve walking distance, alleviate claudication, and enhance arterial blood flow (Bellew & Jr, 2022).

Impact of IPC on Vascular Conductance

The first study article aimed at determining if intermittent pneumatic compression therapy (IPC) could improve vascular conductance and elevate shear stress caused by leg blood flow in patients with spinal cord injury. The research used a randomized control design and used eight adults who suffered from spinal cord injury. Past medical data was collected through a questionnaire, and vital signs were taken every day (Zuj et al., 2019). The study findings showed a remarkable increase in leg endothelial function in many patients with spinal cord injury. The significant improvement was attributed to the IPC’s ability to elevate the leg shear rate, which is a well-known vascular endothelium stimulator, as it happened within 15 minutes of treatment (Zuj et al., 2019). The researchers observed that IPC is a viable choice to significantly increase the shear rate of the posterior tibial artery, which a previous study had noted increased popliteal artery inflow in people suffering from peripheral vascular disease and popliteal venous outflow in spinal cord injury patients. In summary, the preliminary findings of the study propose that IPC therapy may be an effective approach for improving endothelial functions in the lower extremities (Zuj et al., 2019).

Impact of IPC on Motor Function

The study by Wei et al. (2020) aimed to investigate the safety, effectiveness, and effect on the quality of life when IPC is done together with rehabilitation training. The study was a randomized clinical trial that included patients with stroke symptoms who had received magnetic resonance imaging or computed tomography examination to confirm the symptoms. The study used 74 patients as the sample (Wei et al., 2020). The study findings showed that the Barthel and Meyer scores of the treatment group were more than those in the control group. The results showed the ability to perform Activities of Daily Living (ADLs) following IPC therapy (Wei et al., 2020). The combination of these therapies effectively improves the patients’ neurological deficits, restores the limb’s motor function of a person, and improves their quality of life. Like skeletal muscles, IPC acts as a muscle pump, moving energy to the cardiovascular system and enhancing the heart’s blood flow, thereby elevating muscle blood flow when exercising (Wei et al., 2020).

The Impact of IPC on Prevention of Venous Thromboembolism

Wang et al.’s (2020) study aimed to investigate the impact of IPC in the prevention of venous thromboembolism (VET). The study used meta-analysis and systematic review design to investigate the impact of IPC. The studies included in the review include original research and studies focused on IPC efficacy for thromboprophylaxis in ill patients (Wang et al., 2020). The study findings showed that the use of IPC greatly reduced the incidence of deep venous embolism (DVT), VTE, and pulmonary embolism (PE). According to the study, IPC is a mechanical strategy to prevent VTE by deflating and pressurizing the calf of the lower limbs from the distal to the proximal end. Also, IPC elevates fibrinolytic activity and reduces pro-coagulation activation. The study findings showed reduced VTE incidence compared to placebo for both nonsurgical and surgical patients. In comparison with other forms of therapy, IPC can reduce VTE incidence and has a better impact than graduated compression stockings (GCS) (Wang et al., 2020).

IPC Use in Sports Recovery Versus Cardiovascular Prevention Methods

In the sport recovery field, IPC has been widely accepted as a form of therapy that accelerates the processes of recovery and reduces muscle soreness. Mechanical compression, such as IPC, elevates blood circulation, which in turn allows for the acceleration of regeneration because of enhanced tissue fluid exchange (Wiecha et al., 2021). Furthermore, IPC enhances lymphatic drainage and blood circulation, which helps with the removal of metabolic waste and decreases inflammation. Athletes practicing IPC have shown improved muscle flexibility, faster recovery time, and decreased risk of overuse injuries (Wiecha et al., 2021).

On the other hand, the use of IPC as a prevention strategy for cardiovascular disorders shifts the focus on its purpose to improve venous blood return and prevent deep vein thrombosis (DVT) (Zaleska & Olszewski, 2019). In addition, IPC has been proven to be effective in preventing clot formation and venous stasis (Zaleska & Olszewski, 2019). However, from the cardiovascular prevention perspective, patient-specific risk factors should be considered. Timely IPC application greatly contributes to decreasing DVT incidence, ensuring better patient cardiovascular outcomes for inpatients (Zaleska & Olszewski, 2019).

Conclusion

In conclusion, IPC poses as a key and important form of therapy that patients can deploy. Every physical therapist assistant (PTA) should recognize the positive impact of IPC, including improving vascular conductance, enhancing motor function, and preventing venous thrombosis. Also, every PTA should be able to differentiate the purpose of IPC, namely, when it is used in sports and when it is used in cardiovascular prevention. In sports recovery, IPC focuses on maximizing the time used for an individual to heal and get fit, while in cardiovascular prevention, it helps prevent diseases such as deep venous thrombosis.

References

Bellew, J. W., & Jr, T. P. N. (2022). Michlovitz’s modalities for therapeutic intervention. F.A. Davis.

Greenall, R., & Davis, R. E. (2020). Intermittent pneumatic compression for venous thromboembolism prevention: a systematic review on factors affecting adherence. BMJ Open, 10(9), e037036. https://doi.org/10.1136/bmjopen-2020-037036

Wang, Y., Huang, D., Wang, M., & Liang, Z. (2020). Can intermittent pneumatic compression reduce the incidence of venous thrombosis in critically ill patients: A systematic review and meta-analysis. Clinical and Applied Thrombosis/Hemostasis, 26, 107602962091394. https://doi.org/10.1177/1076029620913942

Wei, J., Zhu, X., Xia, L., Zhao, Y., Yang, G., Han, Q., & Shen, J. (2020). Intermittent pneumatic compression combined with rehabilitation training improves motor function deficits in patients with acute cerebral infarction. Acta Neurologica Belgica, 121(6), 1561–1566. https://doi.org/10.1007/s13760-020-01414-2

Wiecha, S., Jarocka, M., Wiśniowski, P., Cieśliński, M., Price, S., Makaruk, B., Kotowska, J., Drabarek, D., Cieśliński, I., & Sacewicz, T. (2021). The efficacy of intermittent pneumatic compression and negative pressure therapy on muscle function, soreness and serum indices of muscle damage: A randomized controlled trial. BMC Sports Science, Medicine and Rehabilitation, 13(1). https://doi.org/10.1186/s13102-021-00373-2

Zaleska, M. T., & Olszewski, W. L. (2019). The effectiveness of intermittent pneumatic compression in therapy of lymphedema of lower limbs: Methods of evaluation and results. Lymphatic Research and Biology, 17(1), 60–69. https://doi.org/10.1089/lrb.2018.0005

Zuj, K. A., Prince, C. N., Hughson, R. L., & Peterson, S. D. (2019). Superficial femoral artery blood flow with intermittent pneumatic compression of the lower leg applied during walking exercise and recovery. Journal of Applied Physiology, 127(2), 559–567. https://doi.org/10.1152/

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Instructions: Review journal resources to find scholarly articles to support your opinion on the use of IPC. The report should provide an overview of the pathological conditions that can benefit from this modality, including but not limited to: causes, population primarily affected, primary indications, and absolute contraindications to use. Discuss the impact the modality has on a patient’s functional abilities by supporting this with effective evidence-based practice in physical therapy intervention. Include discussion regarding the different uses for IPC in sports recovery vs cardiovascular prevention methods in the inpatient setting.

Intermittent Pneumatic Compression

Ensure when selecting your references and resources, you use the strength and validity of the research article to support your opinion of this modality. In the conclusion, summarize the important points that “every PTA” should know about the modality.