Compression Garments in Managing Postural Orthostatic Tachycardia Syndrome (POTS)

Medical News: A groundbreaking study by researchers from Duke University sheds light on the effectiveness and limitations of compression garments in managing Postural Orthostatic Tachycardia Syndrome (POTS) and Neurogenic Orthostatic Hypotension (nOH). This extensive research not only explores patient preferences and experiences but also highlights the gaps in existing products and the need for innovation to better address the unique requirements of these conditions.

 Graphical Abstract - Compression Garments in Managing Postural Orthostatic Tachycardia Syndrome (POTS).

Understanding POTS and nOH: Conditions That Challenge Daily Living
Postural Orthostatic Tachycardia Syndrome or POTS, is a chronic condition affecting an estimated 3 million individuals in the United States, predominantly women aged 15 to 50. It manifests as orthostatic intolerance, with symptoms such as dizziness, fatigue, nausea, and cognitive dysfunction triggered by standing. The underlying issue is impaired autonomic responses, where the body struggles to compensate for gravitational shifts in blood volume, leading to a reflex increase in heart rate.
 
Neurogenic Orthostatic Hypotension (nOH), though less common, poses similar challenges. It is often linked to neurodegenerative diseases like Parkinson’s and is characterized by a failure to regulate blood pressure upon standing. This results in significant drops in blood pressure and symptoms like dizziness, confusion, and fainting. Unlike POTS, nOH affects fewer than 200,000 individuals in the U.S., making it a rare but debilitating condition.
 
Compression garments are widely recommended for both conditions as they help counteract venous pooling by applying external pressure. This improves blood flow back to the heart, alleviating some symptoms. However, this Medical News report reveals that while compression garments provide some relief, their current designs fall short of meeting patients' diverse needs.
 
Research Highlights: Patient Experiences with Compression Garments
The Duke University study surveyed 358 participants (330 with POTS and 28 with nOH) to evaluate their experiences with compression garments. Researchers from the university’s Department of Biomedical Engineering, School of Medicine, and Division of Cardiology conducted this comprehensive study to gain insights into the effectiveness of these products.
 
Usage Patterns: Preferences and Challenges
The findings reveal that nearly all participants (98%) had tried at least one type of compression garment since their diagnosis. The garments were categorized into three types:
 
-Leg compression garments: These include knee-high or thigh-high stockings and were the most commonly used (65.4%). They are widely accessible and familiar to patients.
 
-Abdominal compression garments: Used by 13.4% of participants, these garments apply consistent pressure to the abdominal regi on, targeting venous pooling in the splanchnic area.
 
-Shapewear: Typically designed for aesthetic purposes, shapewear was favored by 20.1% of participants for its concealability under clothing.
 
Interestingly, 67% of participants tried multiple garment types, reflecting dissatisfaction with any single option.
 
Comfort and Concealability: The Balancing Act
Comfort and concealability emerged as key factors influencing garment choice. Participants rated leg compression garments the highest for comfort, scoring 3.05 out of 5, while shapewear scored lowest at 2.67. On the other hand, shapewear excelled in concealability, scoring 3.43, compared to abdominal compression (2.90) and leg compression garments (2.91).
 
This trade-off highlights a critical gap: garments that are comfortable often lack concealability, and vice versa. The study underscores the need for designs that strike a balance between these two factors.
 
Effectiveness and Cost-Efficiency: A Mixed Picture
When it comes to managing symptoms, the results were less encouraging. Only 8.9% of participants felt that compression garments significantly alleviated their symptoms. Leg compression garments, while widely used, often fail to address venous pooling in the abdomen, a major contributor to POTS symptoms. Abdominal compression garments, though more effective for this purpose, were often rated as less comfortable.
 
Cost-efficiency was another concern. Participants rated abdominal compression garments as the most cost-effective, likely due to their targeted functionality. However, the perceived value of all garment types was moderate, with scores hovering around 3 out of 5.
 
Barriers to Effective Use: Where Current Products Fall Short
The study highlights several barriers to the effective use of compression garments:
 
-Design Limitations
Most compression garments are designed for other conditions, such as deep vein thrombosis or post-surgical recovery, and fail to meet the specific needs of POTS and nOH patients. For instance, while abdominal compression is essential for targeting venous pooling in the splanchnic region, many garments provide insufficient pressure (15–25 mmHg) compared to the recommended 30–40 mmHg.
 
-Discomfort
Continuous abdominal compression can be uncomfortable, especially for patients with coexisting conditions like irritable bowel syndrome or gastroesophageal reflux disease. Patients often struggle with garments that are either too restrictive or poorly fitted.
 
-Fit and Accessibility
Off-the-shelf garments frequently fail to provide a proper fit, leading to discomfort and poor adherence. The lack of customization options further compounds this issue.
 
-Patient Education
Many patients lack guidance on how to choose and use compression garments effectively. This can lead to improper use and perceptions of ineffectiveness, discouraging adherence to treatment.
 
Recommendations: Innovations for Better Outcomes
The study emphasizes the need for innovation in compression garment design to better cater to the needs of POTS and nOH patients. Key recommendations include:
 
-Adjustable Compression Devices
Garments that allow users to customize pressure levels could address the discomfort associated with static designs. Features enabling quick engagement and disengagement of abdominal compression would be particularly beneficial.
 
-Enhanced Comfort and Aesthetics
Combining high-pressure functionality with lightweight, breathable fabrics and discreet designs could improve both comfort and concealability.
 
-Education and Support
Healthcare providers should prioritize educating patients on the importance of proper garment use. Resources such as instructional guides and personalized consultations could improve adherence and outcomes.
 
Conclusions: A Call for Patient-Centered Innovation
The study concludes that existing compression garments fall short of meeting the needs of POTS and nOH patients. There is a pressing need for products that offer effective, targeted compression without compromising comfort or aesthetics. Adjustable designs that cater to individual needs could significantly enhance patient satisfaction and compliance.
 
This research serves as a wake-up call for manufacturers and healthcare providers to collaborate on developing innovative solutions. By addressing the gaps identified in this study, compression therapy could become a more viable and effective option for managing POTS and nOH.
 
The study findings were published in the peer-reviewed Journal of Clinical Medicine
https://www.mdpi.com/2077-0383/13/23/7304
 
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