References

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Partsch H., Clark M., Mosti G. Classification of compression bandages: practical aspects. Dermatol Surg. 2008; 34:600-609

Kravitz S., Hegarty-Craver M, Reid L. Challenging present concepts in compression therapy: static stiffness index is not consistent and not clinically relevant. J Wound Care. 2016; 25:(2)S4-S8

Thomas S. Practical limitations of two devices used for the measurement of sub-bandage pressure: implications for clinical practice. J Wound Care. 2014; 23:(6)300-309

Mosti G., Partsch H., Schuren J., Thomas S. Letters. J Wound Care. 2015; 24:(3)157-158

Comité Europeen de Normalisation: Adopted European prestandard. Medical compression hosiery ENV 12718, Brussels 2001.

Partsch H., Rabe E., Stemmer R. Compression therapy of the extremities.: Editions Phlebologiques Francaises; 2000

Stolk R., Van der Wegen-Franken C.P., Neumann H.A. A method for measuring the dynamic behavior of medical compression hosiery during walking. Dermatol Surg. 2004; 30:(5)729-736

Van der Wegen-Franken K., Tank B., Neumann H. Correlation between the static and dynamic stiffness indices of medical compression stockings. Dermatol Surg. 2008; 34:1477-1485

Hirai M, Niimi K., Miyazaki K. Development of a device to determine the stiffness of elastic garments and bandages. Phlebology. 2011; 26:(7)285-291

Partsch H. The static stiffness index: a simple method to assess the elastic property of compression material in vivo. Dermatol Surg. 2005; 31:(6)625-630

Partsch H. The use of pressure change on standing as a surrogate measure of the stiffness of a compression bandage. Eur J Vasc Endovasc Surg. 2005; 30:(4)415-421

Schuren J., Bichel J. Sub-bandage dynamics: stiffness unravelled. Veins and Lymphatics. 2013; 2:(e2)3-6

Mosti G.B., Mattaliano V. Simultaneous changes of leg circumference and interface pressure under different compression bandages. Eur J Vasc Endovasc Surg. 2007; 33:(4)476-482

Christopoulos D.G., Nicolaides A.N., Szendro G. Air-plethysmography and the effect of elastic compression on venous hemodynamics of the leg. J Vasc Surg. 1987; 5:(1)148-159

Spence R.K., Cahall E. Inelastic versus elastic leg compression in chronic venous insufficiency: a comparison of limb size and venous hemodynamics. J Vasc Surg. 1996; 24:(5)783-787

Ibegbuna V., Delis K.T., Nicolaides A.N., Aina O. Effect of elastic compression stockings on venous hemodynamics during walking. J Vasc Surg. 2003; 37:(2)420-425

Poelkens F., Thijssen D.H., Kersten B. Counteracting venous stasis during acute lower leg immobilization. Acta Physiol. 2006; 186:(2)111-118

Mosti G., Partsch H. Measuring venous pumping function by strain-gauge plethysmography. Int Angiol. 2010; 29:(5)421-425

Schuren J. Compression unravelled.: Margreff Druck GmbH, Essen Germany; 2011

Partsch H., Mosti G. Comparison of three portable instruments to measure compression pressure. Int Angiol. 2010; 29:(5)426-430

Neumann H.A., Partsch H., Mosti G., Flour M. Classification of compression stockings: report of the meeting of the International Compression Club, Copenhagen. Int Angiol. 2016; 35:(2)122-128

Partsch H., Partsch B., Braun W. Interface pressure and stiffness of ready made compression stockings: comparison of in vivo and in vitro measurements. J Vasc Surg. 2006; 44:(4)809-814

Suehiro K., Morikage N., Murakami M Putting a class I stocking over a class I stocking does not make a class II stocking. Ann Vasc Dis. 2012; 5:(4)435-438

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Leg ulcers
Compression therapy

The static stiffness index: an important parameter to characterise compression therapy in vivo

02 April 2017
Review
02 April 2017
Volume 1 · Issue 2

Abstract

The compression pressure, which corresponds to the dosage of compression therapy, has been widely neglected up to now, not only concerning scientific literature, but also in clinical practice. It is evident that compression pressures in the upright position and during walking are clinically more relevant than just the resting pressure. The Static Stiffness Index (SSI), which is the difference between standing and resting pressure, is a valuable parameter characterising the efficacy of a specific compression product to narrow/occlude the venous lumen. This is a prerequisite for reducing venous reflux and exerting a massaging effect necessary to improve the venous pumping function during movement. This article provides an overview of the recent literature on the SSI, which supports the recommendations of the International Compression Club. In addition, it aims to provide an insight on the importance of the SSI in daily practice, as an educational tool as well as in defining the properties of applied compression therapy in clinical research.

The International Compression Club (ICC) consists of a group of experts in compression therapy from both the medical field and industry, and was founded to provide a valuable basis for further improvements of internationally accepted regulations and guidelines on all aspects of compression therapy. Since its foundation in 2004, several consensus documents have been published, in two, clear guidelines are described on methods used to define the properties of applied compression.1,2 Since then, for many researchers and clinicians, the Static Stiffness Index (SSI) became a routine during the application of compression therapy.

Recently, the value of the SSI was questioned for not being consistent nor clinically relevant.3 Also accuracy of the routinely used devices for the measurement of sub-bandage pressure, as well as the validity of publications reliant on measurements with these devices, was subject of debate.4,5

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pressure
Static Stiffness Index
compression therapy
Laplace's law