Abstract: We identified four trials, with 116 participants, investigating the effectiveness of compression therapy for treatment of PTS. The methodology used by each trial was too heterogeneous to perform a meta-analysis, so we reported our findings narratively. Two trials studied the effect of graduated elastic compression stockings (GECS) on improvement of PTS symptoms. One study reported beneficial haemodynamic effects, while the other found no benefits on PTS severity compared to placebo (very low-certainty evidence). There was very limited evidence available for adverse effects and quality of life (QoL). The two studies did not report on compliance rates during the study period. Two trials studied the effects of intermittent mechanical compression devices. Both reported improvement in PTS severity (low-certainty evidence). Improvement of the severity of PTS was defined by treatment 'success' or 'failure'. Only one study comparing compression devices evaluated adverse effects and QoL. Although 9% of the participants experienced adverse effects such as leg swelling, irritation, superficial bleeding, and skin itching (moderate-certainty evidence), QoL was improved (moderate-certainty evidence). Studies did not assess compliance using intermittent mechanical compression devices. None of the studies evaluated patient satisfaction. There is very low-certainty evidence regarding the use of GECS for treatment of PTS as assessed by two small studies of short duration. One study reported beneficial haemodynamic effects, while one found no benefits on PTS severity compared to control/placebo stockings. There is very limited evidence for adverse effects, patient satisfaction, QoL, and compliance rates. There is low-certainty evidence favouring use of intermittent pneumatic compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studies of short duration. There is moderate-certainty evidence of improved QoL but possible increased adverse effects related to compression device use owing to small studies of short duration. High-certainty evidence to support the use of compression therapy in prevention of PTS is lacking and any conclusions drawn from current evidence should be interpreted with care. Further research is needed to assess whether compression can result in long-term reduction and relief of the symptoms caused by PTS, or prevent deterioration and leg ulceration.

Plain-language summary: The review authors identified four trials, with 116 participants, investigating the effectiveness of compressing therapies for PTS (most recent search 2 July 2018). Two trials studied the effect of GECS. One study showed an improvement of PTS symptoms and one showed no benefit. Two other trials studied the effect of an intermittent pneumatic compression device. Both reported an improvement in PTS severity. One study evaluated side effects and quality of life. Although 9% of the participants experienced side effects such as leg swelling, irritation, superficial bleeding, and skin itching, quality of life had positive outcomes. None of the studies assessed or reported on patient satisfaction or compliance rates. The evidence for use of GECS or intermittent pneumatic compression device compared to control for the treatment of PTS severity is of very-low and low-certainty reliability. This is due to conflicting results, small studies of short duration, and differences in how the studies measured outcomes. Limited evidence was available for side effects, patient satisfaction, quality of life, and compliance.