Research on venous leg ulcer treatments, doggedly pursued by two University of Manchester academics since 1989, has greatly influenced NICE guidance issued this month.
The work by Professors Jo Dumville and Nicky Cullum on the most effective types of compression treatments is good news for the hundreds of thousands of patients affected by venous leg ulcers every year, costing the NHS tens of millions of pounds.
Venous ulcers are a common long-term condition which adversely affect people's quality of life; nurses deliver the majority of care, which takes the form of compression therapy as a first-line treatment.
According to the NHS National Wound Care Strategy Programme, venous leg ulcers account for 60% to 80% of all leg ulcers.
However, the abundance of different compression treatments and heavy product promotion by the wound care industry makes it difficult for nurses to decide, with patients, on the course of treatment that is most clinically effective and offers the most value to the NHS.
The guidance - known officially as a "Late Stage Assessment" - is set to change that by providing crucial information to nursing staff on the most effective types of compression.
It will also help NHS commissioners and procurement specialists give healthcare professionals access to a range of the most appropriate compression products to ensure their affordability to the NHS.
According to the researchers' evidence, the clinical effectiveness of two-layer compression hosiery and two-layer and 4-layer bandages is similar, while compression hosiery is more cost-effective than bandages. However, compression wraps are less clinically and cost-effective.
Professor Cullum was first asked to review the research evidence on leg ulcer management by the then Department of Health (now the Department of Health and Social Care) in 1989.
Working with Professor Dumville, they have been analysing and publishing the evidence in Cochrane and other systematic reviews, and have worked to fill knowledge gaps by doing new randomised controlled trials and other relevant studies.
A Cochrane systematic review is a rigorously conducted, independent review of research evidence on the effects of healthcare interventions, published by Cochrane, a global, not-for-profit organisation.
The latest randomised controlled trial, VenUS 6, led by Professor Dumville will have further important implications for care and is likely to be published later in 2025 or early 2026.
Professor Dumville said: 'I am delighted that our NIHR-funded research has delivered high-quality and relevant evidence on compression therapy for venous leg ulcers.
"The contribution of these findings to NICE's late-stage assessment underscores the importance of NIHR studies like VenUS 6 in strengthening the clinical evidence base in wound care and informing national recommendations that support best practice in patient care."
Professor Cullum said: "This is the first time there has been a piece of NICE guidance on compression therapy for venous leg ulcers.
"It feels like something of a culmination of all the work Jo Dumville and I have been doing for decades, so we are delighted it has culminated in some national guidance which will help nurses and patients arrive at informed decisions."
- See Professor Cullum's Lockdown Lecture where she talks about her work on leg ulcers and her Humans of Clinical Academia interview with Jude Johnson.
