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Al Onazi et al. Plast Aesthet Res 2020;7:23 I http://dx.doi.org/10.20517/2347-9264.2019.74 Page 9 of 14

Theme: discomfort
Discomfort was reported as a result of a number of factors including: (1) poor fit of the garment; (2) heat
and humidity/weather; and (3) poor tolerance to compression. Issues related to the fit of the garments
mainly included fit at the hand (e.g., irritation of thumb and web spaces), wrist (e.g., space between glove
and sleeve and overlap of compression), elbow (e.g., nerve compression and chafing in elbow crease), or at
the upper most aspect of arm (e.g., band too tight, top of sleeve sliding down, and blistering due to silicon
band). Participants also reported that fit tended to worsen over the course of the day and when the sleeve
was older.
- “My arm is full, and circulation at elbow can feel cut off if the arm is bent for prolonged periods of time.”
- “I don’t think I get the benefits out of it as I would if it fit well.”
- “My sleeve tends to slide down, and I am constantly adjusting it.”

Heat was a common factor for removing the sleeve. Participants mostly reported weather and temperature
as contributors to heat-related discomfort; however, some participants reported increased heat due to hot
flashes or from activity and exercise.
- “In the summer, it is way too hot to wear a sleeve and glove.”
- “It’s too hot, I can’t even get it on in warm weather as I am too sweaty.”
- “When I have a hot flash, I want to take the sleeve off.”

Increased discomfort due to progressive tension/tightness in the limb was also reported as a primary
reason for earlier removal of the sleeve prior to the 12-h recommended time.
- “At the end of my work day, it feels too restrictive and uncomfortable, so I take it off.”

Theme: negative emotions
A minority of participants expressed negative feelings associated with wearing the sleeve daily. The
expressed feelings included words such as “hate”, “guilt”, and “fear”; participants reported the following
concerns regarding negative emotions towards the garments:
- “I hate it. I am tired of the reminder that it is always there, and no end in sight for getting better.”
- “Life changing, ruins my life to wear a sleeve, I can’t do the things I want to do with a sleeve and glove.”
- “When I don’t wear it, I feel guilty.”
- “I fear the lymphedema will get worse.”

Many participants reported burdens related to wearing the sleeve daily, including laundering their
garments, the need for ongoing fitting appointments, and having to get garment prescriptions renewed.
- “I get tired of the regimen, I need a break.”
- “I am tired of proving I still need a sleeve, this is a lifelong condition.”
- “I still need a prescription each year for insurance, this is frustrating.”

Participants requiring custom compression sleeves and gloves expressed frustration with fit, issues with
returning poorly fitted garments, and wait times for garments; participants expressed the following
concerns with their garments:
- “Fittings are hit and miss, especially garment length.”
- “When it comes wrong, I don’t bother sending it back - too much of a hassle.”
- “Long wait for custom garment, then it comes but does not fit well.”

Theme: interference with function
The primary finding in regards to interference with function related to hand function and concerns over
hygiene, especially when using a glove or gauntlet. With respect to function, participants reported the
following concerns:
- “I have difficulty manipulating objects, doing crafts, and with writing due to the glove, so I remove it.”