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Blondeel A, Devoogdt N, Asnong A, Geraerts I, De Groef A, Heroes AK, Van Calster C, Troosters T, Demeyer H, Ginis P, De Vrieze T. Accuracy of consumer-based activity trackers to measure and coach patients with lower limb lymphoedema. PLoS One 2024; 19:e0305768. [PMID: 39024359 PMCID: PMC11257309 DOI: 10.1371/journal.pone.0305768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/04/2024] [Indexed: 07/20/2024] Open
Abstract
PURPOSE This study investigated the accuracy of activity trackers in chronic lower limb lymphoedema (LLL) patients and in comparison to matched controls. MATERIALS AND METHODS Seventeen LLL patients and 35 healthy subjects wore an activity tracker at the hip (Fitbit Zip/Inspire; hip-AT) and one at the wrist (Fitbit Alta/Inspire; wrist-AT) combined with a reference activity monitor (Dynaport Movemonitor; DAM), for 14 consecutive days. To analyze accuracy and agreement, mean daily step count from both AT's were compared to DAM. To evaluate the accuracy as coaching tool, day-by-day differences were calculated. The Kendall correlation coefficient was used to test consistency of ranking daily steps between the AT's and the DAM. RESULTS The wrist-AT significantly overestimated daily step count compared to DAM in the LLL group (+1221 ± 1754 steps per day, p = 0.011) while the hip-AT underestimated the step count, although not significantly. Similar results were found in the healthy control group. As a coaching tool, both wrist-AT and hip-AT showed a moderate correlation with the DAM (r = 0.507 and 0.622, respectively) in the LLL group regarding consistency of ranking from most to least active days. CONCLUSION Wrist-AT's significantly overestimate daily step count in a LLL population. As a coaching tool, both trackers show moderate validity, indicating applicability to improve physical activity.
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Affiliation(s)
- Astrid Blondeel
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Anne Asnong
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Inge Geraerts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | | | | | | | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Pieter Ginis
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
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Toprak Celenay S, Bayramoglu Demirdogen E, Barut O, Cigdem Karacay B, Ozer Kaya D. Postural stability, spinal alignment, mobility, and postural competency in women with unilateral lower extremity lymphedema after radical hysterectomy following gynecologic cancer: A case-control study. Eur J Oncol Nurs 2023; 67:102416. [PMID: 37879191 DOI: 10.1016/j.ejon.2023.102416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/07/2023] [Accepted: 09/07/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE To compare postural stability, spinal alignment, mobility, and postural competency in women with unilateral lower extremity lymphedema after radical hysterectomy following gynecologic cancer with a matched control group. METHODS Twenty-seven women with unilateral lower extremity lymphedema (lymphedema group, age: 54.14 ± 5.80 years) and 30 healthy women (control group, age: 51.90 ± 6.54 years) were included. The lymphedema severity was evaluated with circumferential measurements. Postural stability with the Biodex Balance System SD and the spinal alignment, mobility, and postural competency with the Spinal Mouse device were assessed. RESULTS In the lymphedema group, it was found that 3.7% of the women had mild lymphedema, 7.4% had moderate lymphedema, and 88.9% had severe lymphedema. Static eyes open (EO) (overall, medio-lateral and antero-posterior) and eyes closed (EC) (antero-posterior) stability scores and dynamic EO and EC stability scores (overall and antero-posterior) were detected to be higher in the lymphedema group than in the controls (p < 0.05). Spinal mobility and postural competency scores were lower in the lymphedema group than in the control group (p < 0.05). In other parameters, there were no significant differences between the groups (p > 0.05). CONCLUSION Decreased postural stability, spinal mobility, and postural competency were detected in women with unilateral lower extremity lymphedema; however, no difference was seen in spinal alignment. These changes should be taken into account in the assessment and the treatment of unilateral lower extremity lymphedema.
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Affiliation(s)
- Seyda Toprak Celenay
- Ankara Yildirim Beyazit University, Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| | | | - Ozge Barut
- Kirsehir Ahi Evran University, Rectorship, Pilot University Coordinatorship of Health, Kirsehir, Turkey
| | - Basak Cigdem Karacay
- Kirsehir Ahi Evran University, Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Kirsehir, Turkey
| | - Derya Ozer Kaya
- Izmir Katip Celebi University, Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Izmir, Turkey
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Pirincci CS, Cihan E, Ünüvar BS, Gerçek H, Aytar A, Borman P. Investigation of physical activity, fear of falling, and functionality in individuals with lower extremity lymphedema. Support Care Cancer 2023; 31:360. [PMID: 37247048 DOI: 10.1007/s00520-023-07825-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE To investigate the fear of falling, physical activity, and functionality in patients with lymphedema in the lower extremities. METHODS Sixty-two patients who developed stage 2-3 lymphedema in the lower extremities due to primary or secondary causes (age: 56.03 ± 7.83 years) and 59 healthy controls (age: 54.61 ± 5.43 years) were included in the study. The sociodemographic and clinical characteristics of all individuals included in the study were recorded. In both groups, fear of falling was evaluated with the Tinetti Falls Efficacy Scale (TFES), lower extremity functionality with the Lower Extremity Functional Scale (LEFS), and physical activity with the International Physical Activity Questionnaire-Short Form (IPAQ-SF). RESULTS There was no statistically significant difference between the demographic characteristics of the groups (p > 0.05). The primary and secondary lymphedema groups had similar LEFS (p = 0.207, d = 0.16), IPAQ (p = 0.782, d = 0.04), and TFES (p = 0.318, d = 0.92) scores. However, the TFES score of the lymphedema group was significantly higher than that of the control group (p < 0.01, d = 0.52), while the LEFS (p < 0.01, d = 0.77) and IPAQ scores (p = 0.001, d = 0.30) were significantly higher in the latter. There was a negative correlation between LEFS and TFES (r = -0.714, p < 0.001) and between TFES and IPAQ (r = -0.492, p < 0.001). LEFS and IPAQ were positively correlated (r = 0.619, p < 0.001). CONCLUSION It was determined that individuals with lymphedema developed a fear of falling, and their functionality was negatively affected. This negative effect on functionality can be attributed to reduced physical activity and an increased fear of falling.
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Affiliation(s)
- Cansu Sahbaz Pirincci
- Gulhane Faculty of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey.
| | - Emine Cihan
- Vocational School of Health Science Physiotherapy, Selcuk University, Konya, Turkey
| | | | - Hasan Gerçek
- Vocational School of Health Science, KTO Karatay University, Konya, Turkey
| | - Aydan Aytar
- Gulhane Faculty of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Pınar Borman
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Rockson SG, Karaca-Mandic P, Nguyen M, Shadduck K, Gingerich P, Campione E, Hetrrick H. A non-randomized, open-label study of the safety and effectiveness of a novel non-pneumatic compression device (NPCD) for lower limb lymphedema. Sci Rep 2022; 12:14005. [PMID: 35977981 PMCID: PMC9385615 DOI: 10.1038/s41598-022-17225-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/21/2022] [Indexed: 01/19/2023] Open
Abstract
Lower extremity lymphedema (LEL) can result in detriments to quality of life (QOL) and impose a significant economic burden on patients and payers. A common component of treatment is pneumatic compression, which requires patients to remain immobile. We investigated a novel non-pneumatic compression device (NPCD) that allows patients to remain active during compression treatment, to see if it reduces swelling and improves QOL. We conducted a non-randomized, open-label, 12-week pilot study of adult patients with primary or secondary unilateral LEL, and measured changes in limb edema and QOL using the Lymphedema Quality of Life Questionnaire (LYMQOL). Twenty-four subjects were enrolled; the majority were female (17) with secondary lymphedema (21). Eighteen completed the study. Statistically significant improvements were observed in overall QOL, aggregated LYMQOL total score, and three of four LYMQOL subscales (Function, Appearance, Mood). The fourth (Symptoms) trended toward significant improvement (p = 0.06). The average reduction in affected limb edema was 39.4%. The novel NPCD produced statistically significant improvements in QOL, functioning, and edema volume of patients with LEL. Innovations in devices to manage LEL can be effective while allowing patients to maintain mobility and physical activity during treatment.
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Affiliation(s)
- Stanley G. Rockson
- grid.168010.e0000000419368956Cardiovascular Medicine, Falk Cardiovascular Research Center, Stanford University, Stanford, CA 94305 USA
| | - Pinar Karaca-Mandic
- grid.17635.360000000419368657Carlson School of Management, University of Minnesota, Minneapolis, MN USA
| | | | | | | | - Elizabeth Campione
- grid.260024.20000 0004 0627 4571Department of Physical Therapy, Midwestern University, Downers Grove, IL USA
| | - Heather Hetrrick
- grid.261241.20000 0001 2168 8324Department of Physical Therapy, Nova Southeastern University, Ft. Lauderdale, FL USA
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Kim Y, Kim S, Lim JY, Hwang CM, Ko MH, Hwang JH. Home-Based Intermittent Pneumatic Compression Therapy: The Impact in Chronic Leg Lymphedema in Patients Treated for Gynecologic Cancer. Healthcare (Basel) 2022; 10:healthcare10040638. [PMID: 35455817 PMCID: PMC9032801 DOI: 10.3390/healthcare10040638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023] Open
Abstract
We conducted a prospective study of cancer patients to investigate the efficacy, quality of life, satisfaction, and safety of a home-based intermittent pneumatic compression (IPC) device during the maintenance phase of lower extremity lymphedema. This device has a unique mode designed to mimic the manual lymphatic drainage (MLD) technique and thereby gently facilitate lymphatic draining of proximal extremities. Thirty patients with stage 3 chronic secondary unilateral leg lymphedema in the maintenance phase underwent IPC and conventional compression therapy for 4 weeks at home. The participants were guided to use 1 h course (30 min of MLD-mimicking mode and 30 min of conventional mode) of IPC device twice a day for 4 weeks. We assessed the patients’ limb-volume measurement, quality of life (QOL), and satisfaction four times. There were no significant time-dependent interactions in the inter-limb volume difference ratio (Vratio). In a subgroup analysis, participants who used the home-based IPC device and maintained their routine self-maintenance program of short-stretch bandages (group B, n = 21) showed a more significant decline in Vratio than those who did not maintained their routine care (group A, n = 9). All scores of QOL decreased significantly after the intervention without subgroup difference. All participants were satisfied with the 4-week intervention. This study demonstrated that a home-based IPC device with an MLD-mimicking program is a useful option for maintaining the volume of limbs and improving the QOL of patients with stage 3 chronic leg lymphedema during the maintenance phase.
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Affiliation(s)
- Yoon Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea;
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul 01022, Korea
| | - Seonghee Kim
- Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea; (S.K.); (C.M.H.)
| | - Ji Young Lim
- Department of Physical Therapy, Graduate School of Medical Sciences, Konyang University, Daejeon 35365, Korea;
| | - Chea Min Hwang
- Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea; (S.K.); (C.M.H.)
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Korea;
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea;
- Correspondence: ; Tel.: +82-2-3410-2816; Fax: +82-2-3410-2820
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Zhang J, Ju X, Feng Z, Zhang X, Li J. Progressive resistance exercise training to prevent lower-limb lymphedema after cervical cancer surgery: A feasibility study. Asia Pac J Oncol Nurs 2022; 9:32-38. [PMID: 35528793 PMCID: PMC9072185 DOI: 10.1016/j.apjon.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/12/2021] [Indexed: 11/22/2022] Open
Abstract
Objective Radical hysterectomy with pelvic lymphadenectomy is the standard surgical treatment for early stage cervical cancer. One of the most common complications after this surgery is lower extremity lymphedema (LLL). Program of progressive resistance exercise training (PRET) is a possible way to prevent LLL for cervical cancer patients postoperatively. Before we start a randomized controlled trial to evaluate the preventive effect of PRET, we conducted this pilot study to assess the feasibility of PRET after cervical cancer surgery. Methods The primary purpose of the pilot study was the feasibility of PRET, as well as the satisfaction and adherence to the PRET assessed by a questionnaire. We conducted a single-arm prospective study involving cervical cancer patients who underwent radical hysterectomy with pelvic lymphadenectomy. Participants exercised twice a day for 24 weeks (two weeks of supervised in hospital and then 22 weeks of home-based training) after surgical treatment. All patients were followed up for 12 months. Information that included the limb volume, BMI, perceived difficulty level and adherence rate was collected. Results From February to April 2019, a total of 24 patients participated in the study. None of them dropped out. The adherence rate was more than 75% in majority of the patients, the perceived difficulty level of the PRET was high (for the first phase, the fourth phase and the fifth phase, more than half of the participants felt the intensity of the exercise appropriate), and no serious adverse events in the study were observed. Conclusions Exercise training was safe and feasible. The preliminary results offered us the possibility to further test the preventive effect of PRET in a full-scale randomized controlled trial.
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Affiliation(s)
- Jiajia Zhang
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xingzhu Ju
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zheng Feng
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoju Zhang
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin Li
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Abe K, Tsuji T, Oka A, Shoji J, Kamisako M, Hohri H, Ishikawa A, Liu M. Postural differences in the immediate effects of active exercise with compression therapy on lower limb lymphedema. Support Care Cancer 2021; 29:6535-6543. [PMID: 33928435 PMCID: PMC8464559 DOI: 10.1007/s00520-020-05976-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 12/25/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Although regarded as an important treatment for lymphedema, the therapeutic effects of active exercise with compression therapy (AECT) are supported by little evidence. The purpose of this study was to determine the relative benefits of AECT with different postures for patients with lower limb lymphedema (LLL). METHODS Eighteen women with LLL secondary to surgical treatment of gynecological cancer, completed (1) AECT in a seated position (seated AECT), (2) AECT in a supine position (supine AECT), and (3) compression-only therapy in a supine position (CT) in this randomized, controlled, crossover trial. AECT was performed on a bicycle ergometer while wearing elastic compression bandages. Each intervention was performed for 15 min, and the three conditions were separated by a 1-week washout period. Lower-limb volumes were evaluated using a PerometerTM sensor (Pero-system, Wuppertal, Germany), and symptom severity was assessed before and after each intervention using a visual analog scale (pain, heaviness) and palpation (pitting, stiffness). The effects of the interventions were estimated using linear mixed-effect models. RESULTS The magnitude of limb volume decreases differed significantly among the interventions, with a greater decrease after supine AECT than after CT. Pre-intervention pitting severity and skin stiffness were significantly correlated with the magnitude of volume decrease after all interventions and after AECT in the supine position, respectively. CONCLUSIONS Supine AECT using a bicycle ergometer has marked immediate effects to decrease the fluid volume of severe LLL. CLINICAL TRIAL REGISTRATION UMIN clinical trial registry (UMIN-CTR; ID000020129) by CONSORT 2010, TRN R000023253, December 9, 2015.
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Affiliation(s)
- Kiriko Abe
- Department of Rehabilitation Medicine, Keio University Graduate School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
- Department of Rehabilitation Medicine, Saiseikai Kanagawa Hospital, 6-6 Tomiyacho, Kanagawa-ku, Yokohama, Kanagawa-ken, 221-0821, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan.
| | - Asako Oka
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Junichi Shoji
- Department of Rehabilitation Medicine, Keio University Hospital, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Michiyo Kamisako
- Department of Rehabilitation Medicine, Keio University Hospital, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Hiroka Hohri
- Department of Rehabilitation Medicine, Keio University Hospital, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
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Bona AF, Ferreira KR, Carvalho RBM, Thuler LCS, Bergmann A. Psychometric Evaluation of a Brazilian Version of the Lymphedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphedema in Patients After Cancer Treatment. Lymphat Res Biol 2021; 20:82-88. [PMID: 33780630 DOI: 10.1089/lrb.2020.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The aim of this study was to evaluate psychometric properties of the Lymphedema Functioning, Disability and Health Questionnaire for lower limb lymphedema (Lymph-ICF-LL) in Brazilian patients with secondary lower limb lymphedema after cancer treatment. Methods and Results: A diagnostic test study was performed in 30 patients with lower limb lymphedema. To assess the reliability, the intraclass correlation coefficient (ICC) was analyzed through test-retest, Cronbach alpha coefficient, magnitude of intrasubject variability by standard error of measurement (SEM), and smallest real difference (SRD). To assess the face and content validity, a specific questionnaire was applied to assess the clarity of the scoring system and comprehensiveness of questions. To assess construct validity, correlations between the final Brazilian version of the Lymph ICF-LL and the quality of life questionnaire SF-36 (36-Item Short Form Health Survey Questionnaire) were analyzed. The ICCs and general internal consistency scores of Lymph-ICF-LL were high (ICCs >0.90 and the Cronbach alpha coefficient >0.90, respectively). Measurement variability between the tests was acceptable (SEM 5.9) with SRD of 16.4. Face and content validity were considered excellent by the patients as the scoring system was clear and questions were understandable for 97% and 90% of the patients, respectively. Construct validity was classified as good and all hypotheses for assessing convergent validity were accepted (medium to strong correlation, from -0.69 to -0.84). Conclusion: The Brazilian version of the Lymph-ICF-LL is a reliable and valuable instrument for assessing Brazilian patients with secondary lower limb lymphedema associated with cancer treatment.
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Affiliation(s)
- Alberto F Bona
- Clinical Research Department, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Kamila R Ferreira
- Physical Therapy Service, Brazilian National Cancer Institute, Hospital of Cancer II, Rio de Janeiro, Brazil
| | - Raquel B M Carvalho
- Physical Therapy Service, Brazilian National Cancer Institute, Hospital of Cancer II, Rio de Janeiro, Brazil
| | - Luiz Claudio S Thuler
- Clinical Research Department, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Anke Bergmann
- Clinical Research Department, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
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Shallwani SM, Towers A, Newman A, Salvador S, Yung A, Gilbert L, Gotlieb WH, Zeng X, Thomas D. Feasibility of a Pilot Randomized Controlled Trial Examining a Multidimensional Intervention in Women with Gynecological Cancer at Risk of Lymphedema. Curr Oncol 2021; 28:455-470. [PMID: 33450972 PMCID: PMC7903266 DOI: 10.3390/curroncol28010048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 01/21/2023] Open
Abstract
There is limited knowledge on non-invasive lymphedema risk-reduction strategies for women with gynecological cancer. Understanding factors influencing the feasibility of randomized controlled trials (RCTs) can guide future research. Our objectives are to report on the design and feasibility of a pilot RCT examining a tailored multidimensional intervention in women treated for gynecological cancer at risk of lymphedema and to explore the preliminary effectiveness of the intervention on lymphedema incidence at 12 months. In this pilot single-blinded, parallel-group, multi-centre RCT, women with newly diagnosed gynecological cancer were randomized to receive post-operative compression stockings and individualized exercise education (intervention group: IG) or education on lymphedema risk-reduction alone (control group: CG). Rates of recruitment, retention and assessment completion were recorded. Intervention safety and feasibility were tracked by monitoring adverse events and adherence. Clinical outcomes were evaluated over 12 months: presence of lymphedema, circumferential and volume measures, body composition and quality of life. Fifty-one women were recruited and 36 received the assigned intervention. Rates of recruitment and 12-month retention were 47% and 78%, respectively. Two participants experienced post-operative cellulitis, prior to intervention delivery. At three and six months post-operatively, 67% and 63% of the IG used compression ≥42 h/week, while 56% engaged in ≥150 weekly minutes of moderate-vigorous exercise. The cumulative incidence of lymphedema at 12 months was 31% in the CG and 31.9% in the IG (p = 0.88). In affected participants, lymphedema developed after a median time of 3.2 months (range, 2.7-5.9) in the CG vs. 8.8 months (range, 2.9-11.8) in the IG. Conducting research trials exploring lymphedema risk-reduction strategies in gynecological cancer is feasible but challenging. A tailored intervention of compression and exercise is safe and feasible in this population and may delay the onset of lymphedema. Further research is warranted to establish the role of these strategies in reducing the risk of lymphedema for the gynecological cancer population.
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Affiliation(s)
- Shirin M. Shallwani
- Lymphedema Program, McGill University Health Centre, Montreal, QC H4A 3S5, Canada; (A.T.); (A.N.); (A.Y.); (D.T.)
- Physiotherapy Department, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Anna Towers
- Lymphedema Program, McGill University Health Centre, Montreal, QC H4A 3S5, Canada; (A.T.); (A.N.); (A.Y.); (D.T.)
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
| | - Anne Newman
- Lymphedema Program, McGill University Health Centre, Montreal, QC H4A 3S5, Canada; (A.T.); (A.N.); (A.Y.); (D.T.)
| | - Shannon Salvador
- Gynecologic Oncology Program, Jewish General Hospital, Montreal, QC H3T 1E2, Canada; (S.S.); (W.H.G.)
| | - Angela Yung
- Lymphedema Program, McGill University Health Centre, Montreal, QC H4A 3S5, Canada; (A.T.); (A.N.); (A.Y.); (D.T.)
- Physiotherapy Department, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Lucy Gilbert
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC H4A 3J1, Canada;
- Gynecologic Oncology Division, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Walter H. Gotlieb
- Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
- Gynecologic Oncology Program, Jewish General Hospital, Montreal, QC H3T 1E2, Canada; (S.S.); (W.H.G.)
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC H4A 3J1, Canada;
| | - Xing Zeng
- Gynecologic Oncology Division, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Doneal Thomas
- Lymphedema Program, McGill University Health Centre, Montreal, QC H4A 3S5, Canada; (A.T.); (A.N.); (A.Y.); (D.T.)
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Joshy G, Thandrayen J, Koczwara B, Butow P, Laidsaar-Powell R, Rankin N, Canfell K, Stubbs J, Grogan P, Bailey L, Yazidjoglou A, Banks E. Disability, psychological distress and quality of life in relation to cancer diagnosis and cancer type: population-based Australian study of 22,505 cancer survivors and 244,000 people without cancer. BMC Med 2020; 18:372. [PMID: 33256726 PMCID: PMC7708114 DOI: 10.1186/s12916-020-01830-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Improved survival means that cancer is increasingly becoming a chronic disease. Understanding and improving functional outcomes are critical to optimising survivorship. We quantified physical and mental health-related outcomes in people with versus without cancer, according to cancer type. METHODS Questionnaire data from an Australian population-based cohort study (45 and Up Study (n = 267,153)) were linked to cancer registration data to ascertain cancer diagnoses up to enrolment. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for adverse person-centred outcomes-severe physical functional limitations (disability), moderate/high psychological distress and fair/poor quality of life (QoL)-in participants with versus without cancer, for 13 cancer types. RESULTS Compared to participants without cancer (n = 244,000), cancer survivors (n = 22,505) had greater disability (20.6% versus 12.6%, respectively, PR = 1.28, 95%CI = (1.25-1.32)), psychological (22.2% versus 23.5%, 1.05 (1.02-1.08)) and poor/fair QoL (15.2% versus 10.2%; 1.28 (1.24-1.32)). The outcomes varied by cancer type, being worse for multiple myeloma (PRs versus participants without cancer for disability 3.10, 2.56-3.77; distress 1.53, 1.20-1.96; poor/fair QoL 2.40, 1.87-3.07), lung cancer (disability 2.81, 2.50-3.15; distress 1.67, 1.46-1.92; poor/fair QoL 2.53, 2.21-2.91) and non-Hodgkin's lymphoma (disability 1.56, 1.37-1.78; distress 1.20, 1.05-1.36; poor/fair QoL 1.66, 1.44-1.92) and closer to those in people without cancer for breast cancer (disability 1.23, 1.16-1.32; distress 0.95, 0.90-1.01; poor/fair QoL 1.15, 1.05-1.25), prostate cancer (disability 1.11, 1.04-1.19; distress 1.09, 1.02-1.15; poor/fair QoL 1.15, 1.08-1.23) and melanoma (disability 1.02, 0.94-1.10; distress 0.96, 0.89-1.03; poor/fair QoL 0.92, 0.83-1.01). Outcomes were worse with recent diagnosis and treatment and advanced stage. Physical disability in cancer survivors was greater in all population subgroups examined and was a major contributor to adverse distress and QoL outcomes. CONCLUSIONS Physical disability, distress and reduced QoL are common after cancer and vary according to cancer type suggesting priority areas for research, and care and support.
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Affiliation(s)
- Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, Canberra, ACT, 2601, Australia.
| | - Joanne Thandrayen
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, Canberra, ACT, 2601, Australia
| | - Bogda Koczwara
- Flinders University and Flinders Medical Centre, Adelaide, SA, Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Nicole Rankin
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Karen Canfell
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.,Cancer Research Division, Cancer Council New South Wales, Kings Cross, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | | | - Paul Grogan
- Cancer Research Division, Cancer Council New South Wales, Kings Cross, NSW, Australia
| | - Louise Bailey
- Primary Care Collaborative Cancer Clinical Trials Group Community Advisory Group, Melbourne, VIC, Australia.,Psycho-oncology Cooperative Research Group Community Advisory Group, Camperdown, NSW, Australia
| | - Amelia Yazidjoglou
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, Canberra, ACT, 2601, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, Canberra, ACT, 2601, Australia.,Sax Institute, Haymarket, NSW, Australia
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11
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The Quality of Life and Psychosocial Implications of Cancer-Related Lower-Extremity Lymphedema: A Systematic Review of the Literature. J Clin Med 2020; 9:jcm9103200. [PMID: 33023211 PMCID: PMC7601061 DOI: 10.3390/jcm9103200] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/20/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022] Open
Abstract
Lower-extremity lymphedema (LEL) is a progressive, lifelong complication of cancer that places a substantial burden upon cancer survivors' quality of life (QOL) and psychosocial well-being. Despite its prevalence, cancer-related LEL is inconsistently diagnosed, treated, and poorly recognized by health care professionals. The purpose of this systematic review was to summarize and appraise the quantitative literature evaluating the impact of cancer-related LEL on patients' psychosocial well-being and QOL. Three databases (PubMed, PROQuest, and Scopus) were searched for observational research articles published before May 1st, 2020. Twenty-one articles were eligible (cross-sectional (n = 16), prospective cohort designs (n = 3), and retrospective cohort designs (n = 2)). The majority of studies reported a negative relationship between cancer-related LEL and global QOL and/or one or more psychosocial domains including (1) physical and functional; (2) psycho-emotional; (3) social, relational and financial. A greater number of LEL symptoms and higher LEL severity were associated with poorer QOL. Although the evidence to date suggests a negative relationship between cancer-related LEL and patients' QOL and psychosocial well-being, there is a substantial need for longitudinal analyses to examine the directionality and temporality of this effect in order to inform cancer survivorship care modelling and improve patient outcomes after cancer.
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12
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Kendrová L, Mikuľáková W, Urbanová K, Andraščíková Š, Žultáková S, Takáč P, Peresta Y. Comprehensive Decongestive Therapy as a Treatment for Secondary Lymphedema of the Lower Extremity and Quality of Life of Women After Gynecological Cancer Surgery. Med Sci Monit 2020; 26:e924071. [PMID: 32555125 PMCID: PMC7320633 DOI: 10.12659/msm.924071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Lymphedema is a clinical manifestation of lymphatic system failure, caused by an imbalance between the transport capacity of the lymphatic system and the volume of the produced lymph. Lymphedema is complication and significantly worsens quality of life (QoL). Material/Methods There were 50 patients diagnosed with secondary lymphedema of the lower extremities after gynecological cancer followed by radiotherapy included in this study. The average age was 57.76 years (standard deviation±10.08). Patients were treated at the Department of Physiotherapy, Balneology and Medical Rehabilitation, in hospital NsP in Bardejov. During therapy, we applied manual lymphatic drainage, instrumental lymphatic drainage, multilayer bandage, vascular gymnastics (with loaded external compression), hydrotherapy, and patient education on the adjustment necessary for a life-long regimen. The circumference of the limb was measured using the Kuhnkes disk method, QoL was assessed using the LYMQOL LEG questionnaire, and for assessment of pain the Visual Analogue Scale (VAS) was used. Results After treatment, we found a reduction in lymphedema (P<0.001), an increase in QoL (P<0.001), and a reduction in pain (P<0.001). We found a significant relationship between QoL change and pain in the domains of symptoms, function, and overall QoL (P<0.005). The results showed that reduction of lymphedema was not a significant predictor of QoL (P>0.001). Conclusions We found a positive effect in the treatment of secondary lymphedema of the lower extremity on the QoL of women after uterine cancer surgery, and also found that reduction of lymphedema and age were not predictors of improvement in QoL.
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Affiliation(s)
- Lucia Kendrová
- Department of Physiotherapy, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - Wioletta Mikuľáková
- Department of Physiotherapy, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - Katarína Urbanová
- Department of Physiotherapy, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - Štefánia Andraščíková
- Department of Midwifery, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - Silvia Žultáková
- Department of Midwifery, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - Peter Takáč
- Department of Physiatry, Balneology and Medical Rehabilitation, Medical Faculty of P. J. Šafárik University and L. Pasteur University Hospital in Košice, Košice, Slovakia
| | - Yuriy Peresta
- Department of Physiotherapy, Faculty of Health Care, University of Prešov, Prešov, Slovakia
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13
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Sun W, Yang Y, Zhou F, Huang L, You C. Characteristics of sympathetic skin response in patients with Parkinson's disease accompanied by lower limb edema. Neurophysiol Clin 2020; 50:41-45. [DOI: 10.1016/j.neucli.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022] Open
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14
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Intradermal-Stress-Lymphoscintigraphy in Early Detection and Clinical Management of Secondary Lymphedema. Clin Nucl Med 2019; 44:669-673. [PMID: 31274620 DOI: 10.1097/rlu.0000000000002560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Bakar Y, Tuğral A. Translation, reliability, and validation of the Turkish version of the Lymphedema Quality-of-Life tool in Turkish-speaking patients with lower limb Lymphedema. JOURNAL OF VASCULAR NURSING 2019; 37:11-17. [PMID: 30954192 DOI: 10.1016/j.jvn.2018.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 11/25/2022]
Abstract
The aim of this study was to translate the original English version of the Lymph Quality-of-Life Questionnaire (LYMQoL) into Turkish language and test its reliability and validity in patients with lower limb lymphedema (LLL). A total of 119 patients (86 women and 33 men) with LLL were enrolled in this study. The Turkish version of the Nottingham Health Profile was used to evaluate the criterion validity of related domains in LYMQoL. The LYMQoL was performed after seven days to evaluate its test-retest reliability. Cronbach's alpha value was found to be 0.94 for internal consistency, and the intraclass correlation coefficient score for test-retest reliability was found to be 0.95. The intraclass correlation coefficient score of domains ranged between 0.83 and 0.92. For the criterion validity, "functional aspects" and "symptoms" domains moderately correlated significantly with the Nottingham Health Profile total score. Kappa values ranged from 0.356 to 0.715. According to the factor analysis, four factors that explain the 71% of the cumulative variance were found. In conclusion, this study indicates that the Turkish version of the LYMQoL is a reliable valid tool for the evaluation of disease-specific health-related quality of life in patients with LLL. It can be safely used in both clinical routine and research.
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Affiliation(s)
- Yeşim Bakar
- İzmir Bakırçay University, Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Izmir, Turkey
| | - Alper Tuğral
- Abant Izzet Baysal University, School of Physical Therapy and Rehabilitation, Bolu, Turkey.
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16
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Lee TS, Morris CM, Czerniec SA, Mangion AJ. Does Lymphedema Severity Affect Quality of Life? Simple Question. Challenging Answers. Lymphat Res Biol 2017; 16:85-91. [PMID: 28453410 DOI: 10.1089/lrb.2016.0049] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Lymphedema can have a negative impact on the function and quality of life (QOL) of patients, but most studies have examined lymphedema as a binary variable, rather than a multidimensional disease that ranges in severity. This study explored the potential impact of lymphedema severity on function and overall QOL. METHODS AND RESULTS Of the 54 lymphedema patients recruited, 40 reported their most severe swelling to be in a limb. These participants underwent bioimpedance measurement (L-Dex®) and completed either the disabilities of the arm, shoulder, and hand (DASH) questionnaire or the lower extremity functional scale (LEFS). All participants completed the lymphedema quality of life questionnaire (LYMQOL) and were categorized for severity using International Society of Lymphology (ISL) stage. Mild (Stage 0-I), moderate (Stage IIa), and severe (Stage IIb-III) lymphedema accounted for 22%, 50%, and 28% of the participants, respectively. The median [inter-quartile range (IQR)] L-Dex score was 17.8 (6.6-52.7) for arm participants and 36.4 (15.9-93.5) for leg participants. Apart from a mild difference in LYMQOL ARM Appearance domain (p = 0.046), ISL staging did not have any relationship with DASH, LEFS, and LYMQOL domains, or overall QOL. Higher L-Dex was related to poorer function (DASH p = 0.015; LEFS p = 0.019), but was not related to overall QOL of limb lymphedema participants (p > 0.05). CONCLUSIONS Lymphedema severity did not appear to impact QOL. ISL staging may not be used alone to describe lymphedema severity. Other methods such as bioimpedance, imaging, and self-report of symptoms are required to fully evaluate the impact of lymphedema severity on function and QOL.
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Affiliation(s)
- Teresa S Lee
- 1 Northern Sydney Cancer Centre, Royal North Shore Hospital , St Leonards, Australia .,2 Melanoma Institute Australia , North Sydney, Australia .,3 University of Sydney , Sydney, Australia
| | - Carol M Morris
- 1 Northern Sydney Cancer Centre, Royal North Shore Hospital , St Leonards, Australia .,2 Melanoma Institute Australia , North Sydney, Australia
| | | | - Andrea J Mangion
- 5 Lymphedema Education and Training Institute , Sydney, Australia
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17
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Fukushima T, Tsuji T, Sano Y, Miyata C, Kamisako M, Hohri H, Yoshimura C, Asakura M, Okitsu T, Muraoka K, Liu M. Immediate effects of active exercise with compression therapy on lower-limb lymphedema. Support Care Cancer 2017; 25:2603-2610. [PMID: 28386788 PMCID: PMC5486768 DOI: 10.1007/s00520-017-3671-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/14/2017] [Indexed: 11/28/2022]
Abstract
Purpose Active exercise with compression therapy (AECT) is a standard treatment for gynecological cancer-related lower-limb lymphedema (LLL) in clinical situations. However, there is insufficient evidence regarding the immediate effects of the use of AECT on LLL. The purpose of this study was to evaluate the immediate effects of AECT on LLL. Methods Participants in this randomized controlled crossover trial comprised 23 women with LLL who completed high-load AECT, low-load AECT, and compression-only therapy (CT). AECT was performed on a bicycle ergometer with short stretch bandages. Each intervention was performed for 15 min, with successive interventions separated by a 1-week washout period. Lower-limb volume was assessed using a Perometer™ sensor (Pero-system, Wuppertal, Germany). General symptoms (pain and heaviness) and skin symptoms (pitting and stiffness) were assessed using a visual analog scale and palpation, respectively. Measurements were taken before and after each intervention. Analysis of variance using linear mixed-effect modeling was used for statistical analyses. Results Volume decrement differed significantly between all three interventions (P < 0.05). Lower-limb volume was significantly reduced after high-load AECT compared to that after CT. General symptoms and skin symptoms were similar across the three interventions, but severity of pre-intervention skin symptoms correlated significantly with volume decrement after high- and low-load AECT. High-load AECT using the bicycle ergometer was more effective than CT for decreasing lower-limb volume. Conclusions These results suggest that high-load AECT has marked effects on severe LLL.
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Affiliation(s)
- Takuya Fukushima
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Locomotive Rehabilitation Science, Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Yufuko Sano
- Department of Rehabilitation Medicine, Keio University Hospital, Tokyo, Japan
| | - Chieko Miyata
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Michiyo Kamisako
- Department of Rehabilitation Medicine, Keio University Hospital, Tokyo, Japan
| | - Hiroka Hohri
- Department of Rehabilitation Medicine, Keio University Hospital, Tokyo, Japan
| | - Chikako Yoshimura
- Department of Rehabilitation Medicine, Keio University Hospital, Tokyo, Japan
| | - Megumi Asakura
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Taro Okitsu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Muraoka
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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18
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Svensson S, Eek F, Christiansen L, Wisén A. The effect of different exercise intensities on health related quality of life in people classified as obese. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2017.1296021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Frida Eek
- Physiotherapy Research Group, Department of Health Sciences, Lund University, Lund, Sweden
| | | | - Anita Wisén
- Physiotherapy Research Group, Department of Health Sciences, Lund University, Lund, Sweden
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19
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Baker TA, O'Connor ML, Krok-Schoen JL. Influence of Social and Health Indicators on Pain Interference With Everyday Activities Among Older Black and White Cancer Patients. Gerontol Geriatr Med 2017; 2:2333721415624989. [PMID: 28138484 PMCID: PMC5119878 DOI: 10.1177/2333721415624989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 12/01/2015] [Accepted: 12/03/2015] [Indexed: 11/25/2022] Open
Abstract
Objective: This prospective study aimed to determine the influence social and health factors have on pain interference with everyday activities among older patients receiving outpatient treatment services from a comprehensive cancer center. Method: Participants were surveyed on questions assessing pain interference, and social (communication), health (pain severity, comorbidities), behavioral (self-efficacy, affect), and demographic characteristics. Multivariate analyses were specified to examine determinants of pain interference, with items loading on separate cluster composites: physical interference and psychosocial interference. Results: Pain severity was a significant indicator for physical interference. Similarly, pain severity, education, self-efficacy, negative affect, and communication were predictors of psychosocial interference. Discussion: Factors defining the daily lived experiences of older adults are important in providing baseline information on functional status. This emphasizes the need to rigorously examine the association between pain, and clinical and psychosocial indicators, but more importantly indicators that contribute to the patient’s ability to perform normal everyday activities.
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20
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Zhang X, Brown JC, Schmitz KH. Association between Body Mass Index and Physical Function among Endometrial Cancer Survivors. PLoS One 2016; 11:e0160954. [PMID: 27529546 PMCID: PMC4986945 DOI: 10.1371/journal.pone.0160954] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/27/2016] [Indexed: 01/04/2023] Open
Abstract
Objectives We sought to quantify the relationship between body mass index (BMI) and physical function among endometrial cancer survivors. Understanding this relationship would help healthcare providers target efforts to refer obese endometrial cancer survivors to weight loss and exercise interventions. Methods We conducted a survey of 213 endometrial cancer survivors who received cancer care at an academic l health system between 2006 and 2010. Physical function subscale was quantified using physical functional component score from the SF-12 questionnaire. We compared physical function of endometrial cancer survivors to population-based age-standardized normative values. Results Among the 213 patients, 16% were normal weight (BMI ≤25 kg/m2), and 52% were obese (≥30 kg/m2). Higher BMI categories were associated with lower physical function (Ptrend = 0.003), as a continuous variable each 5kg/m2 higher BMI, physical function score was lower by 0.15 points (β = -0.15; P = 0.045). Compared to population-based age-standardized normative values, patients <75yrs reported lower physical function, whereas patients ≥75yrs reported better physical function. BMI was the only covariate associated with differences in physical function between survivors and age-standardized normative values (P = 0.039). Conclusions Among endometrial cancer survivors, higher BMI is associated with lower physical function. Younger endometrial cancer survivors report lower physical function compared to age-standardized normative values. Healthcare providers should be aware that younger, obese endometrial cancer survivors may particularly benefit from interventions such as exercise and weight loss to increase or preserve physical function.
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Affiliation(s)
- Xiaochen Zhang
- Public Health Science, Penn State College of Medicine, Hershey, PA, United States of America
| | - Justin C. Brown
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Kathryn H. Schmitz
- Public Health Science, Penn State College of Medicine, Hershey, PA, United States of America
- * E-mail:
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21
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Puszkiewicz P, Roberts AL, Smith L, Wardle J, Fisher A. Assessment of Cancer Survivors' Experiences of Using a Publicly Available Physical Activity Mobile Application. JMIR Cancer 2016; 2:e7. [PMID: 28410168 PMCID: PMC5369632 DOI: 10.2196/cancer.5380] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/24/2016] [Accepted: 04/10/2016] [Indexed: 01/06/2023] Open
Abstract
Background Regular participation in physical activity (PA) is associated with improved physical and psychosocial outcomes in cancer survivors. However, PA levels are low during and after cancer treatment. Interventions to promote PA in this population are needed. PA mobile apps are popular and have potential to increase PA participation, but little is known about how appropriate or relevant they are for cancer survivors. Objective This study aims to (1) assess recruitment, study uptake, and engagement for a publicly available PA mobile app (GAINFitness) intervention in cancer survivors; (2) assess cancer survivors’ attitudes towards the app; (3) understand how the app could be adapted to better meet the needs of cancer survivors; and (4) to determine the potential for change in PA participation and psychosocial outcomes over a 6-week period of using the app. Methods The present study was a one-arm, pre-post design. Cancer survivors (N=11) aged 33 to 62 years with a mean (SD) age of 45 (9.4), and 82% (9/11) female, were recruited (via community/online convenience sampling to use the app for 6 weeks). Engagement with the app was measured using self-reported frequency and duration of usage. Qualitative semi-structured telephone interviews were conducted after the 6-week study period and were analyzed using thematic analysis. PA, well-being, fatigue, quality of life (QOL), sleep quality, and anxiety and depression were self-reported at baseline and at a 6-week follow-up using the Godin Leisure Time Exercise Questionnaire (GLTEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale Questionnaire, the Health and Quality of Life Outcomes (EQ5D) Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS), respectively. Results Of the people who responded to the study advertisement, 73% (16/22) agreed to participate and 100% (11/11) of the participants who started the study completed all baseline and follow-up outcome measures and the telephone interview. On average, participants used the app twice a week for 25 minutes per session. Four themes were identified from the qualitative interviews surrounding the suitability of the app for cancer survivors and how it could be adapted: (1) barriers to PA, (2) receiving advice about PA from reliable sources, (3) tailoring the application to one’s lifestyle, and (4) receiving social support from others. Pre-post comparison showed significant increases in strenuous PA, improvements in sleep quality, and reductions in mild PA. There were no significant changes in moderate PA or other psychosocial outcomes. Conclusions All participants engaged with the app and qualitative interviews highlighted that the app was well-received. A generic PA mobile app could bring about positive improvements in PA participation and psychosocial outcomes among cancer survivors. However, a targeted PA app aimed specifically towards cancer survivors may increase the relevance and suitability of the app for this population.
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Affiliation(s)
- Patrycja Puszkiewicz
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Anna L Roberts
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Lee Smith
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom.,The Cambridge Centre for Sport and Exercise Sciences, Department of Life Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Abigail Fisher
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
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22
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Stolldorf DP, Dietrich MS, Ridner SH. A Comparison of the Quality of Life in Patients With Primary and Secondary Lower Limb Lymphedema: A Mixed-Methods Study. West J Nurs Res 2016; 38:1313-34. [PMID: 27151079 DOI: 10.1177/0193945916647961] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Patients with lower limb lymphedema experience symptoms that may differ in intensity and distress. This mixed-methods study compares symptom intensity and distress and the impact of lymphedema on patients' quality of life by primary and secondary (cancer and noncancer) lymphedema groups. Individuals completed an online questionnaire (i.e., demographic form, Lymphedema Symptom Intensity and Distress Survey-Leg, and an open-ended question). Analyses included descriptive and inferential statistics (quantitative data) and content analysis (qualitative data). Participants differed statistically significantly by gender, employment status, and lymphedema location. Groups differed significantly in lack of self-confidence, χ(2)(df = 2) = 9.19, p = .010. Cancer patients reported higher intensity and distress scores for some symptoms, but these differences were not statistically significant. Patients reported lacking psychosocial well-being and resources and experiencing physical and functional impairments and treatment and care challenges. Patients with lower limb lymphedema experience psychosocial impairments and problems with quality of and access to care.
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