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Cataldi D, Bennett JP, Wong MC, Quon BK, Liu YE, Kelly NN, Kelly T, Schoeller DA, Heymsfield SB, Shepherd JA. Accuracy and precision of multiple body composition methods and associations with muscle strength in athletes of varying hydration: The Da Kine Study. Clin Nutr 2024; 43:284-294. [PMID: 38104490 DOI: 10.1016/j.clnu.2023.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Athletes vary in hydration status due to ongoing training regimes, diet demands, and extreme exertion. With water being one of the largest body composition compartments, its variation can cause misinterpretation of body composition assessments meant to monitor strength and training progress. In this study, we asked what accessible body composition approach could best quantify body composition in athletes with a variety of hydration levels. METHODS The Da Kine Study recruited collegiate and intramural athletes to undergo a variety of body composition assessments including air-displacement plethysmography (ADP), deuterium-oxide dilution (D2O), dual-energy X-ray absorptiometry (DXA), underwater-weighing (UWW), 3D-optical (3DO) imaging, and bioelectrical impedance (BIA). Each of these methods generated 2- or 3-compartment body composition estimates of fat mass (FM) and fat-free mass (FFM) and was compared to equivalent measures of the criterion 6-compartment model (6CM) that accounts for variance in hydration. Body composition by each method was used to predict abdominal and thigh strength, assessed by isokinetic/isometric dynamometry. RESULTS In total, 70 (35 female) athletes with a mean age of 21.8 ± 4.2 years were recruited. Percent hydration (Body Water6CM/FFM6CM) had substantial variation in both males (63-73 %) and females (58-78 %). ADP and DXA FM and FF M had moderate to substantial agreement with the 6C model (Lin's Concordance Coefficient [CCC] = 0.90-0.95) whereas the other measures had lesser agreement (CCC <0.90) with one exception of 3DO FFM in females (CCC = 0.91). All measures of FFM produced excellent precision with %CV < 1.0 %. However, FM measures in general had worse precision (% CV < 2.0 %). Increasing quartiles (significant p < 0.001 trend) of 6CM FFM resulted in increasing strength measures in males and females. Moreover, the stronger the agreement between the alternative methods to the 6CM, the more robust their correlation with strength, irrespective of hydration status. CONCLUSION The criterion 6CM showed the best association to strength regardless of the hydration status of the athletes for both males and females. Simpler methods showed high precision for both FM and FFM and those with the strongest agreement to the 6CM had the highest strength associations. SUMMARY BOX This study compared various body composition analysis methods in 70 athletes with varying states of hydration to the criterion 6-compartment model and assessed their relationship to muscle strength. The results showed that accurate and precise estimates of body composition can be determined in athletes, and a more accurate body composition measurement produces better strength estimates. The best laboratory-based techniques were air displacement plethysmography and dual-energy x-ray absorptiometry, while the commercial methods had moderate-poor agreement. Prioritizing accurate body composition assessment ensures better strength estimates in athletes.
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Affiliation(s)
- Devon Cataldi
- Department of Epidemiology, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Jonathan P Bennett
- Department of Epidemiology, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Michael C Wong
- Department of Epidemiology, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Brandon K Quon
- Department of Epidemiology, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Yong En Liu
- Department of Epidemiology, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Nisa N Kelly
- Department of Epidemiology, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Thomas Kelly
- Hologic Inc, 250 Campus Dr, Marlborough, MA 01752, USA
| | - Dale A Schoeller
- Isotope Ratio Core Biotech Center and Nutritional Sciences, Henry Mall Madison, WI 53706, USA
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 7080, USA
| | - John A Shepherd
- Department of Epidemiology, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA.
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Gülören G, Doğan Y, Özgül S, Gürşen C, Çinar GN, İpekten F, Akbayrak T. Acute Effects of Remedial Exercises with and without Compression on Breast-Cancer-Related Lymphedema. Healthcare (Basel) 2023; 11:2949. [PMID: 37998441 PMCID: PMC10671079 DOI: 10.3390/healthcare11222949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
Remedial exercises are an important part of the treatment for lymphedema, but there is little evidence to support the acute effects of remedial exercises with or without compression. The aim of this study was to investigate whether and how daily (performed within 24 h) remedial exercises with and without compression bandaging acutely affect the severity of lymphedema and its symptoms in breast-cancer-related lymphedema (BCRL). In total, 34 patients with BCRL completed three sets of remedial exercises (within 24 h) with and without compression bandaging in a randomized order separated by a 3-day wash-out period. The severity of lymphedema and extracellular water ratio were assessed before and 24 h post exercise by using bilateral circumferential measurements and bioimpedance spectroscopy (in L-dex score), respectively, and the severity of self-reported symptoms (swelling, heaviness, and tightness) was assessed using a visual analogue scale. While there was no difference in all outcomes at 24 h post exercise without compression (p > 0.05), all outcomes decreased significantly compared to baseline at 24 h after the exercise with compression (p < 0.001). The remedial exercises performed in the absence of compression within 24 h do not acutely increase the lymphedema and symptoms in BCRL. These are important preliminary findings, which can be used to inform future prospective evaluation of the long-term effects of remedial exercise performed without compression.
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Affiliation(s)
- Gülbala Gülören
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06100, Turkey; (Y.D.); (S.Ö.); (C.G.); (G.N.Ç.); (T.A.)
| | - Yahya Doğan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06100, Turkey; (Y.D.); (S.Ö.); (C.G.); (G.N.Ç.); (T.A.)
| | - Serap Özgül
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06100, Turkey; (Y.D.); (S.Ö.); (C.G.); (G.N.Ç.); (T.A.)
| | - Ceren Gürşen
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06100, Turkey; (Y.D.); (S.Ö.); (C.G.); (G.N.Ç.); (T.A.)
| | - Gamze Nalan Çinar
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06100, Turkey; (Y.D.); (S.Ö.); (C.G.); (G.N.Ç.); (T.A.)
| | - Funda İpekten
- Department of Biostatistics, Faculty of Medicine, Erciyes University, Kayseri 38039, Turkey;
| | - Türkan Akbayrak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06100, Turkey; (Y.D.); (S.Ö.); (C.G.); (G.N.Ç.); (T.A.)
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3
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Liu Y, Zhao X, Song J, Zhao W, Ge Y, Guan J. The Effect of Manual Lymph Drainage and Compression Bandaging for Stage 2 Breast Cancer-Related Lymphedema: A Randomized Controlled Trial. Lymphat Res Biol 2023; 21:479-484. [PMID: 37140566 DOI: 10.1089/lrb.2022.0074] [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: 05/05/2023] Open
Abstract
Aim: To explore the effect of manual lymph drainage (MLD), compression bandaging (CB), or combined decongestive therapy (CDT), including MLD and CB, on stage 2 breast cancer-related lymphedema (BCRL). Methods: Sixty women with stage 2 BCRL were enrolled. They were randomly divided into the MLD group, the CB group or the CDT group. Each group, respectively, received MLD alone, CB alone, or CDT composed of MLD and CB, for 2 weeks. The volume and the local tissue water (LTW) of affected arms were measured before and after treatment. Arm circumferences were measured at 4 cm interval starting from the wrist to the shoulder with a tape measure. LTW was detected using the (tissue dielectric constant, TDC) method and was expressed as TDC value in two sites on the ventral midpoint of upper arm and forearm. Results: The volume of affected arms in each group after 2-weeks' treatment was lower than their baseline and the difference was statistically significant (p < 0.05). But there was no significant difference in volume change among three groups. The TDC value of the upper arm and forearm in the group CB and the group CDT decreased distinctly compared with baseline (p < 0.05). But the TDC value of the upper arm and forearm after MLD did not change (p > 0.05). Compared with the group MLD and the group CDT, the reduction of the TDC value in the group CB was more significant (p < 0.05). Conclusions: MLD or CB alone could effectively reduce the volume of affected arms for patients with stage 2 BCRL, and CB also could reduce the LTW more significantly. CDT did not seem to show an extra advantage. Therefore, CB may be the first choice for stage 2 BCRL. But for patients who are unwilling or intolerant to CB, MLD can be selected.
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Affiliation(s)
- Ying Liu
- Department of Rehabilitation and Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xiaoyi Zhao
- Department of Rehabilitation and Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Jian Song
- Department of Rehabilitation and Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Wowa Zhao
- Department of Rehabilitation and Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Ying Ge
- Department of Rehabilitation and Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Jinghong Guan
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
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De Vrieze T, Gebruers N, Nevelsteen I, Thomis S, De Groef A, Tjalma WAA, Belgrado JP, Vandermeeren L, Monten C, Hanssens M, Asnong A, Dams L, Van der Gucht E, Heroes AK, Devoogdt N. Does Manual Lymphatic Drainage Add Value in Reducing Suprafascial Fluid Accumulation and Skin Elasticity in Patients With Breast Cancer-Related Lymphedema? Phys Ther 2022; 102:pzac137. [PMID: 36209432 DOI: 10.1093/ptj/pzac137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/31/2022] [Accepted: 07/10/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the effectiveness of fluoroscopy-guided manual lymph drainage (MLD) versus that of traditional and placebo MLD, when added to decongestive lymphatic therapy (DLT) for the treatment of breast cancer-related lymphedema (BCRL) (EFforT-BCRL trial), on the suprafascial accumulation of lymphatic fluid and skin elasticity. METHODS In this multicenter, 3-arm, double-blind, randomized controlled trial (EFforT-BCRL trial), 194 participants (mean age = 61 [SD = 10] years) with unilateral BCRL were recruited. All participants received standardized DLT (education, skin care, compression therapy, exercises) and were randomized to fluoroscopy-guided, traditional, or placebo MLD. Participants received 60 min/d of treatment during the 3-week intensive phase and 18 sessions of 30 minutes during the 6-month maintenance phase. During this phase, participants were instructed to wear a compression garment, to perform exercises, and to perform a self-MLD procedure once daily. This study comprises secondary analyses of the EFforT-BCRL trial. Outcomes were the amount of fluid accumulation in the suprafascial tissues (local tissue water, extracellular fluid, and thickness of the skin and subcutaneous tissue) and skin elasticity at the level of the arm and trunk. Measurements were performed at baseline; after intensive treatment; after 1, 3, and 6 months of maintenance treatment; and after 6 months of follow-up. RESULTS At the level of the arm, there was a significant improvement over time in the 3 groups for most of the outcomes. At the level of the trunk, no remarkable improvement was noted within the individual groups. No significant interaction effects (between-group differences) were present. Only skin elasticity at the level of the arm, evaluated through palpation, showed a significant interaction effect. CONCLUSION All 3 groups showed similar improvements in response to DLT regardless of the type of MLD that was added. The effect of the addition of MLD to other components of DLT for reducing local tissue water and extracellular fluid or skin thickness and for improving skin elasticity and fibrosis in participants with chronic BCRL was limited. IMPACT Although MLD has been applied all over the world for many years, evidence regarding its added value in reducing arm volume in patients with BCRL is lacking. These results show that adding MLD to other components of DLT has limited value in reducing local tissue water and extracellular fluid or skin thickness and in improving skin elasticity and fibrosis in patients with chronic BCRL. To date, there is no clinical indication to continue including time-consuming MLD in physical therapist sessions for patients with chronic BCRL.
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Affiliation(s)
- Tessa De Vrieze
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium
| | - Nick Gebruers
- University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium
- University of Antwerp and Antwerp University Hospital, Multidisciplinary Oedema Clinic, Antwerp, Belgium
| | - Ines Nevelsteen
- UZ Leuven - University Hospitals Leuven, Multidisciplinary Breast Centre, Leuven, Belgium
| | - Sarah Thomis
- UZ Leuven - University Hospitals Leuven, Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Centre for Lymphoedema, Leuven, Belgium
| | - An De Groef
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium
| | - Wiebren A A Tjalma
- University of Antwerp and Antwerp University Hospital, Multidisciplinary Oedema Clinic, Antwerp, Belgium
- University of Antwerp, Department of Medicine, MIPRO, Antwerp, Belgium
- Antwerp University Hospital, Multidisciplinary Breast Clinic, Antwerp, Belgium
| | - Jean-Paul Belgrado
- Université Libre de Bruxelles, Lymphology Research Unit, Brussels, Belgium
| | | | - Chris Monten
- Ghent University Hospital, Department of Radiotherapy, Ghent, Belgium
| | - Marianne Hanssens
- General Hospital Groeninge, Department of Oncology, Centre for Oncology, Kortrijk, Belgium
| | - Anne Asnong
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Lore Dams
- University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium
| | - Elien Van der Gucht
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - An-Kathleen Heroes
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Nele Devoogdt
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- UZ Leuven - University Hospitals Leuven, Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Centre for Lymphoedema, Leuven, Belgium
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5
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Dylke E. Measurement of breast cancer-related lymphoedema. J Physiother 2022; 68:238-243. [PMID: 36244958 DOI: 10.1016/j.jphys.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Elizabeth Dylke
- Discipline of Physiotherapy, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia.
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6
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De Vrieze T, Gebruers N, Nevelsteen I, Fieuws S, Thomis S, De Groef A, Tjalma WA, Belgrado JP, Vandermeeren L, Monten C, Hanssens M, Devoogdt N. Manual lymphatic drainage with or without fluoroscopy guidance did not substantially improve the effect of decongestive lymphatic therapy in people with breast cancer-related lymphoedema (EFforT-BCRL trial): a multicentre randomised trial. J Physiother 2022; 68:110-122. [PMID: 35428594 DOI: 10.1016/j.jphys.2022.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 01/22/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022] Open
Abstract
QUESTIONS When added to decongestive lymphatic therapy (DLT), what is the effect of fluoroscopy-guided manual lymphatic drainage (MLD) versus traditional MLD or placebo MLD for the treatment of breast cancer-related lymphoedema (BCRL)? DESIGN Multicentre, three-arm, randomised controlled trial with concealed allocation, intention-to-treat analysis and blinding of assessors and participants. PARTICIPANTS At five hospitals in Belgium, 194 participants with unilateral chronic BCRL were recruited. INTERVENTION All participants received standard DLT (education, skin care, compression therapy and exercises). Participants were randomised to also receive fluoroscopy-guided MLD (n = 65), traditional MLD (n = 64) or placebo MLD (n = 65). Participants received 14 sessions of physiotherapy during the 3-week intensive phase and 17 sessions during the 6-month maintenance phase. Participants performed self-management on the other days. OUTCOME MEASURES All outcomes were measured: at baseline; after the intensive phase; after 1, 3 and 6 months of maintenance phase; and after 6 months of follow-up. The primary outcomes were reduction in excess volume of the arm/hand and accumulation of excess volume at the shoulder/trunk, with the end of the intensive phase as the primary endpoint. Secondary outcomes included daily functioning, quality of life, erysipelas and satisfaction. RESULTS Excess lymphoedema volume decreased after 3 weeks of intensive treatment in each group: 5.3 percentage points of percent excessive volume (representing a relative reduction of 23.3%) in the fluoroscopy-guided MLD group, 5.2% (relative reduction 20.9%) in the traditional MLD group and 5.4% (relative reduction 24.8%) in the placebo MLD group. The effect of fluoroscopy-guided MLD was very similar to traditional MLD (between-group difference 0.0 percentage points, 95% CI -2.0 to 2.1) and placebo MLD (-0.2 percentage points, 95% CI -2.1 to 1.8). Fluid accumulated at the shoulder/trunk in all groups. The average accumulation with fluoroscopy-guided MLD was negligibly less than with traditional MLD (-3.6 percentage points, 95% CI -6.4 to -0.8) and placebo MLD (-2.4 percentage points, 95% CI -5.2 to 0.4). The secondary outcomes also showed no clinically important between-group differences. CONCLUSION In patients with chronic BCRL, MLD did not provide clinically important additional benefit when added to other components of DLT. REGISTRATION NCT02609724.
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Affiliation(s)
- Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium.
| | - Nick Gebruers
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium; Multidisciplinary Oedema Clinic, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium
| | | | - Steffen Fieuws
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Sarah Thomis
- Centre for Lymphedema, Department of Vascular Surgery & Department of Physical Medicine and Rehabilitation, UZ Leuven, Leuven, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Wiebren Aa Tjalma
- Multidisciplinary Oedema Clinic, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium; Department of Medicine University of Antwerp, Antwerp, Belgium; Multidisciplinary Breast Clinic, Antwerp University Hospital, Antwerp, Belgium
| | - Jean-Paul Belgrado
- Lymphology Research Unit, Université libre de Bruxelles, Brussels, Belgium
| | | | - Chris Monten
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Marianne Hanssens
- Centre for Oncology, Department of Oncology, General Hospital Groeninge, Kortrijk, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
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Liu Y, Long X, Guan J. Tissue Dielectric Constant Combined With Arm Volume Measurement as Complementary Methods in Detection and Assessment of Breast Cancer-Related Lymphedema. Lymphat Res Biol 2021; 20:26-32. [PMID: 33761282 DOI: 10.1089/lrb.2020.0065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim: To investigate the role of tissue dielectric constant (TDC) in the detection and assessment of breast cancer-related lymphedema (BCRL) and to determine whether the TDC could potentially be used as a complementary method for arm volume measurement. Methods: Sixty-nine patients with BCRL were enrolled in this study. Local tissue water was assessed bilaterally by using the TDC method in four sites: upper arm, forearm, hand, and lateral thorax. Arm circumferences were measured at the 4-cm interval, starting from the shoulder to the wrist by using a tape measure. The arm volume was calculated by a standard formula. Patients' demographic information and clinical characteristics were also recorded. Results: Fifty-one of the 69 patients were diagnosed with clinical lymphedema. Using a TDC ratio of 1.2 or a diagnostic reference standard of ≥2 cm arm circumference, the sensitivity of these two methods was found to be identical at 73.9%. The TDC values in four sites on the affected side were significantly higher (p < 0.05) relative to the unaffected side. The inter-side TDC ratio of upper arm and forearm was substantially higher than that of lateral thorax and hand (p < 0.05). The TDC ratio of upper arm, forearm, and hand, especially of the upper arm and forearm, was positively correlated with inter-limb volume difference and stage of lymphedema. Conclusion: The TDC method elucidated a meaningful clinical correlation to the arm volume measurement. Applying those two methods together showed promise in the detection and assessment of BCRL. The forearm and upper arm were reliable examination sites for TDC measurements in the clinic.
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Affiliation(s)
- Ying Liu
- Department of Physical Medicine and Rehabilitation, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Jinghong Guan
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
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Edwick DO, Hince DA, Rawlins JM, Wood FM, Edgar DW. Alternate Electrode Positions for the Measurement of Hand Volumes Using Bioimpedance Spectroscopy. Lymphat Res Biol 2020; 18:560-571. [DOI: 10.1089/lrb.2019.0078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Dale O. Edwick
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia
| | - Dana A. Hince
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, Australia
| | - Jeremy M. Rawlins
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia
- Department of Plastic and Maxillofacial Surgery, Royal Perth Hospital, Perth, Australia
| | - Fiona M. Wood
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia
- Burn Injury Research Unit, The University of Western Australia, Nedlands, Australia
| | - Dale W. Edgar
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, Australia
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Thomis S, Dams L, Fourneau I, De Vrieze T, Nevelsteen I, Neven P, Gebruers N, Devoogdt N. Correlation Between Clinical Assessment and Lymphofluoroscopy in Patients with Breast Cancer-Related Lymphedema: A Study of Concurrent Validity. Lymphat Res Biol 2020; 18:539-548. [DOI: 10.1089/lrb.2019.0090] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Sarah Thomis
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven–University Hospitals of Leuven, Leuven, Belgium
- Research Unit Vascular Surgery, Department of Cardiovascular Sciences, KU Leuven–University of Leuven, Leuven, Belgium
| | - Lore Dams
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven–University Hospitals of Leuven, Leuven, Belgium
- Research Unit Vascular Surgery, Department of Cardiovascular Sciences, KU Leuven–University of Leuven, Leuven, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Ines Nevelsteen
- Multidisciplinary Breast Centre, UZ Leuven–University Hospitals of Leuven, Leuven, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Centre, UZ Leuven–University Hospitals of Leuven, Leuven, Belgium
| | - Nick Gebruers
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Oedema Clinic, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Nele Devoogdt
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven–University Hospitals of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
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10
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Edwick DO, Hince DA, Rawlins JM, Wood FM, Edgar DW. Bioimpedance Spectroscopy Is a Valid and Reliable Measure of Edema Following Hand Burn Injury (Part 1-Method Validation). J Burn Care Res 2020; 41:780-787. [PMID: 32386214 DOI: 10.1093/jbcr/iraa071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The assessment of swelling following burn injury is complicated by the presence of wounds and dressings and due to patients experiencing significant pain and impaired movement. There remains a lack of sensitive objective measures for edema in patients presenting with hand burn injury. Bioimpedance spectroscopy (BIS) is a measure of body composition that has been demonstrated by our group to be reliable for measuring whole body and limb edema during resuscitation and to be sensitive to edema changes within healing wounds. The aim of this study was to determine the reliability and validity of BIS as a measure of edema following hand burn injury specifically. One hundred patients presenting with burn injury including a portion of a hand were recruited to this trial. Repeated measures of the hand were recorded using a novel application of BIS and in parallel with water displacement volumetry (WDV). The results were analyzed using mixed-effects regressions. Paired repeated measures were obtained for 195 hands, using four electrode configurations. BIS demonstrated high reliability in measuring hand BIS-Intraclass Correlation Coefficient 0.995 to 0.999 (95% CI 0.992-1.000) and sensitivity-Minimum Detectable Difference 0.74 to 3.86 Ω (0.09-0.48 Ω/cm). A strong correlation was shown with WDV, Pearson's r = -0.831 to -0.798 (P < .001). BIS is a sensitive and reliable measure of edema following acute hand burn injury.
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Affiliation(s)
- Dale O Edwick
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia.,Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia.,Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Australia.,School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Dana A Hince
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, Australia
| | - Jeremy M Rawlins
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia.,Department of Plastic and Maxillofacial Surgery, Royal Perth Hospital, Australia
| | - Fiona M Wood
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia.,Burn Injury Research Unit, University of Western Australia, Perth, Australia
| | - Dale W Edgar
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia.,Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia.,Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Australia.,Institute of Health Research, The University of Notre Dame Australia, Fremantle, Australia.,Burn Injury Research Unit, University of Western Australia, Perth, Australia
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11
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De Vrieze T, Gebruers N, Nevelsteen I, De Groef A, Tjalma WA, Thomis S, Dams L, Van der Gucht E, Penen F, Devoogdt N. Reliability of the MoistureMeterD Compact Device and the Pitting Test to Evaluate Local Tissue Water in Subjects with Breast Cancer-Related Lymphedema. Lymphat Res Biol 2020; 18:116-128. [DOI: 10.1089/lrb.2019.0013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Nick Gebruers
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Oedema Clinic, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Ines Nevelsteen
- Multidisciplinary Breast Centre, UZ Leuven–University Hospitals Leuven, Leuven, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
| | - Wiebren A.A. Tjalma
- Multidisciplinary Oedema Clinic, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
- Department of Medicine, MIPRO, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Breast Clinic, Antwerp University Hospital, Antwerp, Belgium
| | - Sarah Thomis
- Department of Vascular Surgery, Centre for Lymphoedema, UZ Leuven–University Hospitals Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, Center for Lymphoedema, UZ Leuven–University Hospitals Leuven, Leuven, Belgium
| | - Lore Dams
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Elien Van der Gucht
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Frauke Penen
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Vascular Surgery, Centre for Lymphoedema, UZ Leuven–University Hospitals Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, Center for Lymphoedema, UZ Leuven–University Hospitals Leuven, Leuven, Belgium
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12
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He L, Qu H, Wu Q, Song Y. Lymphedema in survivors of breast cancer. Oncol Lett 2020; 19:2085-2096. [PMID: 32194706 PMCID: PMC7039097 DOI: 10.3892/ol.2020.11307] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 11/07/2019] [Indexed: 12/16/2022] Open
Abstract
The tremendous improvement of survival in patients with breast cancer can be attributed to several treatment strategies, but these strategies also lead to the occurrence of breast cancer-related lymphedema (BCRL). BRCL is regularly associated with factors such as axillary lymph node dissection and local lymph node radiotherapy and manifests as an increase of >10% in the volume of affected limbs. Being overweight or having obesity (body mass index ≥25 kg/m2), an excessive number of positive lymph nodes (>8) and capsular invasion by a tumor are additional risk factors for lymphedema. It is worth assessing the risk before surgery as this can prevent the occurrence of BCRL at the initial stage of breast cancer management. The clinical utility of many diagnostic tools and lymphedema surveillance allows early stage and even subclinical BCRL to be diagnosed, and allows real-time monitoring of the disease. The early diagnosis of BRCL allows treatment at an early stage, which is beneficial to the reduction of excess limb volume and the improvement of quality of life. At present, the major therapeutic methods of BCRL include complex decongestive therapy, pneumatic compression devices, participating in exercise, microsurgery and liposuction, each of which alleviates lymphedema effectively. No medications for treatment of BRCL have yet been developed. However, the recent findings on the success of molecular therapy in animal models may remedy this deficiency. Furthermore, the volume reduction of swollen limbs without swelling rebound by transplanting autologous stem cells has been successfully reported in some pilot studies, which may provide a new technique for treating BCRL. This review aimed to discuss the pathogenesis, clinical manifestation, risk factors, advantages and disadvantages of diagnostic tools, lymphedema surveillance and the characteristics of traditional and newly emerging BCRL treatments.
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Affiliation(s)
- Lin He
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Huili Qu
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Qian Wu
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Yuhua Song
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
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13
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Oh S, Gustafsson L, Eames S. Current practice trends of oedema management in the hands of people with tetraplegia in Australia. Spinal Cord Ser Cases 2019; 5:71. [PMID: 31632729 PMCID: PMC6786418 DOI: 10.1038/s41394-019-0215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/05/2019] [Accepted: 07/18/2019] [Indexed: 11/16/2022] Open
Abstract
Study design Survey research design. Objectives To describe current practice methods for oedema management in people with tetraplegia. Setting Australia. Methods Online survey with open and closed questions regarding clinical practice trends in the assessment and treatment of oedema in the hands in people with tetraplegia. Results Seventeen occupational therapists working in spinal cord injury (SCI) in Australia completed the survey. Oedema was identified by visual inspection (n = 17, 100%) and recorded using circumferential tape measurement (n = 13, 76%). Elevation was used by all participants in conjunction with compression gloves (n = 13, 76%), retrograde massage (n = 13, 76%), compression bandaging (n = 12, 71%) and the boxing glove splint (n = 9, 53%). Participants stated that oedema presented challenges to patients with difficulty exercising (n = 11, 65%), changes to body image (n = 5, 29%) and pain (n = 4, 24%). Conclusion Assessment and treatment practices were not consistent. Oedema in the hands in people with tetraplegia was perceived to have various impacts on a person's rehabilitation and hand function. The findings highlight the need for research evidence to guide practice.
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Affiliation(s)
- Soo Oh
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD Australia
- Occupational Therapy department, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD Australia
- School of Allied Health Sciences, Griffith University, Brisbane, QLD Australia
| | - Sally Eames
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD Australia
- Community and Oral Health, Metro North Hospital and Health Service, Brisbane, QLD Australia
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14
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Mayrovitz HN. Assessing Upper and Lower Extremities Via Tissue Dielectric Constant: Suitability of Single Versus Multiple Measurements Averaged. Lymphat Res Biol 2019; 17:316-321. [DOI: 10.1089/lrb.2018.0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Harvey N. Mayrovitz
- College of Medical Sciences, Nova Southeastern University, Fort Lauderdale, Florida
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15
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16
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Protocol of a randomised controlled trial regarding the effectiveness of fluoroscopy-guided manual lymph drainage for the treatment of breast cancer-related lymphoedema (EFforT-BCRL trial). Eur J Obstet Gynecol Reprod Biol 2017; 221:177-188. [PMID: 29277358 DOI: 10.1016/j.ejogrb.2017.12.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/13/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Lymphoedema is a dreadful complication following breast cancer therapy. According to the International Society of Lymphology, the consensus treatment for breast cancer-related lymphoedema (BCRL) is the decongestive lymphatic therapy. This is a two-phase treatment and combines different treatment modalities including skin care, manual lymphatic drainage (MLD), compression therapy and exercise. However, the additional effect of MLD is debated since pooled data only demonstrated a limited non-significant additional value. A possible explanation is that in previous studies MLD has been applied blind, without knowledge of patient-specific lymphatic routes of transport. In addition, the MLD hand manoeuvres used by the therapists in previous studies, possibly did not optimally stimulate lymphatic transport. Recently, near-infrared fluorescence imaging has been introduced to visualise the superficial lymphatic network which allows MLD at the most needed location. The aim of the present study is to determine the effectiveness of the fluoroscopy-guided MLD, additional to the other parts of the decongestive lymphatic therapy and compared to the traditional or a placebo MLD, in the treatment of BCRL. STUDY DESIGN A three-arm double-blinded randomised controlled trial will be conducted in different university hospitals in Belgium. Based on a sample size calculation, 201 participants with chronic BCRL stage 1 or 2 of the arm or hand, with at least 5% difference between both sides (corrected for hand dominance) need to be recruited. All participants receive the standard treatment: skin care, compression therapy and exercises. The intervention group additionally receives fluoroscopy-guided MLD. One control group additionally receives the traditional 'blind' MLD and a second control group receives a placebo MLD. All subjects receive 3 weeks of daily intensive treatments and 6 months of maintenance treatment. Follow-up period is 6 months. The primary outcomes are the reduction in lymphoedema volume of the arm/hand and the change in stagnation of lymph fluid at level of the shoulder/trunk.
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17
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Hoffner M, Peterson P, Månsson S, Brorson H. Lymphedema Leads to Fat Deposition in Muscle and Decreased Muscle/Water Volume After Liposuction: A Magnetic Resonance Imaging Study. Lymphat Res Biol 2017; 16:174-181. [PMID: 28956970 PMCID: PMC5906724 DOI: 10.1089/lrb.2017.0042] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Lymphedema leads to adipose tissue deposition. Water–fat magnetic resonance imaging (MRI) can quantify and localize fat and water. The presence of excess fat and excess water/muscle in the subfascial compartment of the lymphedematous limb has not been investigated before. The aim of this study was to investigate epifascial and subfascial fat and water contents in patients with chronic lymphedema before and after liposuction. Methods and Results: Seven patients with arm lymphedema and six with leg lymphedema were operated on. The limbs were examined with water–fat MRI before liposuction (baseline) and at five time points. Complete reduction of the excess limb volumes was achieved. The excess epifascial fat was evident in the edematous limbs and a drop was seen following surgery. There were differences in excess water at all time points. At 1 year there was a decrease in excess water. Excess subfascial fat was seen in the edematous limbs at all time points. Subfascial excess water/muscle did not show any differences after surgery. However, starting from 3 months there was less subfascial water/muscle compared with baseline. Conclusions: Subfascial fat in the lymphedematous limbs did not change. In contrast, the water in the subfascial compartment was reduced over time, which may represent a decrease of muscle volume after treatment due to less mechanical load after liposuction. Using water–fat MRI-based fat quantification, the fat and water contents may be quantified and localized in the various compartments in lymphedema.
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Affiliation(s)
- Mattias Hoffner
- 1 Department of Clinical Sciences, Lund University , Malmö, Sweden .,2 Department of Surgery, Blekinge Hospital , Karlskrona, Sweden
| | - Pernilla Peterson
- 3 Medical Radiation Physics, Department of Translational Medicine, Lund University, Skåne University Hospital , Malmö, Sweden
| | - Sven Månsson
- 3 Medical Radiation Physics, Department of Translational Medicine, Lund University, Skåne University Hospital , Malmö, Sweden
| | - Håkan Brorson
- 1 Department of Clinical Sciences, Lund University , Malmö, Sweden .,4 Department of Plastic and Reconstructive Surgery, Skåne University Hospital , Malmö, Sweden
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18
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Douglass J, Graves P, Gordon S. Intrarater Reliability of Tonometry and Bioimpedance Spectroscopy to Measure Tissue Compressibility and Extracellular Fluid in the Legs of Healthy Young People in Australia and Myanmar. Lymphat Res Biol 2016; 15:57-63. [PMID: 27673568 DOI: 10.1089/lrb.2016.0021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Measurements of tissue compressibility and extracellular fluid (ECF) are used to monitor progression of lymphedema, a chronic swelling of the subcutaneous tissue. Later stages of lymphedema are characterized by fibrotic induration in the subcutis and hyperkeratosis of the skin. Several devices are available to measure these changes, but previous reliability and validity studies have been conducted primarily on adult women with unilateral arm lymphedema using contralateral limbs as controls. To date, no studies have included either adolescents or measurement of leg tissue. METHODS AND RESULTS An intrarater reliability study was conducted to compare three devices measuring skin and subcutaneous tissue compressibility; a mechanical Tonometer, a digital Indurometer, and a SkinFibroMeter. ECF loads were measured using bioimpedance spectroscopy (BIS). Two populations of tropical-dwelling young people were included; Australian residents in North Queensland aged 8-21 years (n = 34) and people aged 10-21 years residing in Central Myanmar (n = 38). Neither cohort had any clinical sign of lymphedema or other leg abnormality. The mechanical Tonometer and the digital Indurometer had excellent intraclass correlation coefficient (ICC) scores between 0.792 (95% CI 0.055-0.901) and 0.964 (95% CI 0.945-0.984) and the SkinFibroMeter had good to excellent reliability with ICC scores of between 0.565 (95% CI 0.384-0.747) and 0.877 (95% CI 0.815-0.840). BIS exhibited the highest reliability with ICC scores approaching 1.0. CONCLUSIONS These results support the reliable use of tonometry and BIS to assess tissue compressibility and ECF loads in the legs of adolescent populations in developed and developing tropical countries.
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Affiliation(s)
- Janet Douglass
- 1 Division of Tropical Medicine, James Cook University , Queensland, Australia
| | - Patricia Graves
- 1 Division of Tropical Medicine, James Cook University , Queensland, Australia
| | - Susan Gordon
- 2 Flinders University , School of Health Sciences, Bedford Park, South Australia
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19
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Lahtinen T, Seppälä J, Viren T, Johansson K. Experimental and Analytical Comparisons of Tissue Dielectric Constant (TDC) and Bioimpedance Spectroscopy (BIS) in Assessment of Early Arm Lymphedema in Breast Cancer Patients after Axillary Surgery and Radiotherapy. Lymphat Res Biol 2015; 13:176-85. [PMID: 26305554 DOI: 10.1089/lrb.2015.0019] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Early diagnosis of breast cancer treatment-related lymphedema (BCRL) is of great importance for longstanding treatment results. Tissue dielectric constant (TDC) and bioimpedance spectroscopy (BIS) both have a potential for early diagnosis, but have not been compared. METHODS AND RESULTS One hundred women, treated for breast cancer with breast surgery, axillary dissection, and radiotherapy, were examined within one year after breast cancer treatment, as part of the follow-up procedure. Affected/at-risk and contralateral arms were measured with the TDC technique specific to localized skin water content and the BIS technique assessing arm extracellular fluid (ECF). Thirty-eight patients were clinically diagnosed for lymphedema (38.0%). The sensitivity and specificity for the TDC method were 65.8% and 83.9%, and for BIS method 42.1% and 93.5%, (p < 0.001 and NS), respectively. Of all lymphedema, 18.4% were detected only by TDC and 2.6% by BIS. Affected arm to contralateral arm TDC ratios for upper arm and forearm, 1.56 ± 0.49 and 1.28 ± 0.33, demonstrating the localized feature of the TDC measurements were significantly greater than the BIS arm ratio 1.12 ± 0.12 (both p < 0.001). CONCLUSIONS Discrepancies between TDC and BIS techniques in assessing lymphedema are related to different measurement techniques and assessed tissue water components. Independently of selected technique-specific threshold limit, the TDC technique was more sensitive than the BIS technique in the early assessment of BCRL and demonstrated that nearly 20% of early lymphedema are only superficially localized. The results further supported the complementary role of TDC and arm volume measurements as a highly diagnostic method for early lymphedema.
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Affiliation(s)
- Tapani Lahtinen
- 1 Cancer Center, Kuopio University Hospital , Kuopio, Finland
| | - Jan Seppälä
- 1 Cancer Center, Kuopio University Hospital , Kuopio, Finland
| | - Tuomas Viren
- 1 Cancer Center, Kuopio University Hospital , Kuopio, Finland
| | - Karin Johansson
- 2 Department of Health Sciences, Lund University , Lund, Sweden
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20
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Rockson SG. Detection of tissue edema in breast cancer-associated lymphedema. Lymphat Res Biol 2015; 13:1. [PMID: 25768054 DOI: 10.1089/lrb.2015.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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