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Burian EA, Rungby J, Karlsmark T, Nørregaard S, Cestari M, Franks PJ, Moffatt CJ. The impact of obesity on chronic oedema/lymphoedema of the leg - an international multicenter cross-sectional study (LIMPRINT). Int J Obes (Lond) 2024:10.1038/s41366-024-01544-0. [PMID: 38961152 DOI: 10.1038/s41366-024-01544-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND/OBJECTIVES Obesity and chronic oedema/lymphoedema are two distinct but related conditions, rarely investigated together. The aim was to study the impact of increased weight on chronic oedema and related factors. SUBJECTS/METHODS A cross-sectional study, 38 centers, nine countries. Patients with clinically confirmed chronic oedema/lymphoedema of the leg were included. Weight category was estimated as: normal weight (BMI 20-30), class I-II obesity (BMI 30-40), or class III obesity (BMI > 40). Factors were tested for an association with increased weight, using a multivariable model. RESULTS A total of 7397 patients were included; 43% with normal weight, 36% class I-II obesity and 21% class III obesity. Increased weight was associated with more advanced stages of chronic oedema (ISL stage III; the most advanced form); affecting 14% in normal weight, 18% class I-II obesity and 39% class III obesity (p < 0.001). Ten factors were independently associated with increased weight: diabetes (OR 2.4), secondary lymphoedema (OR 2.7), cellulitis/erysipelas within 12 months (OR 1.2), bilateral lymphoedema (OR 3.6), compression therapy (OR 2.1), increased swelling duration (1-2 years OR 1.3, 2-5 years OR 2.5, 5-10 years OR 3.6, >10 years OR 3.5) decreased mobility (walking with aid OR 1.9, being chair bound OR 1.2) and age (reference<45 years; 45-64 years OR 1.5, 75-84 years OR 0.6, 85+ years OR 0.2). Increased weight was associated with a lower presentation of peripheral arterial disease (OR 0.7) and poorer chronic oedema control (OR 0.8). Patients with obesity had lower function, appearance and more severe symptoms (LYMQOL) and lower quality of life (EuroQol). CONCLUSIONS Obesity negatively impacts chronic oedema, leading to more advanced stages. Achieving good control of swelling with compression is more difficult in these patients. Increased awareness of chronic oedema/lymphoedema as a complication of obesity is important for early detection and for developing effective strategies to prevent and manage them.
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Affiliation(s)
- Ewa Anna Burian
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Tonny Karlsmark
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susan Nørregaard
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Peter J Franks
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Christine Joy Moffatt
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Monteiro AJ, de Labra C, Losa-Iglesias ME, Dias A, Becerro-de-Bengoa-Vallejo R, Silva-Migueis H, Nuno SL, López-López D, Gómez-Salgado J. Impact of Lymphedema on Foot-Health-Related Quality of Life: A Case-Control Investigation. Adv Skin Wound Care 2024; 37:376-381. [PMID: 38899819 DOI: 10.1097/asw.0000000000000164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To evaluate the foot-health-related quality of life in individuals with versus without lower-limb lymphedema. METHODS A case-control study was carried out in an academic clinic in Lisbon, Portugal. Eighty participants (40 controls and 40 with lymphedema) were included in the study. The researchers examined sociodemographic and clinical data and foot-health-related quality of life in both groups. In the group with lymphedema, lower-limb lymphedema was also characterized. RESULTS Individuals with lower-limb lymphedema had significantly lower scores on all dimensions of the Foot Health Status Questionnaire in comparison with the control group. CONCLUSIONS Individuals with lower-limb lymphedema appear to have a poorer foot-health-related quality of life than the general population.
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Affiliation(s)
- Ana Júlia Monteiro
- Ana Júlia Monteiro, MSc, PT, is PhD student, Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain, and Adjunct Professor, Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa-Lisboa, Lisboa, Portugal. Carmen de Labra, PhD, PhysC, is Associate Professor, Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña. Marta Elena Losa-Iglesias, PhD, MSc, DP, RN, is Full Professor, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, Spain. Adriano Días, PhD, ELC, is Full Professor, Epidemiology, Department of Public Health and Grade Program of Public/Collective Health, Botucatu Medical School/UNESP, Botucatu, Brazil. Ricardo Becerro-de-Bengoa-Vallejo, PhD, MLIS, DPM, RN, DHL, FFPM, RCPS, is Full Professor, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain. Helena Silva-Migueis, PhD, MSc, PT, is External Collaborator, Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña and Adjunct Professor, Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa-Lisboa. Sérgio Loureiro Nuno, MSc, PT, is PhD Student, Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain and Adjunct Professor in Department of Physiotherapy, Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal. Daniel López-López, PhD, MPH, MSc, DP, is Reader in Podiatry, Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain. Juan Gómez Salgado, PhD, MPH, MSc, RN, is Full Professor, Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain, and Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
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Bowman C, Rockson SG. The lymphedema patient experience within the healthcare system: a cross-sectional epidemiologic assessment. Sci Rep 2024; 14:12600. [PMID: 38824156 PMCID: PMC11144203 DOI: 10.1038/s41598-024-63145-1] [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: 03/27/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024] Open
Abstract
Lymphedema is a progressive lymphatic disease that potentiates physical and psychosocial distress. Despite its impact, patients reportedly encounter lymphatic ignorance throughout the healthcare system. This cross-sectional study aims to summarize clinical characteristics and interactions of lymphedema patients within the healthcare system. Two lymphedema patient cohorts were included: The Global Registry Analysis Cohort included lymphedema patients who contributed to an international digital lymphatic registry and the Interactions Cohort included patients who initiated a questionnaire about interactions with the medical system. The global registry was used to obtain demographic and clinical characteristics from affiliated lymphedema patients. A 23-item online questionnaire on healthcare experiences and satisfaction with lymphatic healthcare was then distributed to the Interactions Cohort. Complete responses were obtained from 2474 participants. Participants were a mean age of 57.5 ± 16.1 years and 51.4% had a cancer history. Participants reported substantial delays in diagnosis and treatment. Cancer-related and non-cancer-related lymphedema patients reported similar levels of perceived physician disinterest in their lymphedema; however, non-cancer-related lymphedema patients reported more care dissatisfaction. Ultimately, patients continue to face delays in lymphedema diagnosis and treatment. We developed an evidence-based model highlighting areas of reform needed to improve lymphatic education and healthcare.
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Affiliation(s)
- Catharine Bowman
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Stanley G Rockson
- Stanford University School of Medicine, Stanford, CA, USA.
- Stanford Center for Lymphatic and Venous Disorders, Stanford University School of Medicine, Falk Cardiovascular Research Center, 300 Pasteur Drive, Stanford, CA, 94305, USA.
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Thomas M, Morgan K, Humphreys I. Lymphoedema specialists embedded into community nurse and wound services: impacts and outcomes. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:360-370. [PMID: 38639747 DOI: 10.12968/bjon.2024.33.8.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
BACKGROUND Lymphoedema is a progressive condition causing significant alterations to life, exerting pressures on unscheduled care from complications including cellulitis and wounds. An on the ground education programme (OGEP) was implemented to raise knowledge, competence and confidence in lymphoedema management in community clinical services. The aim of this study was to explore the impact and outcomes of the OGEP intervention. METHODS Data were captured before and after OGEP on 561 lymphoedema patients in the community setting. Data recorded included resource use, costs and outcomes (EQ-5D-5L and LYMPROM). RESULTS Data demonstrated statistically significant reductions in resource allocations including staff visits (P<0.001), cellulitis admissions (P<0.001), compression consumables and wound dressing costs (P<0.001). Overall, the total mean per patient cost decreased from £1457.10 to £964.40 (including intervention) with outcomes significantly improved in EQ-5D-5L/LYMPROM scores. CONCLUSION The analysis suggests the OGEP intervention may offer reductions in resource costs and improvements in patient outcomes. OGEP may therefore provide an innovative solution in future care delivery.
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Affiliation(s)
| | - Karen Morgan
- Clinical Lead, Lymphoedema Wales Clinical Network
| | - Ioan Humphreys
- Senior Researcher, School of Health and Social Care, Swansea University
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Cooper-Stanton G, Gale N, Sidhu M, Allen K. UK survey on experiences of men with non-cancer-related lymphoedema: part one. Br J Community Nurs 2024; 29:S27-S31. [PMID: 38578925 DOI: 10.12968/bjcn.2024.29.sup4.s27] [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] [Indexed: 04/07/2024]
Abstract
This initial article delves into the methodology, methods and theories, while the subsequent article will centre on the discoveries, discussion and conclusion. The study aimed to address the research question: how do men perceive their engagement in the self-management of non-cancer-related lymphoedema? An interpretivist qualitative methodology was employed, utilising an online survey based on the validated lymphoedema quality of life tool (LYMQoL). The data underwent inductive narrative inquiry. The study incorporated theories such as hegemonic masculinity and the health, illness, men and masculinities (HIMM) framework. The findings will be detailed in the second article in this series. This article has delineated the objective, methodologyand methods, employing a qualitative interpretivist approach through narrative inquiry. The study incorporated masculinity theories, including hegemonic masculinity and HIMM. The second article will present the findings and their significance within the broader literature.
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Affiliation(s)
- Garry Cooper-Stanton
- Doctoral Researcher, Associate Dean UCLan, Clinical Nurse Specialist Lymphoedema, University of Birmingham, Health Services Management Centre (HSMC), 40 Edgbaston Park Road, Birmingham, B15 2RT
| | - Nicola Gale
- Head of School of Social Policy, Professor of Health Policy and Sociology, University of Birmingham, School of Social Policy, Muirhead Tower, Edgbaston, Birmingham, B15 2TT
| | - Manbinder Sidhu
- Associate Professor, School of Social Policy, HSMC, Park House, Edgbaston, Birmingham, B15 2RT
| | - Kerry Allen
- Associate Professor Head of Education, University of Birmingham, School of Social Policy, HSMC, Park House, Edgbaston, Birmingham, B15 2RT
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Mestre S, Vignes S, Malloizel-Delaunay J, Abba S, Villet S, Picolet A, Vicaut E, Quéré I. Positive Impact of a New Compressive Garment in Patients with Genital Lymphedema: OLYMPY Study. Lymphat Res Biol 2024; 22:138-146. [PMID: 38563697 PMCID: PMC11044870 DOI: 10.1089/lrb.2023.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Purpose: Genital lymphedema is a chronic debilitating condition associated with highly impaired health-related quality of life (QoL). This prospective multicenter study evaluated the use of a new compressive garment in patients with secondary and primary genital lymphedema. Methods: Thirty-two patients prospectively enrolled were advised to wear the compressive garment for 12 weeks (day and night). The primary endpoint was change in patient-reported QoL at 12 weeks via the patient global impression of change (PGI-C) instrument. Secondary outcomes included change in other QoL measures at 12 weeks (visual analog scale, Lymphedema Quality of Life Inventory [LyQLI], and EQ-5D questionnaires), lymphedema severity (genital lymphedema score [GLS]), and physician assessment (Clinical Global Impression-Improvement [CGI-I]). Safety and tolerability were also assessed. Results: After 12 weeks, improvement was reported in 78.6% of patients (PGI-C). Physician assessment (CGI-I) indicated clinical improvement in 82.8% of patients. Patient assessment of lymphedema symptoms showed a significant decrease in discomfort (p = 0.02) and swelling (p = 0.01). Significant declines in the mean global GLS (p < 0.0001), and in the proportion of patients reporting heaviness, tightness, swelling, or urinary dysfunction (p < 0.05 for all), were also observed. LyQLI scores decreased (indicating improved QoL) in each of the physical, psychosocial (p = 0.05), and practical domains. The compressive garment was well tolerated with high compliance, and adverse events (due to swelling or discomfort) led to permanent discontinuation in only three patients. Conclusion: The use of a new genital compression garment over 12 weeks improves the QoL and clinical measures in patients with genital lymphedema (ClinicalTrials.gov ID: NCT04602559; Registration: October 20, 2020).
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Affiliation(s)
- Sandrine Mestre
- Department of Vascular Medicine, Montpellier University, Montpellier, France
- UA11 INSERM–UM Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP), Montpellier, France
| | - Stéphane Vignes
- Department of Lymphology, Referral Center for Rare Vascular Diseases, Cognacq-Jay Hospital, Paris, France
| | | | - Sarah Abba
- Department of Lymphology, Referral Center for Rare Vascular Diseases, Cognacq-Jay Hospital, Paris, France
| | | | | | - Eric Vicaut
- Clinical Research Unit, Saint-Louis, Lariboisière, Fernand-Widal Hospital, Paris, France
| | - Isabelle Quéré
- Department of Vascular Medicine, Montpellier University, Montpellier, France
- UA11 INSERM–UM Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP), Montpellier, France
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Monteiro AJ, de Labra C, Losa-Iglesias ME, Dias A, Becerro-de-Bengoa-Vallejo R, Silva-Migueis H, Macedo F, López-López D, Gómez-Salgado J. The relationship of kinesiophobia in patients with lymphedema: a case-control investigation. Front Psychiatry 2024; 15:1293614. [PMID: 38445089 PMCID: PMC10912151 DOI: 10.3389/fpsyt.2024.1293614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Kinesiophobia and lymphedema appear to be related conditions, and it is important to understand this relationship, as many of the symptoms and comorbidities presented by individuals with lower limb lymphedema are prevented and treated through movement, thus constituting kinesiophobia as a barrier to intervention. The objective of this study is, therefore, to evaluate and analyze the kinesiophobic beliefs reported by individuals with and without lower limb lymphedema, regarding the agreement, severity and differences found, and to establish levels of kinesiophobia. Methods A case-control study with a total sample of 80 participants (40 with lower limb lymphedema and 40 without) was performed. Both groups (with and without lymphedema) were characterized anthropologically, sociodemographically, and clinically. In the case group, lymphedema was evaluated. Participants in both groups completed the Tampa Scale for Kinesiophobia - 13 items (TSK-13). Results Individuals with lower limb lymphedema had higher TSK-13 scores than their matched group without lymphedema. The items belonging to the activity avoidance subscale had the highest agreement and score in both groups. Differences between groups were mainly established for items belonging to the somatic focus subscale, showing that individuals with lower limb lymphedema have kinesiophobic beliefs related to the perceived severity of their lymphedema. The prevalence of kinesiophobia was increased in both groups, but the severity was mild. Conclusions Considering the apparent tendency of people with lower limb lymphedema to present kinesiophobia and movement-limiting beliefs regarding the condition, greater attention should be paid to its assessment, prevention and treatment from a multidisciplinary and multimodal perspective, which takes into account the multiplicity of factors inherent to kinesiophobia and lymphedema and thus reduce their impact on the management of lymphedema.
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Affiliation(s)
- Ana Júlia Monteiro
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
- Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa - Lisboa, Lisbon, Portugal
| | - Carmen de Labra
- Research, Health, and Podiatry Group, Department of Physiotherapy, Medicine and Biomedical Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | | | - Adriano Dias
- Epidemiology – Department of Public Health and Grade Program of Public/Collective Health, Botucatu Medical School/Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | | | - Helena Silva-Migueis
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
- Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa - Lisboa, Lisbon, Portugal
| | - Filipe Macedo
- Integrated Continuing Care Unit, Casa de Santa Maria, Camarate, Portugal
| | - Daniel López-López
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
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Burian EA, Franks PJ, Borman P, Quéré I, Karlsmark T, Keeley V, Sugama J, Cestari M, Moffatt CJ. Factors associated with cellulitis in lymphoedema of the arm - an international cross-sectional study (LIMPRINT). BMC Infect Dis 2024; 24:102. [PMID: 38238718 PMCID: PMC10797905 DOI: 10.1186/s12879-023-08839-z] [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: 07/13/2023] [Accepted: 11/22/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Lymphoedema is a globally neglected health care problem and a common complication following breast cancer treatment. Lymphoedema is a well-known predisposing factor for cellulitis, but few have investigated the risk factors for cellulitis in this patient cohort on an international level. The aim of this study was to identify the frequency of cellulitis in patients with lymphoedema of the arm, including potential risk factors for cellulitis. METHODS An international, multi-centre, cross-sectional study including patients with clinically assessed arm lymphoedema. The primary outcome was the incidence of cellulitis located to the arm with lymphoedema within the last 12 months, and its potential associated risk factors. The secondary outcome was life-time prevalence of cellulitis. Adults with clinically-assessed arm lymphoedema/chronic oedema (all causes) and able to give informed consent were included. End-of-life-patients or those judged as not in the patient's best interest were excluded. Both univariable and multivariable analysis were performed. RESULTS A total of 2160 patients were included from Australia, Denmark, France, Ireland, Italy, Japan, Turkey and United Kingdom. Secondary lymphoedema was present in 98% of the patients; 95% of these were judged as related to cancer or its treatment. The lifetime prevalence of cellulitis was 22% and 1-year incidence 11%. Following multivariable analysis, factors associated with recent cellulitis were longer swelling duration and having poorly controlled lymphoedema. Compared to having lymphoedema less than 1 year, the risk increased with duration: 1-2 years (OR 2.15), 2-5 years (OR 2.86), 5-10 years (OR 3.15). Patients with well-controlled lymphoedema had a 46% lower risk of cellulitis (OR 0.54, 95% CI 0.39-0.73, p < 0.001). More advanced stages of lymphoedema were associated with cellulitis even after adjustment for swelling duration and control of swelling by logistic regression (stage II OR 5.44, stage III OR 9.13, p = 0.002), demonstrated in a subgroup analysis. CONCLUSION Patients with advanced arm lymphoedema are at particular risk of developing cellulitis. Prevention of lymphoedema progression is crucial. The results lend towards a positive effect of having well-treated lymphoedema on the frequency of cellulitis.
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Affiliation(s)
- Ewa Anna Burian
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, 2400, Denmark.
| | - Peter J Franks
- Centre for Research and Implementation of Clinical Practice, London, UK
| | - Pinar Borman
- Medical Faculty, Department of Physical Medicine and Rehabilitation, Ankara Medipol University, Ankara, Turkey
| | - Isabelle Quéré
- CHU Montpellier, University of Montpellier, IDESP, Montpellier, France
| | - Tonny Karlsmark
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, 2400, Denmark
| | - Vaughan Keeley
- Lymphoedema Department, University Hospitals of Derby and Burton NHS Trust, Derby and University of Nottingham Medical School, Nottingham, UK
| | - Junko Sugama
- Research Centre for Implementation Nursing Science Initiative, Research Promotion Headquarters, Fujita Health University, Aichi, Japan
| | | | - Christine J Moffatt
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, 2400, Denmark
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Keeley V, Riches K, Ward L, Franks PJ. A Prospective Preliminary Study Examining the Physiological Impact of Pneumatic Compression Dosing in the Treatment of Lower Extremity Lymphedema. Lymphat Res Biol 2023; 21:456-462. [PMID: 37140559 PMCID: PMC10615048 DOI: 10.1089/lrb.2022.0087] [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] [Indexed: 05/05/2023] Open
Abstract
Background: Optimal frequency and duration of pneumatic compression device (PCD) therapy for lymphedema is undetermined. This prospective, randomized preliminary study evaluated the impact of different PCD dosing protocols on physiological and patient-reported outcomes (PROs) to estimate treatment effects, assess the responsiveness of various measurement techniques, and identify endpoints for a definitive PCD dosing trial. Methods and Results: Twenty-one patients with lower extremity lymphedema were randomized into three groups for treatment with the Flexitouch advanced PCD: (A) once per day for 1 hour, 12 consecutive days; (B) twice per day in 1-hour treatments, 5 consecutive days; or (C) twice per day in 2-hour treatments, 5 consecutive days. Outcomes measured were changes in limb volume (LV), tissue fluid, tissue tone, and PROs. Those in group A experienced mean (standard deviation) LV reductions of 109 (58) mL (p = 0.003) on day 1 and of 97 (86) mL (p = 0.024) on day 5. Group A also showed possible single-treatment decreases in extracellular fluid volume by bioimpedance spectroscopy (BIS) on day 5. There were no consistent changes in groups B and C. Long-term assessment of LV and BIS showed no clear change. Tonometry, ultrasound, local tissue water, and PROs showed wide variation among participants. Conclusions: LV measurements showed potential benefit for 1-hour daily PCD treatment. A definitive dosing trial should include LV, BIS, and PROs in a comparison of 1- and 2-hour daily treatment protocols conducted over a study period of 4 weeks. These data may inform appropriate outcome measures for other intervention studies in lymphedema.
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Affiliation(s)
- Vaughan Keeley
- Lymphoedema Service, University Hospitals of Derby and Burton, Derby, United Kingdom
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Katie Riches
- Lymphoedema Service, University Hospitals of Derby and Burton, Derby, United Kingdom
| | - Leigh Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Peter J. Franks
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom
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Monteiro AJ, de Labra C, Losa-Iglesias ME, Dias A, Becerro-de-Bengoa-Vallejo R, Silva-Migueis H, Cardoso P, López-López D, Gómez-Salgado J. Depressive symptoms and their severity in a sample with lymphedema: a case-control investigation. Front Psychiatry 2023; 14:1202940. [PMID: 37476539 PMCID: PMC10354281 DOI: 10.3389/fpsyt.2023.1202940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/13/2023] [Indexed: 07/22/2023] Open
Abstract
Objectives Depression is a condition that can be associated with other illnesses, especially chronic illnesses. Lower limb lymphedema is a chronic, disabling condition that can affect the quality of life and be related to psychological and psychosocial factors that interfere with people's lives. This study aims to characterize and analyze the depressive symptoms and their severity reported by people with lower limb lymphedema and compare them with a matched group without lymphedema. Methods A case-control study was carried out (n = 80) with participants divided into a case group (40 people with lower limb lymphedema) and a control group (40 people without lower limb lymphedema). Both groups were anthropometrically, sociodemographically, and clinically characterized. In the case group, a characterization of lymphedema was performed. Participants completed the Beck Depression Inventory-II. Results Individuals with lower limb lymphedema have higher BDI-II scores than the matched group without lymphedema. Somatic depressive symptoms were, in general, the most reported and the ones with the highest scores. The depressive symptoms most reported by the case group were tiredness or fatigue, loss of energy, and changes in sleeping. Tiredness or fatigue, loss of energy, and loss of interest in sex were the most severe depressive symptoms reported by individuals with lower limb lymphedema. Conclusion Considering the apparent tendency to depression, greater attention should be given to the mental health of people with lower limb lymphedema.
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Affiliation(s)
- Ana Júlia Monteiro
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain
- Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa - Lisboa, Lisbon, Portugal
| | - Carmen de Labra
- NEUROcom, Centro Interdisciplinar de Química e Bioloxía (CICA), Instituto de Investigación Biomédica de A Coruña (INIBIC), School of Nursery and Podiatry, University of A Coruña, A Coruña, Spain
| | | | - Adriano Dias
- Epidemiology – Department of Public Health and Grade Program of Public/Collective Health, Botucatu Medical School/UNESP, Botucatu, Brazil
| | | | - Helena Silva-Migueis
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain
- Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa - Lisboa, Lisbon, Portugal
| | - Paula Cardoso
- Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa - Lisboa, Lisbon, Portugal
- Instituto Português de Oncologia de Lisboa Francisco Gentil – E.P.E. – Lisboa, Lisboa, Portugal
| | - Daniel López-López
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
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11
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Suchy JP, Glasoe WM, Koehler LA. A Tissue Dielectric Constant Evaluation of Knee Edema: A Retrospective Intra-rater Reliability and Association Study of Repeated Measures. Cureus 2023; 15:e42089. [PMID: 37602087 PMCID: PMC10435093 DOI: 10.7759/cureus.42089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND This research compared the reliability and association of tissue dielectric constant (TDC) measures of knee edema to circumferential measurements of knee girth recorded as part of a physical therapy examination. METHODS Twenty adults having observable unilateral knee edema were enrolled. A single examiner measured edematous knee swelling with a TDC device and a tape measure across two visits. The presence of edema was recorded as a positive number in reporting side-to-side differences and a positive percentage in documenting change over time. Intra-rater reliability of the measures was assessed with an intra-class correlation coefficient (ICC). Percent change in edema was evaluated independently for both methods using a paired t-test, and the association between measures was assessed by a Pearson's statistic. RESULTS Both measures were reliable (ICC ≥ 0.81), and both detected a significant percentage decrease (p < 0.05) in edema across visits. The TDC measure changed by 8.3%, an amount nearly four times larger compared to knee girth (2.4%). The subsequent follow-up comparison revealed an inverse relationship (p = 0.049; r = -0.44) between the two percent change measurements of edema. CONCLUSION The two methods capture different physical attributes of edema. The TDC records the water content of the tissue, while the use of a tape measure records circumferential limb girth. The TDC measurement was reliable and more responsive in detecting a percentage decrease in knee edema in comparison to a circumferential measure of knee girth. The TDC method may have wider use in directly measuring edema in other tissue structures and regions of the body.
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Affiliation(s)
- James P Suchy
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, USA
| | - Ward M Glasoe
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, USA
| | - Linda A Koehler
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, USA
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12
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Jørgensen MG, Gözeri E, Petersen TG, Sørensen JA. Surgical-site infection is associated with increased risk of breast cancer-related lymphedema: A nationwide cohort study. Clin Breast Cancer 2023:S1526-8209(23)00085-X. [PMID: 37095025 DOI: 10.1016/j.clbc.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Surgical-site infection (SSI) is one of the most common short-term complications following breast cancer treatment and can inhibit lymphatic drainage. It is currently not known whether SSI increases the risk of long-term breast cancer-related lymphedema (BCRL). Thus, the objective of this study was to examine the association between surgical-site infection and the risk of BCRL METHODS: This nationwide study identified all patients treated for unilateral, primary invasive, nonmetastatic breast cancer in Denmark between January 1, 2007, and December 31, 2016 (n = 37,937). A redemption of antibiotics after breast cancer treatment was used as a disease proxy for SSI, included as a time-varying exposure. The risk of BCRL was analyzed up to 3 years after breast cancer treatment using multivariate Cox regression and adjusted for cancer treatment, demographics, comorbidities, and socioeconomic variables. RESULTS There were 10,368 (27.33%) patients with a SSI and 27,569 (72.67%) without a SSI (incidence rate per 100 patients, 33.10 (95%CI, 32.47-33.75). The BCRL incidence rate per 100 person-years for patients with SSI was 6.72 (95%CI: 6.41-7.05) and 4.86 (95%CI: 4.70-5.02) for patients without an SSI. There was an overall significant increased risk of BCRL in patients with an SSI (adjusted HR, 1.11; 95%CI: 1.04-1.17), with the highest risk 3 years after breast cancer treatment (adjusted HR, 1.28; 95%CI: 1.08-1.51) CONCLUSION: This large nationwide cohort study showed that SSI was associated with an overall 10% increased risk of BCRL. These findings may be used to identify patients at high risk of BCRL that would benefit from enhanced BCRL surveillance.
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Affiliation(s)
- Mads G Jørgensen
- Department of Plastic Surgery, Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
| | - Ebru Gözeri
- University of Copenhagen, Copenhagen, Denmark
| | - Tanja G Petersen
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Jens A Sørensen
- Department of Plastic Surgery, Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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13
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Peghin M, Graziano E, Rovelli C, Grossi PA. Prevention and treatment of recurrent cellulitis. Curr Opin Infect Dis 2023; 36:95-101. [PMID: 36853755 DOI: 10.1097/qco.0000000000000903] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW Recurrent cellulitis is a challenging clinical condition affecting up to 47% of patients after the first episode, especially those with predisposing risk factors. The purpose of this review is to describe the state of the art of literature evidence and to highlight recent developments in its management. RECENT FINDINGS Recurrent cellulitis can occur after successful treatment of cellulitis. Conditions that commonly increase the risk of cellulitis include local and systemic modifiable and nonmodifiable factors. A rigorous approach to the management of risk factors and treatment of acute infection is important as the risk of recurrence rises with repeated episodes. Risk factors, if present, need to be targeted in association with antibiotic prophylaxis. Penicillin V is the preferred antibiotic for prevention but other antibiotics and new drugs can be considered in cases of β-lactam allergy, intolerance, or failure. SUMMARY Recurrent cellulitis is associated with short term and long-term morbidity as well as significant healthcare costs. Management of underlying predisposing conditions is crucial to prevent recurrence in addition with evaluation of pharmacological measures, but specialized and multidisciplinary skills are needed. More efforts are needed to prevent and treat this underestimated problem.
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Affiliation(s)
- Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
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14
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Loibnegger-Traußnig K, Schwerdtfeger AR, Flaggl F. Effects of a Stress Management Training in Patients With Lymphedema and Obesity During Rehabilitation. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2023. [DOI: 10.1027/2512-8442/a000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Abstract: Background: Evidence for behavioral weight loss interventions demonstrates promising effects, but stress management training for weight loss and stress reduction in patients with lymphedema and obesity during rehabilitation has not been investigated yet. Aim: This study aims to examine innovative psychological treatment options for weight loss and stress management through a multifaceted approach in patients with lymphedema and obesity. Method: Seventy-one patients with lymphedema and obesity participating in an existing rehabilitation took part in this clinical trial. Half of them ( n = 36) were allocated to an additional stress management intervention. At the beginning of rehabilitation and the end (after 3 weeks; n = 66) participants’ weight, physical fitness, heart rate variability (HRV), and perceived stress were assessed. After around 8 months ( n = 28) chronic and perceived stress were evaluated again. Results: Irrespective of group allocation, rehabilitation had a positive, but short-term effect on perceived stress ( d = 0.60). Although patients receiving the additional stress management training did neither show a decrease in perceived stress nor an increase of HRV from pre- to post-assessment, they lost more weight and improved physical fitness at post-assessment as compared to the control group. Limitations: A stress-reducing effect of the training was not found, thus questioning the underlying mechanism of the applied intervention. Conclusions: Findings suggest a clinically relevant impact of psychological interventions in patients with lymphedema and a promising pathway for further research.
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15
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Wang L. Editorial for "Subcutaneous Adipose Tissue Edema in Lipedema Revealed by Noninvasive 3T Magnetic Resonance Lymphangiography". J Magn Reson Imaging 2023; 57:609-610. [PMID: 35979906 DOI: 10.1002/jmri.28400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 01/20/2023] Open
Affiliation(s)
- Ligong Wang
- School of Radiation Medicine and Protection, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
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16
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Crescenzi R, Donahue PM, Garza M, Patel NJ, Lee C, Guerreso K, Hall G, Luo Y, Chen SC, Herbst KL, Pridmore M, Aday AW, Beckman JA, Donahue MJ. Subcutaneous Adipose Tissue Edema in Lipedema Revealed by Noninvasive 3T MR Lymphangiography. J Magn Reson Imaging 2023; 57:598-608. [PMID: 35657120 PMCID: PMC9718889 DOI: 10.1002/jmri.28281] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Lipedema exhibits excessive lower-extremity subcutaneous adipose tissue (SAT) deposition, which is frequently misidentified as obesity until lymphedema presents. MR lymphangiography may have relevance to distinguish lipedema from obesity or lymphedema. HYPOTHESIS Hyperintensity profiles on 3T MR lymphangiography can identify distinct features consistent with SAT edema in participants with lipedema. STUDY TYPE Prospective cross-sectional study. SUBJECTS Participants (48 females, matched for age [mean = 44.8 years]) with lipedema (n = 14), lipedema with lymphedema (LWL, n = 12), cancer treatment-related lymphedema (lymphedema, n = 8), and controls without these conditions (n = 14). FIELD STRENGTH/SEQUENCE 3T MR lymphangiography (nontracer 3D turbo-spin-echo). ASSESSMENT Review of lymphangiograms in lower extremities by three radiologists was performed independently. Spatial patterns of hyperintense signal within the SAT were scored for extravascular (focal, diffuse, or not apparent) and vascular (linear, dilated, or not apparent) image features. STATISTICAL TESTS Interreader reliability was computed using Fleiss Kappa. Fisher's exact test was used to evaluate the proportion of image features between study groups. Multinomial logistic regression was used to assess the relationship between image features and study groups. The odds ratio (OR) and 95% confidence interval (CI) of SAT extravascular and vascular features was reported in groups compared to lipedema. The threshold of statistical significance was P < 0.05. RESULTS Reliable agreement was demonstrated between three independent, blinded reviewers (P < 0.001). The frequency of SAT hyperintensities in participants with lipedema (36% focal, 36% diffuse), LWL (42% focal, 33% diffuse), lymphedema (62% focal, 38% diffuse), and controls (43% focal, 0% diffuse) was significantly distinct. Compared with lipedema, SAT hyperintensities were less frequent in controls (focal: OR = 0.63, CI = 0.11-3.41; diffuse: OR = 0.05, CI = 0.00-1.27), similar in LWL (focal: OR = 1.29, CI = 0.19-8.89; diffuse: OR = 1.05, CI = 0.15-7.61), and more frequent in lymphedema (focal: OR = 9.00, CI = 0.30-274.12; diffuse: OR = 5.73, CI = 0.18-186.84). DATA CONCLUSION Noninvasive MR lymphangiography identifies distinct signal patterns indicating SAT edema and lymphatic load in participants with lipedema. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Rachelle Crescenzi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Engineering, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paula M.C. Donahue
- Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
- Dayani Center for Health and Wellness, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Maria Garza
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niral J. Patel
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chelsea Lee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kelsey Guerreso
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Greg Hall
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yu Luo
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sheau-Chiann Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Michael Pridmore
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aaron W. Aday
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joshua A. Beckman
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J. Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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17
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Kruger N, Plinsinga ML, Noble-Jones R, Piller N, Keeley V, Hayes SC. The Lymphatic System, Lymphoedema, and Medical Curricula-Survey of Australian Medical Graduates. Cancers (Basel) 2022; 14:cancers14246219. [PMID: 36551705 PMCID: PMC9777454 DOI: 10.3390/cancers14246219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to survey the perceptions of recent (i.e., within the past 12 months) Australian medical graduates regarding (i) their understanding of the lymphatic system and lymphoedema, and (ii) the extent to which the lymphatic system and lymphoedema were covered as part of their medical degree. Medical graduates were invited to participate in a 17-item online survey that asked respondents to rate their level of agreement (using a 5-point Likert scale; higher scores = higher agreement) to statements that explored their understanding and comprehensiveness of their medical degree. Responses to each item were described using n (%). Subscale scores for understanding and medical degree were computed by summing scores of individual items, described using means (SD) and compared by participant characteristics. Medical graduates (n = 230) perceived their understanding of the lymphatic system and lymphoedema to be low, and comprehensiveness of medical curricula specific to the lymphatic system and lymphoedema to be lacking. Subscale scores did not differ by participant characteristics. Improvement of medical graduates understanding of lymphoedema may facilitate greater awareness of lymphoedema, thus optimizing the timeliness of diagnosis and access to treatment.
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Affiliation(s)
- Natalie Kruger
- Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, QLD 4111, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD 4111, Australia
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Nathan, Brisbane, QLD 4006, Australia
- Correspondence:
| | - Melanie L. Plinsinga
- Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, QLD 4111, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD 4111, Australia
| | - Rhian Noble-Jones
- Lymphoedema Clinical Network Wales, Swansea University, Swansea SA2 8PP, UK
| | - Neil Piller
- School of Medicine, Flinders University, Adelaide, SA 5042, Australia
| | - Vaughan Keeley
- Lymphoedema Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, UK
| | - Sandra C. Hayes
- Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, QLD 4111, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD 4111, Australia
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18
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Brown SR, Skoch BM. Lymphedema Considerations in Palliative Care #447. J Palliat Med 2022; 25:1599-1600. [PMID: 36190487 DOI: 10.1089/jpm.2022.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
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19
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Cooper-Stanton GR, Gale N, Sidhu M, Allen K. A qualitative systematic review and meta-aggregation of the experiences of men diagnosed with chronic lymphoedema. J Res Nurs 2022; 27:704-732. [DOI: 10.1177/17449871221088791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Lymphoedema is a chronic condition that is estimated to affect up to four people per 1000 of the UK population with this increasing with age. Men account for up to 20% of lymphoedema service caseloads with research focussing upon women affected. Aims To retrieve primary qualitative research on the experiences of men with chronic lymphoedema. Methods A qualitative review was undertaken using the Joanna Briggs Institute (JBI) meta-aggregation method. A search strategy was applied to 12 databases, from inception to February 2021, with 22 studies identified and appraised. The findings were extracted and synthesised via the JBI approach. Results Four synthesised findings were identified: (1) The ‘New Norm’, how diagnosis led to men being faced with a ‘new version’ of themselves; (2) ‘Journey into the Unknown’ relates to the unforeseen diagnosis of the condition; (3) ‘Access’ – challenge in receiving a diagnosis, and support; and (4) ‘Personhood’ – the impact of the condition upon external constructs and relationships. Conclusions Men are faced with similar challenges as women coupled with societal expectations with respect to gender identity and expression. This leads to those wishing to engage with men to adopt ‘gender-based tailoring’ within healthcare services, information and support.
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Affiliation(s)
- Garry R Cooper-Stanton
- Doctoral Researcher/Lecturer, Health Services Management, University of Birmingham, Birmingham, UK
| | - Nicola Gale
- Professor, Health Services Management, University of Birmingham, Birmingham, UK
| | - Manbinder Sidhu
- Research Fellow, Health Services Management, University of Birmingham, Birmingham, UK
| | - Kerry Allen
- Senior Lecturer, Health Services Management, University of Birmingham, Birmingham, UK
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20
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Webb E, Bissett B, Neeman T, Bowden F, Preston E, Mumford V. Compression Therapy Is Cost-Saving in the Prevention of Lower Limb Recurrent Cellulitis in Patients with Chronic Edema. Lymphat Res Biol 2022; 21:160-168. [PMID: 35997601 PMCID: PMC10125391 DOI: 10.1089/lrb.2022.0029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Cellulitis is a common and often recurrent infection that causes substantial financial burden and morbidity. Compression therapy reduces the risk of recurrent cellulitis episodes for adults with chronic edema; however, little is known about the cost-effectiveness of the intervention. Methods and Results: A cost analysis was undertaken during a randomized controlled trial (RCT) involving 84 participants with lower limb chronic edema and a history of recurrent cellulitis. The intervention group received compression therapy and education, while the control group received education only. A clinical audit and survey were used to measure health service and patient resource use for (1) the most recent episode of cellulitis, and (2) compression therapy over 18 months. Australian reference costs were used to calculate cellulitis and compression therapy costs, and the mean expenditure in both the RCT groups. Of the 84 RCT participants, 43 were surveyed and audited on the cost of cellulitis, and 40 on the cost of compression therapy. The mean cost of a hospitalized and nonhospitalized episode of cellulitis was $9071 and $506 from a health service perspective, and $4496 and $1320 from a patient perspective. The mean cost of compression therapy per participant over 18 months was $1905 and $421 from health service and patient perspectives, respectively. During the RCT, the mean annual cost per participant was $4972 in the experimental group and $26,382 in the control group, giving a cost-saving of $21,483 (95% confidence interval, 3136-48,176) per participant. Conclusion: For patients with lower limb chronic edema and recurrent cellulitis, compression therapy is both efficacious and cost-saving. Trial Registration: ACTRN12617000412336.
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Affiliation(s)
- Elizabeth Webb
- Physiotherapy Department, Calvary Public Hospital Bruce, Canberra, Australia.,Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australia
| | - Bernie Bissett
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australia
| | - Teresa Neeman
- Biological Data Science Institute, the Australian National University Joint Colleges of Science, Health, and Medicine, Australian National University, Canberra, Australia
| | - Francis Bowden
- Medical School, Australian National University, Canberra, Australia
| | - Elisabeth Preston
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australia
| | - Virginia Mumford
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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21
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Ong BS, Dotel R, Ngian VJJ. Recurrent Cellulitis: Who is at Risk and How Effective is Antibiotic Prophylaxis? Int J Gen Med 2022; 15:6561-6572. [PMID: 35983462 PMCID: PMC9379124 DOI: 10.2147/ijgm.s326459] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
Recurrent cellulitis following successful treatment is common and prevention should be a major component in the management of cellulitis. Conditions that increase the risk of recurrence include chronic edema, venous disease, dermatomycosis and obesity. These risk factors should be actively managed as further episodes of cellulitis increases the risk of recurrence. The role of non-antibiotic measures is important and should be first-line in prevention. Antibiotic prophylaxis is effective, but its role is limited to non-purulent cellulitis where risk factors are appropriately managed.
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Affiliation(s)
- Bin S Ong
- Department of Ambulatory Care, Division of Medicine, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Ravindra Dotel
- Department of Ambulatory Care, Division of Medicine, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | - Vincent Jiu Jong Ngian
- Department of Ambulatory Care, Division of Medicine, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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22
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Al Onazi MM, Campbell KL, Thompson RB, Ghosh S, Mackey JR, Muir A, McNeely ML. Decongestive progressive resistance exercise with an adjustable compression wrap for breast cancer-related lymphoedema (DREAM): protocol for a randomised controlled trial. BMJ Open 2022; 12:e053165. [PMID: 35379618 PMCID: PMC8981291 DOI: 10.1136/bmjopen-2021-053165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Breast cancer-related lymphoedema (BCRL) is a chronic swelling in the arm on the side of the breast cancer surgery, affecting one in five women. Recent studies in BCRL have demonstrated that resistance exercise can improve symptoms and quality of life without worsening lymphoedema. No studies have explored whether combining the principles of progressive resistance exercise training with therapeutic strategies of compression therapy and the decongestive lymphatic exercise sequence are beneficial in reducing arm lymphoedema volume. The aim of this three-arm, provincial randomised controlled trial is to determine the efficacy of a 12-week decongestive progressive resistance exercise (DRE) programme in combination with the one of two types of compression garments compared with standard care. METHODS AND ANALYSIS Sixty women with BCRL will be recruited and randomly assigned to one of the following three groups: (1) Standard care, (2) DRE with use of a daytime compression garment during exercise and (3) DRE with use of an adjustable compression wrap during exercise. The primary outcome is the percentage reduction in arm lymphoedema volume. Secondary outcomes include bioimpedance analysis, muscular strength, shoulder range of motion, physical activity level and health-related quality of life. Exploratory outcomes include evaluating changes in arm tissue composition using MRI and examining outcomes between the two DRE experimental groups. The primary analysis will compare changes between the groups from baseline to week 12 reflecting the end of the randomised control trial period. ETHICS AND DISSEMINATION The trial has received ethics approval from the Health Research Ethics Board of Alberta: Cancer Committee. The study results will be disseminated through scientific peer-reviewed publications, and presented at national and international conferences, and other media portals. The programme protocol will be shared with healthcare professionals and patient groups through clinical workshops and webinars. TRIAL REGISTRATION NUMBER NCT05022823. PROTOCOL VERSION 12 November 2021. ISSUE DATE 26 April 2021.
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Affiliation(s)
- Mona M Al Onazi
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Sunita Ghosh
- Department of Mathematics and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - John R Mackey
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Anne Muir
- Cancer Rehabilitation Clinic, University of Alberta, Edmonton, Alberta, Canada
| | - Margaret L McNeely
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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23
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The effects of gravity and compression on interstitial fluid transport in the lower limb. Sci Rep 2022; 12:4890. [PMID: 35318426 PMCID: PMC8941011 DOI: 10.1038/s41598-022-09028-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Edema in the limbs can arise from pathologies such as elevated capillary pressures due to failure of venous valves, elevated capillary permeability from local inflammation, and insufficient fluid clearance by the lymphatic system. The most common treatments include elevation of the limb, compression wraps and manual lymphatic drainage therapy. To better understand these clinical situations, we have developed a comprehensive model of the solid and fluid mechanics of a lower limb that includes the effects of gravity. The local fluid balance in the interstitial space includes a source from the capillaries, a sink due to lymphatic clearance, and movement through the interstitial space due to both gravity and gradients in interstitial fluid pressure (IFP). From dimensional analysis and numerical solutions of the governing equations we have identified several parameter groups that determine the essential length and time scales involved. We find that gravity can have dramatic effects on the fluid balance in the limb with the possibility that a positive feedback loop can develop that facilitates chronic edema. This process involves localized tissue swelling which increases the hydraulic conductivity, thus allowing the movement of interstitial fluid vertically throughout the limb due to gravity and causing further swelling. The presence of a compression wrap can interrupt this feedback loop. We find that only by modeling the complex interplay between the solid and fluid mechanics can we adequately investigate edema development and treatment in a gravity dependent limb.
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Bock KJ, Muldoon J. A 24-hour interval compression plan for managing chronic oedema: part 1-the science and theory behind the concept. J Wound Care 2022; 31:S4-S9. [PMID: 35148639 DOI: 10.12968/jowc.2022.31.sup2.s4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Compression, skin care, manual lymph drainage and exercise form the mainstays of treatment of chronic limb oedema. The compression aspect of the regimen is often prescribed and used without conscious concern for the patient's ability for self-adjustment and skin hygiene. This article will focus on the action of compression therapy using a new concept of encouraging patients to apply and reapply an adjustable compression garment or multiple garment types during a 24-hour interval. The benefits of this focus on interval compression therapy on all aspects of care will be explained and case studies presented.
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Affiliation(s)
- Karen J Bock
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, US
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Deutscher D, Hayes D, Cook KF, Werneke MW, Tucker CA, Mioduski JE, Levenhagen K, Tidhar D, Pfarr M, Kallen MA. Upper Quadrant Edema Patient-Reported Outcome Measure Is Reliable, Valid, and Efficient for Patients With Lymphatic and Venous Disorders. Phys Ther 2021; 101:6375661. [PMID: 34636891 DOI: 10.1093/ptj/pzab219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 06/02/2021] [Accepted: 08/01/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The main aims of this study were to (1) create a patient-reported outcome measure (PROM) item bank for measuring the impact of upper quadrant edema (UQE) on physical function by calibrating responses to newly developed items; and (2) assess reliability, validity, and administration efficiency of scores based on computerized adaptive test (CAT) and 10-item short-form (SF) administration modes. METHODS This was a retrospective study including data from patients treated in outpatient rehabilitation clinics for UQE that responded to all 27 candidate items at intake. Item response theory model assumptions of unidimensionality, local item independence, item fit, and presence of differential item functioning were evaluated. UQE-CAT- and UQE-SF-generated scores were assessed for reliability, validity, and administration efficiency. RESULTS The total cohort included 3486 patients (mean [SD] age = 61 [13] years; range = 14-89 years). After removing 2 items, a 25-item solution was supported for its unidimensionality and fit to the item response theory model with reliability estimates of more than 0.93 for scores based on both CAT and SF administration modes. No items demonstrated differential item functioning. Scores discriminated among multiple patient groups in clinically logical ways and were moderately responsive to change with negligible floor and acceptable ceiling effects. CAT scores were generated using an average of 5.6 items (median = 5). CONCLUSION Scores on the UQE PROM were reliable, valid, and efficient for assessing perceived physical function of patients with upper quadrant edema; thus, the measure is suitable for research and routine clinical administration. IMPACT The newly developed UQE PROM is reliable and valid and offers efficient administration modes for assessing perceived physical function of patients with UQE caused by lymphatic and venous disorders, both for research and routine clinical care in busy outpatient rehabilitation settings. As an item response theory-based measure, the UQE PROM allows administration of condition-specific functional questions with low response burden for patients. This study supports a transition to PROMs that are based on modern measurement approaches to achieve high accuracy and efficiency.
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Affiliation(s)
- Daniel Deutscher
- Net Health Systems, Inc, Pittsburgh, Pennsylvania, USA
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Deanna Hayes
- Net Health Systems, Inc, Pittsburgh, Pennsylvania, USA
| | | | | | - Carole A Tucker
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | | | - Kim Levenhagen
- Program in Physical Therapy, Saint Louis University, Saint Louis, Missouri, USA
| | - Dorit Tidhar
- Physical Therapy Department, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Megan Pfarr
- HSHS Wisconsin & Prevea Health, Green Bay, Wisconsin, USA
| | - Michael A Kallen
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Colgan MP, Kyne N, Hannon B, Grehan E, Morris K, Conway M, Murray N, Carney O, Mac Sweeney M. A Snapshot of Lymphedema in Ireland: Results from LIMPRINT. Lymphat Res Biol 2021; 19:473-478. [PMID: 34672791 DOI: 10.1089/lrb.2021.0061] [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: To estimate the prevalence and impact of chronic edema (CE) in two Irish health care settings as part of LIMPRINT, an international study developed and co-ordinated by the International Lymphoedema Framework (ILF), and researched in Ireland by the National Lymphoedema Framework Ireland (NLFI). Methods and Results: Data were collected using clinical assessment tools previously validated by the ILF. Three hospital settings were chosen, both an in-patient and out-patient oncology unit in Galway and a vascular out-patient unit in Dublin. Patients attending an oncology clinic or in an in-patient ward on a specified day were invited to participate as desired, and all patients attending vascular out-patients for a 4-week period were included in the study. All patients were assessed for the presence of CE, and if present, patients were asked to answer several questionnaires regarding diagnosis, available services, quality of life, and wound care where appropriate. The collection of data was anonymized and was inputted to a central database (Clindex). A total of 152 patients were assessed, 76 from the oncology service and 76 from the vascular service. Eighty-seven (57%) patients were female and 65 (43%) patients were male. The mean age was 65 years with a range 15-93 years. Twenty-five patients (16%) had CE, 8 (11%) in the oncology service and 17 (22%) in the vascular service. All the oncology patients were normal weight while almost 60% (n = 10) of the vascular patients were obese. Two (25%) of the oncology patients had a history of cellulitis, whereas seven (41%) of the vascular patients had a history of cellulitis. Four of the oncology patients (50%) received full lymphedema management whereas two oncology patients (20%) received no treatment at all. In contrast, in the vascular group, only two patients (12%) received full lymphedema management. Eight patients (47%) were receiving no treatment at all and seven (41%) were in compression garments and received skin care advice only. Conclusion: Though number of patients are small, these results highlight the high prevalence of CE in both oncology and vascular service patients as well as the disparities in management. In addition, there is a high incidence of cellulitis reported that is possibly not surprising given the low number of patients receiving full lymphedema care. Good data collection is essential if we are to provide and fund a comprehensive service in the future.
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Affiliation(s)
| | - Norah Kyne
- Furbo Hill, Spiddal, Co. Galway, Ireland
| | | | - Elaine Grehan
- Tiaquin, Colmanstown, Ballinasloe, Co. Galway, Ireland
| | - Kay Morris
- Primary Care Strategy and Planning, HSE, Model Business Park, Cork, Ireland
| | - Monica Conway
- Bio-Health Centre, Mary Street Medical Centre, Clonmel, Ireland
| | - Nina Murray
- Local Government and Heritage, Wexford, Ireland
| | - Olive Carney
- Centre for Nurse Education, Mater Misericordiae University Hospital, Dublin, Ireland
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Rockson SG. The Impact of LIMPRINT. Lymphat Res Biol 2021; 19:409-410. [PMID: 34672787 DOI: 10.1089/lrb.2021.29112.sr] [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
Affiliation(s)
- S G Rockson
- MD, Editor-in-Chief Stanford University School of Medicine Lymphatic Research and Biology, Stanford University School of Medicine, Stanford, California, USA
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Moffatt CJ, Burian E, Karlsmark T, Keeley V, Vignes S, Doiron S, Tilley A, Liebl M, Reißhauer A, Murray S, Sykorova M, Quéré I, Franks PJ. Factors Predicting Limb Volume Reduction Using Compression Bandaging Within Decongestive Lymphatic Therapy in Lymphedema: A Multicountry Prospective Study. Lymphat Res Biol 2021; 19:412-422. [PMID: 34672790 DOI: 10.1089/lrb.2021.0060] [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: 11/12/2022] Open
Abstract
Objectives: To identify predictive factors associated with limb volume reduction using different decongestive lymphatic therapy (DLT) systems in patients with lymphoedema, over a period of up to 28 days. Methods: A multicountry (Canada, France, Germany, the United Kingdom) prospective cohort study using (DLT): skin care, exercise, compression bandaging, and manual lymphatic drainage for up to 4 weeks. Reduction in limb volume comparing DLT with (1) standard multilayer bandaging with inelastic material, and with (2) multilayer bandaging with Coban2, together with the identification of factors associated with limb volume changes. Results: Out of 264 patients with upper or lower limb lymphedema, 133 used Coban2 and 131 used standard care. Following DLT, mean limb volume reduction was 941 mL using Coban2 compared with 814 mL using standard care. A difference of 127 mL was found (95% confidence interval -275 to 529 mL, p = 0.53). Of the 176 patients with leg swelling, 166 (94.3%) had a limb volume measurement after 28 days and were included in the risk factor analysis. Of these, 132 (79.5%) were female, with overall mean age of 60.1 years (standard deviation = 14.7), with secondary lymphedema in 102/163 (62.6%). Duration of lymphedema was >10 years in 75/161 (46.6%) and 99/166 (59.7%) were International Society of Lymphology late-stage II/III, indicating longstanding and/or a high frequency of patients with advanced stages of lymphedema. Ninety-one (54.8%) received Coban2 and 75 (45.2%) had standard care. Multivariable factors for a greater leg volume reduction were large initial leg volume (p < 0.001), DLT treatment duration of 4 weeks compared with 2 weeks (p = 0.01), and peripheral arterial disease (p = 0.015). Conclusion: Limb volume changes were found to be similar between groups. Lack of standardization of DLT makes interpretation of effectiveness problematic. There is an urgent need for randomized-controlled trials. Despite this, severe lymphedema with a large limb volume responded well to DLT in this study.
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Affiliation(s)
- Christine J Moffatt
- Institute of Nursing and Midwifery Care Excellence, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.,Copenhagen Wound Healing Centre, Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Ewa Burian
- Copenhagen Wound Healing Centre, Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Tonny Karlsmark
- Copenhagen Wound Healing Centre, Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Vaughan Keeley
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom.,University Hospitals of Derby and Burton, Derby, United Kingdom
| | - Stéphane Vignes
- Centre for Rare Vascular Diseases, Cognacq-Jay Hospital, Paris, France
| | - Sophie Doiron
- Dr.Georges-L-Dumont University Hospital, Moncton, Canada
| | | | - Max Liebl
- Charite Universitatmedizen, Berlin, Germany
| | | | - Susie Murray
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | | | - Isabelle Quéré
- National Reference Centre for Rare and Vascular Diseases, Chu-Montpellier, France.,Department of Vascular Medicine, UMR IDESP, Université de Montpellier, Chu-Montpellier, France
| | - Peter J Franks
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom
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Cestari M, Michelini S, Ricci M, Franks PJ, Murray S, Moffatt CJ, Michelini S. LIMPRINT in Italy. Lymphat Res Biol 2021; 19:468-472. [PMID: 34672792 DOI: 10.1089/lrb.2021.0062] [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: 11/12/2022] Open
Abstract
Background: To define the profile of patients presenting with chronic edema (CE) in three centers in Italy (Lymphoedema IMpact and PRevalence INTernational). Methods and Results: Data were collected in patients referred for CE between September 2016 and July 2017. A total of 1637 were recruited, 86.7% (1419) outpatients and 13.3% (218) inpatients with 80.6% (1319) female and mean age 54 years. Primary lymphedema occurred in 28.2% (461). In the 71.8% (1176) with secondary CE cancer occurred in 72% (846) and 28% (330) due to other causes. Data showed that 84.2% (226) had full upper body mobility, 15.5% (41) had limited mobility and 0.2% (2) had lost all mobility. Lower limb mobility status: 90.4% (1205) complete mobility, 8.4% (112) reduced mobility and 1.2% (21) wheelchair bound. Concurrent leg ulceration occurred in 32.9% (322) with 3.1% (51) having antibiotics. Treatment patterns varied with only 32.4% (530) receiving instructions in skin care, 61.2% (1002) multilayer compression and a further 67.8% (1110) compression garment with 17.6% (288) having sequential pressure therapy. Only 1.4% (23) had received psychological support. Out of the total 481/1637 (29.4%) were not prescribed any treatment. Only 50.4% (825) had access to subsidized treatments within the National and Regional Health Care System, whereas 49.6% (81) had to pay themselves with only half (50.9%) having access to treatment centers that were near their home. Conclusion: Results from this study and active lobbying have led to changes in reimbursement of care for primary and secondary lymphedema in Italy; this has led to a much more optimistic picture for those affected.
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Affiliation(s)
- Marina Cestari
- O.U. Territorial Rehabilitation, NHS Umbria 2, Terni, Italy
| | | | - Maurizio Ricci
- University Hospital Company, Hospitals Reunited, Ancona, Italy
| | - Peter J Franks
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Susie Murray
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Christine J Moffatt
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom.,Institute of Nursing and Midwifery Care Excellence, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.,Copenhagen Wound Healing Centre, Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Serena Michelini
- Unit of Physical Medicine and Rehabilitation, Sant'Andrea Hospital, "Sapienza," University 13 of Rome, Rome, Italy
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30
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Newman A, Keeley V, Pinnington L, Green C, Riches K, Franks PJ, Idris I, Moffatt CJ. Prevalence and Impact of Chronic Edema in Bariatric Patients: A LIMPRINT Study. Lymphat Res Biol 2021; 19:431-441. [PMID: 34672794 DOI: 10.1089/lrb.2021.0055] [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: Chronic edema (CO) is a complex condition, arising from different factors, including immobility and obesity. Edema and obesity can have a significant impact on quality of life of patients and their families. Understanding how to manage edema in obese patients is an increasing challenge for both patients and clinicians. As effective treatment options are limited for this population, it is more cost-effective for patients to lose weight before starting treatment. When patients cannot maintain weight loss, one option is to have bariatric surgery. This study was part of LIMPRINT: Lymphedema IMpact and PRevalence INTernational, a study with the aim of identifying the prevalence and impact of CO in different countries and health care settings. Study Purpose: To evaluate the prevalence and impact of CO among patients in a United Kingdom bariatric surgical service. Methods and Results: The gold standard pitting test assessed the presence of edema. General (EuroQOL-5 Dimensions [EQ-5D], RAND 36-Item Short Form Health Survey, Version 1.0 [SF-36], Generalized Anxiety Disorder 7-Item Scale [GAD-7] and Patient Health Questionnaire-9 [PHQ-9]), and edema-specific (Lymphedema Quality of Life [LYMQOL]) quality-of-life questionnaires were used to evaluate impact of edema. The prevalence of edema was 52.1% (25 of 48 participants had edema), potentially linked to obesity, immobility, and medications. Most participants had International Society of Lymphology (ISL) Stage I edema. There were no statistically significant differences between the quality of life of participants with and without edema. However, comparing SF-36 results and normative population data indicated that quality of life was much lower than those in the normative population. Conclusions: This study highlights the high prevalence of edema and low quality of life of this bariatric population. ClinicalTrials.gov ID: NCT03154593.
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Affiliation(s)
- Amy Newman
- University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom
| | - Vaughan Keeley
- University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom.,School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Derby, United Kingdom
| | - Lorraine Pinnington
- School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Derby, United Kingdom
| | - Carol Green
- University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom
| | - Katie Riches
- University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom
| | - Peter J Franks
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Iskandar Idris
- University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom.,School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Derby, United Kingdom
| | - Christine J Moffatt
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom.,Copenhagen Wound Healing Centre, Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Institute of Nursing and Midwifery Care Excellence, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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31
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Brouillard P, Witte MH, Erickson RP, Damstra RJ, Becker C, Quéré I, Vikkula M. Primary lymphoedema. Nat Rev Dis Primers 2021; 7:77. [PMID: 34675250 DOI: 10.1038/s41572-021-00309-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/09/2022]
Abstract
Lymphoedema is the swelling of one or several parts of the body owing to lymph accumulation in the extracellular space. It is often chronic, worsens if untreated, predisposes to infections and causes an important reduction in quality of life. Primary lymphoedema (PLE) is thought to result from abnormal development and/or functioning of the lymphatic system, can present in isolation or as part of a syndrome, and can be present at birth or develop later in life. Mutations in numerous genes involved in the initial formation of lymphatic vessels (including valves) as well as in the growth and expansion of the lymphatic system and associated pathways have been identified in syndromic and non-syndromic forms of PLE. Thus, the current hypothesis is that most cases of PLE have a genetic origin, although a causative mutation is identified in only about one-third of affected individuals. Diagnosis relies on clinical presentation, imaging of the structure and functionality of the lymphatics, and in genetic analyses. Management aims at reducing or preventing swelling by compression therapy (with manual drainage, exercise and compressive garments) and, in carefully selected cases, by various surgical techniques. Individuals with PLE often have a reduced quality of life owing to the psychosocial and lifelong management burden associated with their chronic condition. Improved understanding of the underlying genetic origins of PLE will translate into more accurate diagnosis and prognosis and personalized treatment.
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Affiliation(s)
- Pascal Brouillard
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
| | - Marlys H Witte
- Department of Surgery, Neurosurgery, and Pediatrics, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Robert P Erickson
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Robert J Damstra
- VASCERN PPL European Reference Centre; Department of Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital, Drachten, Netherlands
| | | | - Isabelle Quéré
- Department of Vascular Medicine, Centre de référence des Maladies Lymphatiques et Vasculaires Rares, Inserm IDESP, CHU Montpellier, Université de Montpellier, Montpellier, France
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium. .,VASCERN VASCA European Reference Centre; Center for Vascular Anomalies, Division of Plastic Surgery, University Clinics Saint-Luc, University of Louvain, Brussels, Belgium. .,Walloon Excellence in Lifesciences and Biotechnology (WELBIO), de Duve Institute, University of Louvain, Brussels, Belgium.
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Franks PJ, Quéré I, Keeley V, Tilley A, Liebl M, Murray S, Burian EA, Moffatt CJ. Quality of Life and Costs Within Decongestive Lymphatic Therapy in Patients with Leg Lymphedema: A Multicountry, Open-Label, Prospective Study. Lymphat Res Biol 2021; 19:423-430. [PMID: 34582725 DOI: 10.1089/lrb.2021.0057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Little is known of the impact in terms of health-related quality of life (HRQoL) and cost-effectiveness with decongestive therapy. Objectives: To examine changes in limb volume, quality of life (QoL), and treatment cost of methods of decongestive lymphatic therapy (DLT). Methods: Patients with chronic edema/lymphedema of the leg were invited to participate in a study of DLT in four countries (United Kingdom, France, Germany, and Canada). In each country two sites were selected. One site used their standard method of DLT in their service, including compression with multilayer bandaging with inelastic material. The other site used a system that included 3M™ Coban 2™ as the bandage treatment alongside other standard components of DLT. Patients were followed for either 2 or 4 weeks depending on the local protocols. At entry, at 2 weeks, and at 4 weeks, patients were assessed by using a health index (EQ-5D), a disease-specific HRQoL tool (LYMQOL) and resource usage was recorded over the treatment period. Results: Of the 165 patients with cost data, 90 were treated with Coban 2 and 75 with standard care compression bandaging. There was good evidence of an improvement in EQ-5D of 0.077 (p < 0.001) in all patients. LYMQOL showed significant improvements (p < 0.001) with lower scores. There were no major differences between the two arms of the study with respect to HRQoL. The number of treatment episodes was higher in those treated with standard care (8.15 vs. 6.37), but the overall treatment cost was higher with Coban 2 (£890.7) compared with standard care (£723.0). Conclusion: QoL improved in the standard care and Coban 2 group bandages, and there was no demonstrable difference between the care systems. Further work is required to examine the role of the individual parts of DLT that provide the greatest benefit to patients and the health systems that support them.
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Affiliation(s)
- Peter J Franks
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Isabelle Quéré
- National Reference Centre for Rare and Vascular Diseases, Chu-Montpellier, France.,Department of Vascular Medicine, UMR IDESP, Université de Montpellier, Chu-Montpellier, France
| | - Vaughan Keeley
- Lymphoedema Department, University Hospitals of Derby and Burton NHS Trust, Derby, United Kingdom.,School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Andrea Tilley
- Archstone Physiotherapy and Wellness Centre, St. John, Canada
| | - Max Liebl
- Department of Physical Medicine & Rehabilitation, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Susie Murray
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Ewa A Burian
- Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Christine J Moffatt
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom.,Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.,Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Burian EA, Karlsmark T, Nørregaard S, Kirketerp-Møller K, Kirsner RS, Franks PJ, Quéré I, Moffatt CJ. Wounds in chronic leg oedema. Int Wound J 2021; 19:411-425. [PMID: 34258856 PMCID: PMC8762561 DOI: 10.1111/iwj.13642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/31/2022] Open
Abstract
Wounds and chronic oedema are common disorders, but rarely studied together. The objective of this cross-sectional study was to investigate the point-prevalence and risk factors of wounds on the leg, in chronic leg oedema. Forty sites in nine countries were included. Of 7077 patients with chronic leg oedema, 12.70% had wounds. Independent risk factors were: peripheral arterial disease (odds ratio (OR) 4.87, 95% confidence intervals (CI) 3.63-6.52), cellulitis within the past 12 months (OR 2.69, 95% CI 2.25-3.21), secondary lymphoedema (OR 2.64, 95% CI 1.93-3.60), being male (OR 2.08, 95% CI 1.78-2.44), being over 85 years of age (OR 1.80, 95% CI 1.23-2.62), underweight (OR 1.79, 95% CI 1.14-2.79), bed bound (OR 1.79, 95% CI 1.01-3.16), chair bound (OR 1.52, 95% CI 1.18-1.97), diabetes (OR 1.47, 95% CI 1.23-1.77), and walking with aid (OR 1·41, 95% CI 1.17-1.69). 43.22% of those with wounds had clinically defined well-controlled oedema, associated with a significantly lower risk of wounds (OR 0.50, 95% CI 0.42-0.58, P < .001). Hard/fibrotic tissue (OR 1.71, 95% CI 1.19-2.48), and a positive Stemmers sign (OR 1.57, 95% CI 1.05-2.35) were associated with wounds. The study reinforces the importance of measures to control oedema, as controlled swelling was associated with a 50% lower risk of wounds.
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Affiliation(s)
- Ewa Anna Burian
- Department of Dermato-Venereology, Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Tonny Karlsmark
- Department of Dermato-Venereology, Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Susan Nørregaard
- Department of Dermato-Venereology, Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Klaus Kirketerp-Møller
- Department of Dermato-Venereology, Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Robert Scott Kirsner
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Peter John Franks
- Centre for Research and Implementation of Clinical Practice, London, UK
| | - Isabelle Quéré
- Department of Vascular Medicine, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| | - Christine Joy Moffatt
- Department of Dermato-Venereology, Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.,Centre for Research and Implementation of Clinical Practice, London, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK
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Burian E, Karlsmark T, Franks P, Keeley V, Quéré I, Moffatt C. Cellulitis in chronic oedema of the lower leg: an international cross‐sectional study. Br J Dermatol 2021; 185:110-118. [DOI: 10.1111/bjd.19803] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 01/03/2023]
Affiliation(s)
- E.A. Burian
- Department of Dermato‐Venereology & Wound Healing Centre Bispebjerg Hospital Copenhagen Denmark
| | - T. Karlsmark
- Department of Dermato‐Venereology & Wound Healing Centre Bispebjerg Hospital Copenhagen Denmark
| | - P.J. Franks
- Centre for Research and Implementation of Clinical Practice London UK
| | - V. Keeley
- Lymphoedema Department Royal Derby HospitalDerby and University of Nottingham Medical School Nottingham UK
| | - I. Quéré
- Department of Vascular Medicine Montpellier University Hospital CentreUniversity of Montpellier France
| | - C.J. Moffatt
- Department of Dermato‐Venereology & Wound Healing Centre Bispebjerg Hospital Copenhagen Denmark
- School of Social Sciences Nottingham Trent University Nottingham UK
- Nottingham University Hospitals NHS Trust Nottingham UK
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It was just mind blowing to be honest: a qualitative phenomenological study exploring cancer survivor's experiences of indocyanine green lymphography used to inform lymphedema therapy management. Support Care Cancer 2021; 29:6389-6397. [PMID: 33885963 DOI: 10.1007/s00520-021-06229-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE A diagnosis of secondary lymphedema following cancer treatment can necessitate lifelong therapy. Indocyanine green (ICG) lymphography is a technique for visualising lymphatics to enable individualised lymphedema diagnosis, staging and therapy prescription. The participant experience of undergoing the procedure and the impact of imaging findings on lymphedema management is unknown. This study aimed to explore participant's experiences of ICG lymphography to inform cancer-related lymphedema therapy. METHODS A qualitative phenomenological study was conducted using semi-structured interviews with 17 adult participants who had undergone ICG lymphography for stage 0 to 2 upper or lower limb secondary cancer-related lymphedema (International Society of Lymphology, Lymphology 53(1):3-10, 2020). RESULTS Seventeen participants were included in the study ranging in age from 36 to 78 years (M = 53.8 years), the majority had a primary diagnosis of breast cancer (N = 7) or melanoma (N = 7). Three overarching themes emerged. Firstly, describing the experience of the ICG lymphography procedure. Secondly, the new knowledge explained symptoms and tailored treatment. Participants reflected on how seeing their lymphatic system helped in understanding about their lymphedema symptoms and guided changes towards more individualised lymphedema management. The final theme described the internal impact of self-knowledge, which included impacts of the new information on empowerment and motivation to self-manage participant's condition as well as their feelings. CONCLUSIONS ICG lymphography had beneficial impacts on participant's understanding of their lymphedema symptoms and often led to changes in management, positive outcomes in response to management changes and peace of mind about management plans, leading to feeling more empowered to self-manage their condition.
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Webb E, Neeman T, Bowden FJ, Gaida J, Mumford V, Bissett B. Compression Therapy to Prevent Recurrent Cellulitis of the Leg. N Engl J Med 2020; 383:630-639. [PMID: 32786188 DOI: 10.1056/nejmoa1917197] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic edema of the leg is a risk factor for cellulitis. Daily use of compression garments on the leg has been recommended to prevent the recurrence of cellulitis, but there is limited evidence from trials regarding its effectiveness. METHODS In this single-center, randomized, nonblinded trial, we assigned participants with chronic edema of the leg and recurrent cellulitis, in a 1:1 ratio, to receive leg compression therapy plus education on cellulitis prevention (compression group) or education alone (control group). Follow-up occurred every 6 months for up to 3 years or until 45 episodes of cellulitis had occurred in the trial. The primary outcome was the recurrence of cellulitis. Participants in the control group who had an episode of cellulitis crossed over to the compression group. Secondary outcomes included cellulitis-related hospital admission and quality-of-life assessments. RESULTS A total of 183 patients were screened, and 84 were enrolled; 41 participants were assigned to the compression group, and 43 to the control group. At the time of a planned interim analysis, when 23 episodes of cellulitis had occurred, 6 participants (15%) in the compression group and 17 (40%) in the control group had had an episode of cellulitis (hazard ratio, 0.23; 95% confidence interval [CI], 0.09 to 0.59; P = 0.002; relative risk [post hoc analysis], 0.37; 95% CI, 0.16 to 0.84; P = 0.02), and the trial was stopped for efficacy. A total of 3 participants (7%) in the compression group and 6 (14%) in the control group were hospitalized for cellulitis (hazard ratio, 0.38; 95% CI, 0.09 to 1.59). Most quality-of-life outcomes did not differ between the two groups. No adverse events occurred during the trial. CONCLUSIONS In this small, single-center, nonblinded trial involving patients with chronic edema of the leg and cellulitis, compression therapy resulted in a lower incidence of recurrence of cellulitis than conservative treatment. (Funded by Calvary Public Hospital Bruce; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000412336.).
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Affiliation(s)
- Elizabeth Webb
- From the Physiotherapy Department, Calvary Public Hospital Bruce, Bruce, ACT (E.W.), the Biological Data Science Institute, the Australian National University Joint Colleges of Science, Health, and Medicine (T.N.), and the Medical School (F.J.B.), Australian National University, the University of Canberra Research Institute for Sport and Exercise (J.G.), and the Discipline of Physiotherapy, Faculty of Health, University of Canberra (E.W., B.B.), Canberra, ACT, and the Australian Institute of Health Innovation, Macquarie University, Sydney (V.M.) - all in Australia
| | - Teresa Neeman
- From the Physiotherapy Department, Calvary Public Hospital Bruce, Bruce, ACT (E.W.), the Biological Data Science Institute, the Australian National University Joint Colleges of Science, Health, and Medicine (T.N.), and the Medical School (F.J.B.), Australian National University, the University of Canberra Research Institute for Sport and Exercise (J.G.), and the Discipline of Physiotherapy, Faculty of Health, University of Canberra (E.W., B.B.), Canberra, ACT, and the Australian Institute of Health Innovation, Macquarie University, Sydney (V.M.) - all in Australia
| | - Francis J Bowden
- From the Physiotherapy Department, Calvary Public Hospital Bruce, Bruce, ACT (E.W.), the Biological Data Science Institute, the Australian National University Joint Colleges of Science, Health, and Medicine (T.N.), and the Medical School (F.J.B.), Australian National University, the University of Canberra Research Institute for Sport and Exercise (J.G.), and the Discipline of Physiotherapy, Faculty of Health, University of Canberra (E.W., B.B.), Canberra, ACT, and the Australian Institute of Health Innovation, Macquarie University, Sydney (V.M.) - all in Australia
| | - Jamie Gaida
- From the Physiotherapy Department, Calvary Public Hospital Bruce, Bruce, ACT (E.W.), the Biological Data Science Institute, the Australian National University Joint Colleges of Science, Health, and Medicine (T.N.), and the Medical School (F.J.B.), Australian National University, the University of Canberra Research Institute for Sport and Exercise (J.G.), and the Discipline of Physiotherapy, Faculty of Health, University of Canberra (E.W., B.B.), Canberra, ACT, and the Australian Institute of Health Innovation, Macquarie University, Sydney (V.M.) - all in Australia
| | - Virginia Mumford
- From the Physiotherapy Department, Calvary Public Hospital Bruce, Bruce, ACT (E.W.), the Biological Data Science Institute, the Australian National University Joint Colleges of Science, Health, and Medicine (T.N.), and the Medical School (F.J.B.), Australian National University, the University of Canberra Research Institute for Sport and Exercise (J.G.), and the Discipline of Physiotherapy, Faculty of Health, University of Canberra (E.W., B.B.), Canberra, ACT, and the Australian Institute of Health Innovation, Macquarie University, Sydney (V.M.) - all in Australia
| | - Bernie Bissett
- From the Physiotherapy Department, Calvary Public Hospital Bruce, Bruce, ACT (E.W.), the Biological Data Science Institute, the Australian National University Joint Colleges of Science, Health, and Medicine (T.N.), and the Medical School (F.J.B.), Australian National University, the University of Canberra Research Institute for Sport and Exercise (J.G.), and the Discipline of Physiotherapy, Faculty of Health, University of Canberra (E.W., B.B.), Canberra, ACT, and the Australian Institute of Health Innovation, Macquarie University, Sydney (V.M.) - all in Australia
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Faculty Survey on the Status of Lymphology Education in Professional Doctor of Physical Therapy Programs. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Webb E, Neeman T, Gaida J, Bowden FJ, Mumford V, Bissett B. Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic oedema: a randomised controlled trial protocol. BMJ Open 2019; 9:e029225. [PMID: 31420389 PMCID: PMC6701661 DOI: 10.1136/bmjopen-2019-029225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Cellulitis represents a significant burden to patients' quality of life (QOL) and cost to the healthcare system, especially due to its recurrent nature. Chronic oedema is a strong risk factor for both an initial episode of cellulitis and cellulitis recurrence. Expert consensus advises compression therapy to prevent cellulitis recurrence in individuals with chronic oedema, however, there is little supporting evidence. This research aims to determine if the management of chronic oedema using compression therapy effectively delays the recurrence of lower limb cellulitis. METHODS AND ANALYSIS A randomised controlled trial with cross-over will be used to assess the impact of compression therapy on clinical outcomes (time to next episode of cellulitis, rate of cellulitis-related hospital presentations, QOL and leg volume). Using concealed allocation, 162 participants will be randomised into the intervention (compression) or control (no compression) group. Randomisation will be stratified by prophylactic antibiotic use. Participants will be followed up at 6 monthly intervals for up to 3 years or until 45 episodes of cellulitis occur across the cohort. Following an episode of recurrent cellulitis, control group participants will cross-over to the intervention group. Survival analysis will be undertaken to assess the primary outcome measure of time to cellulitis recurrence. The hypotheses are that compression therapy to control lower limb chronic oedema will delay recurrent lower limb cellulitis, reduce the rate of associated hospitalisations, minimise affected limb volume and improve the QOL of this population. ETHICS AND DISSEMINATION Ethics approval has been obtained from the ethics committees of all relevant institutions. Results will be disseminated through relevant peer-reviewed journal articles and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12617000412336; Pre-results. The ICTOC trial is currently in progress. Participant recruitment started in May 2017 and is expected to continue until December 2019.
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Affiliation(s)
- Elizabeth Webb
- Department of Physiotherapy, Calvary Public Hospital Bruce, Canberra, Australian Capital Territory, Australia
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Teresa Neeman
- Biological Data Science Institute, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jamie Gaida
- University of Canberra Research Institute for Sport and Exercise (UC-RISE), University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Francis J Bowden
- Calvary Public Hospital Bruce, Canberra, Australian Capital Territory, Australia
- Australian National University Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Virginia Mumford
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Bernie Bissett
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
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Blei F. Update June 2019. Lymphat Res Biol 2019; 17:374-399. [PMID: 31194622 DOI: 10.1089/lrb.2019.29065.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Bjork R, Ehmann S. S.T.R.I.D.E. Professional Guide to Compression Garment Selection for the Lower Extremity. J Wound Care 2019; 28:1-44. [DOI: 10.12968/jowc.2019.28.sup6a.s1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The following supplement is a rare example of a paper that combines clinical experience and theoretical knowledge on textiles used in compression therapy. The authors' intention is to propose a decision support system for choosing specific compression devices, which can be adjusted to counteract the individual signs and symptoms in an optimally adopted way. The document concentrates on compression devices which can be self-applied by the patients—compression stockings and adjustable wraps. The acronym ‘S.T.R.I.D.E.’, incorporating both textile characteristics and clinical presentation, stands for: Shape, Texture, Refill, Issues, Dosage and Etiology. The intent of the mnemotechnical value is to highlight that successful compression includes more than dosage alone. In addition to dosage, etiology and patient presentation need to be incorporated, including a patient's physical ability to use compression effectively as part of the daily routine, thereby promoting adherence. The suggested algorithms provide a valuable guide to stride across the important, but still underestimated field of medical compression therapy and will help to put the prescription of a specific product on a more rational basis. Enjoy reading! Hugo Partsch Emeritus Professor Medical University of Vienna, Austria
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Affiliation(s)
- Robyn Bjork
- International Lymphedema and Wound Training Institute, Alaska, US
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