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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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Karasimav Ö, Borman P, Dalyan M, Yalçin E, Eliuz ZB, Poyraz İ, Türk S. Lower limb lymphedema disrupts both static and dynamic balance. Clin Biomech (Bristol, Avon) 2024; 115:106241. [PMID: 38703697 DOI: 10.1016/j.clinbiomech.2024.106241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/13/2024] [Accepted: 04/09/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The impact of lower-limb-lymphedema on quality of life of patients regarding balance is unclear due to the scarcity of literature. The aim of this study was to determine the static and dynamic balance of patients with lower-limb-lymphedema in comparison with healthy subjects. METHODS This case-control designed study included 30 lymphedema patients and 30 healthy individuals, of whom were 52 female and 8 male with a mean age of 50.63 ± 9.72 years. Static balance stability and anterior-posterior with lateral sway parameters on four conditions (eyes-opened-stable-ground, eyes-closed-stable-ground, eyes-opened-unstable-ground, eyes-closed-unstable-ground) and dynamic stability of all participants were evaluated. FINDINGS The demographic variables were similar between the groups. Majority of the patients had lymphedema due to cancer surgery with a stage of 2. Dynamic stability was significantly disrupted in lymphedema group in comparison with controls (P = 0.049). Static balance parameters were impaired on all conditions except the eyes opened-stable ground in lymphedema patients (P = 0.048,P = 0.043,P = 0.017). The dynamic with static balance and lateral sway parameters were correlated with the duration of lymphedema(P = 0.046,P = 0.002,P = 0.005). Anterior-posterior sway on eyes-closed-unstable-ground condition was correlated with functional status (P = 0.02). Static balance on eyes-opened-unstable-ground condition and anterior-posterior sway parameters were correlated with physical activity level (P = 0.015,P = 0.016,P < 0.05). INTERPRETATION Closing eyes and the deterioration of ground caused significant alteration of the static and dynamic balance both separately and together in patients with lower-limb-lymphedema compared to healthy subjects. Regarding the static and dynamic imbalance, we suggest the evaluation of balance and inclusion of balance exercises in routine lymphedema rehabilitation program, especially in the early period of disease.
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Affiliation(s)
- Özlem Karasimav
- Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Sports Health and Rehabilitation Laboratory, Ankara, Turkey.
| | - Pınar Borman
- Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Lymphedema Clinic and Laboratory, Ankara, Turkey
| | - Meltem Dalyan
- Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Lymphedema Clinic and Laboratory, Ankara, Turkey
| | - Elif Yalçin
- Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Posture and Gait Analysis Laboratory, Ankara, Turkey
| | - Zahide Betül Eliuz
- Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Posture and Gait Analysis Laboratory, Ankara, Turkey
| | - İpek Poyraz
- Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Sports Health and Rehabilitation Laboratory, Ankara, Turkey
| | - Seren Türk
- Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Sports Health and Rehabilitation Laboratory, Ankara, Turkey
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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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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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Karasimav O, Borman P, Dalyan M, Yalcin E, Eliuz ZB, Koc SS, Turhan S. Static and Dynamic Imbalance in Patients with Breast Cancer-Related Lymphedema. Lymphat Res Biol 2023; 21:601-607. [PMID: 37196199 DOI: 10.1089/lrb.2023.0012] [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: 05/19/2023] Open
Abstract
Background: Breast cancer-related lymphedema (BCRL) was associated with postural imbalance, but the immature knowledge introduced debate about which component of the balance was affected by BCRL in the literature. The aim of this study was to determine the static and dynamic balance of patients with BCRL in comparison with healthy subjects. Methods and Results: This case-control designed study recruited 30 BCRL patients and 30 healthy individuals. The demographic and clinical variables of the subjects were recorded. The static balance stability parameters on four conditions (eyes opened-stable ground, eyes closed-stable ground, eyes opened-unstable ground, eyes closed-unstable ground) and dynamic stability of all participants were evaluated. The values of both stable ground conditions were similar between the groups (p < 0.05). However, values of both eyes opened-unstable ground (p = 0.032) and eyes closed-unstable ground (p = 0.034) conditions were significantly impaired in BCRL in comparison with controls. Besides, comparison of sway area of the opened versus closed eyes conditions on unstable ground (p = 0.036), and movement speed while correcting the center of pressure on unstable ground (with opened and closed eyes, p = 0.014 and p = 0.004 respectively) revealed increased values in the BCRL group. Likewise, the dynamic stability was significantly disrupted in the BCRL group (p = 0.043). Conclusion: Closing eyes did not affect the postural balance in patients with BCRL, whereas the deterioration of ground altered the balance significantly in the BCRL group compared with healthy subjects. We suggest the inclusion of balance exercises and guidance for selection of correct shoes and insoles in routine lymphedema rehabilitation program.
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Affiliation(s)
- Ozlem Karasimav
- Department of Sports Medicine, Sports Health and Rehabilitation Laboratory, Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Ankara, Turkey
| | - Pinar Borman
- Department of Physical Medicine and Rehabilitation, Lymphedema Clinic and Laboratory, Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Ankara, Turkey
| | - Meltem Dalyan
- Department of Physical Medicine and Rehabilitation, Lymphedema Clinic and Laboratory, Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Ankara, Turkey
| | - Elif Yalcin
- Department of Physical Medicine and Rehabilitation, Posture and Gait Analysis Laboratory, Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Ankara, Turkey
| | - Zahide Betul Eliuz
- Department of Physical Medicine and Rehabilitation, Posture and Gait Analysis Laboratory, Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Ankara, Turkey
| | - Saadet Selin Koc
- Department of Sports Medicine, Sports Health and Rehabilitation Laboratory, Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Ankara, Turkey
| | - Seren Turhan
- Department of Sports Medicine, Sports Health and Rehabilitation Laboratory, Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Ankara, Turkey
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Toprak Celenay S, Bayramoglu Demirdogen E, Barut O, Cigdem Karacay B, Ozer Kaya D. Postural stability, spinal alignment, mobility, and postural competency in women with unilateral lower extremity lymphedema after radical hysterectomy following gynecologic cancer: A case-control study. Eur J Oncol Nurs 2023; 67:102416. [PMID: 37879191 DOI: 10.1016/j.ejon.2023.102416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/07/2023] [Accepted: 09/07/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE To compare postural stability, spinal alignment, mobility, and postural competency in women with unilateral lower extremity lymphedema after radical hysterectomy following gynecologic cancer with a matched control group. METHODS Twenty-seven women with unilateral lower extremity lymphedema (lymphedema group, age: 54.14 ± 5.80 years) and 30 healthy women (control group, age: 51.90 ± 6.54 years) were included. The lymphedema severity was evaluated with circumferential measurements. Postural stability with the Biodex Balance System SD and the spinal alignment, mobility, and postural competency with the Spinal Mouse device were assessed. RESULTS In the lymphedema group, it was found that 3.7% of the women had mild lymphedema, 7.4% had moderate lymphedema, and 88.9% had severe lymphedema. Static eyes open (EO) (overall, medio-lateral and antero-posterior) and eyes closed (EC) (antero-posterior) stability scores and dynamic EO and EC stability scores (overall and antero-posterior) were detected to be higher in the lymphedema group than in the controls (p < 0.05). Spinal mobility and postural competency scores were lower in the lymphedema group than in the control group (p < 0.05). In other parameters, there were no significant differences between the groups (p > 0.05). CONCLUSION Decreased postural stability, spinal mobility, and postural competency were detected in women with unilateral lower extremity lymphedema; however, no difference was seen in spinal alignment. These changes should be taken into account in the assessment and the treatment of unilateral lower extremity lymphedema.
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Affiliation(s)
- Seyda Toprak Celenay
- Ankara Yildirim Beyazit University, Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| | | | - Ozge Barut
- Kirsehir Ahi Evran University, Rectorship, Pilot University Coordinatorship of Health, Kirsehir, Turkey
| | - Basak Cigdem Karacay
- Kirsehir Ahi Evran University, Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Kirsehir, Turkey
| | - Derya Ozer Kaya
- Izmir Katip Celebi University, Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Izmir, Turkey
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Altas EU, Demirdal ÜS. The effects of post-mastectomy lymphedema on balance, Kinesiophobia and fear of falling. J Community Health Nurs 2021; 38:130-138. [PMID: 33949261 DOI: 10.1080/07370016.2021.1887564] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this study is to investigate the effects of post-mastectomy lymphedema on balance, kinesiophobia and fear of falling. A cross-sectional study with a control group. Seventy patients and 62 healthy volunteers were included. After determining the stage and limb volumes of the patients, all participants were evaluated with scales. There was a statistically significant difference in all scales compared to the control group (p < .001). There was a correlation between the stage of lymphedema and limb volume difference, balance, kinesiophobia, fear of falling (p < .001). In proportion with its stage and severity, lymphedema causes balance disorder, kinesiophobia and fear of falling.
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Affiliation(s)
- Elif Umay Altas
- Department of Physical Medicine and Rehabilitation, Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey
| | - Ümit Seçil Demirdal
- Department of Physical Medicine and Rehabilitation, Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey
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