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Nishiyama M, Sakaguchi Y, Morito S, Nagase K, Sakumoto T, Yamashita K, Hashiguchi M, Fukuda M, Toda S, Aoki S. A new lymphedema treatment using pyro-drive jet injection. Hum Cell 2024; 37:465-477. [PMID: 38218753 DOI: 10.1007/s13577-023-01021-2] [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: 10/09/2023] [Accepted: 12/07/2023] [Indexed: 01/15/2024]
Abstract
Lymphedema, resulting from impaired lymphatic drainage, causes inflammation, fibrosis and tissue damage leading to symptoms such as limb swelling and restricted mobility. Despite various treatments under exploration, no standard effective therapy exists. Here a novel technique using the pyro-drive jet injection (PJI) was used to create artificial clefts between collagen fibers, which facilitated the removal of excess interstitial fluid. The PJI was used to deliver a mixture of lactated Ringer's solution and air into the tail of animals with secondary skin edema. Edema levels were assessed using micro-CT scanning. Histopathological changes and neovascularization were evaluated on the injury-induced regenerative tissue. Regarding tissue remodeling, we focused on connective tissue growth factor (CTGF) and vascular endothelial growth factor (VEGF)-C. PJI markedly diminished soft tissue volume in the experimental lymphedema animals compared to the non-injected counterparts. The PJI groups exhibited a significantly reduced proportion of inflammatory granulation tissue and an enhanced density of lymphatic vessels and α-smooth muscle actin (αSMA)-positive small vessels in the fibrous granulation tissue compared to the controls. In addition, PJI curtailed the prevalence of CTGF- and VEGF-C-positive cells in regenerative tissue. In a lymphedema animal model, PJI notably ameliorated interstitial edema, promoted lymphatic vessel growth, and bolstered αSMA-positive capillaries in fibrous granulation tissue. PJI's minimal tissue impact post-lymph node dissection indicates significant potential as an early, standard preventative measure. Easily applied in general clinics without requiring specialized training, it offers a cost-effective and highly versatile solution to the management of lymphedema.
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Affiliation(s)
- Megumi Nishiyama
- Division of Pathology, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Yuko Sakaguchi
- Medical Device Division Life Sciences SBU, Daicel Corporation, Osaka, Japan
| | - Sayuri Morito
- Division of Pathology, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Kei Nagase
- Department of Urology, Faculty of Medicine, Saga University, Saga, Japan
| | - Takehisa Sakumoto
- Division of Pathology, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Kunihiko Yamashita
- Medical Device Division Life Sciences SBU, Daicel Corporation, Osaka, Japan
| | - Mariko Hashiguchi
- Division of Pathology, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Makoto Fukuda
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Shuji Toda
- Department of Pathology, Takagi Hospital, 141-11 Sakemi, Okawa, Fukuoka, 831-0016, Japan
| | - Shigehisa Aoki
- Division of Pathology, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan.
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Schiltz D, Eibl D, Mueller K, Biermann N, Prantl L, Taeger CD. Therapist versus Machine-Immediate Effects of Manual versus Mechanical Lymphatic Drainage in Patients with Secondary Lymphedema. J Clin Med 2024; 13:1277. [PMID: 38592094 PMCID: PMC10931544 DOI: 10.3390/jcm13051277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/10/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Complex decongestive therapy (CDT) is the standard and basic therapy for lymphedema. The central component of CDT is manual lymphatic drainage (MLD). In addition to CDT, other measures such as intermittent pneumatic compression therapy (IPCT) (active compression machine therapy) are available. In this prospective research study, the objective and subjective effects of MLD and IPCT on lymphedema of the lower extremity were investigated and both therapies were directly compared. Furthermore, the patients' body mass index (BMI) and stage of lymphedema were tested for their effect on the respective therapy. Methods: Patients participating in the study received both therapies (MLD and IPCT) on the same lymphedema-affected limb at an interval of two days. The objective volumetric therapy effect was measured by the digital volume measurement of the affected limb. The subjective effects of the therapies were measured using two specially designed questionnaires. Results: A total of 40 patients were included in the study. There was no significant difference in the volume differences between the interventions, BMI categories, lymphedema, or treatment order regarding the immediate and two-day effect. Conclusions: No significant difference was found in the subjective or objective therapy efficacy of the two methods. Intermittent pneumatic compression therapy is considered a comparable therapeutic procedure when properly indicated.
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Affiliation(s)
- Daniel Schiltz
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (N.B.); (L.P.)
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Helios Hospital Emil von Behring, 14165 Berlin, Germany
| | - Dominik Eibl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (N.B.); (L.P.)
| | - Karolina Mueller
- Center for Clinical Studies, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Niklas Biermann
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (N.B.); (L.P.)
| | - Lukas Prantl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (N.B.); (L.P.)
| | - Christian Dirk Taeger
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany (N.B.); (L.P.)
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Da Cuña-Carrera I, Soto-González M, Abalo-Núñez R, Lantarón-Caeiro EM. Is the Absence of Manual Lymphatic Drainage-Based Treatment in Lymphedema after Breast Cancer Harmful? A Randomized Crossover Study. J Clin Med 2024; 13:402. [PMID: 38256536 PMCID: PMC10816533 DOI: 10.3390/jcm13020402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/30/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: Manual lymphatic drainage (MLD), included within the complex decongestive therapy, as a therapy for the treatment of lymphedema has raised controversy about its benefits for lymphedema after breast cancer. The aim of this research is to test the effects of MLD on lymphedema after breast cancer during the treatment maintenance phase. (2) Methods: A randomized, single-blinded, controlled crossover trial was conducted to analyze the effects of a manual lymphatic drainage intervention compared to a control group without MLD intervention for the treatment of lymphedema. Arm volume measured by circumference measurement, subcutaneous tissue thickness measured by ultrasound, and the sensation of pain, heaviness, and swelling were evaluated as outcome measures. (3) Results: For the control group, an increase in volume was found in some of the circumference and subcutaneous tissue thickness measurements, in addition to a worsening of arm pain, swelling and heaviness. (4) Conclusion: The absence of treatment based on MLD in lymphedema after breast cancer worsens volume measurements, as well as arm heaviness. Therefore, it would be advisable to carry out this type of therapy as part of the maintenance treatment for lymphedema in breast cancer.
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Affiliation(s)
- Iria Da Cuña-Carrera
- Clinic Physiotherapy Group, Galicia South Health Research Institute, Servicio Galego de Saúde, 36312 Vigo, Spain; (I.D.C.-C.); (R.A.-N.); (E.M.L.-C.)
- Faculty of Physiotherapy, Campus A Xunqueira s/n, University of Vigo, 36005 Pontevedra, Spain
| | - Mercedes Soto-González
- Clinic Physiotherapy Group, Galicia South Health Research Institute, Servicio Galego de Saúde, 36312 Vigo, Spain; (I.D.C.-C.); (R.A.-N.); (E.M.L.-C.)
- Faculty of Physiotherapy, Campus A Xunqueira s/n, University of Vigo, 36005 Pontevedra, Spain
| | - Rocío Abalo-Núñez
- Clinic Physiotherapy Group, Galicia South Health Research Institute, Servicio Galego de Saúde, 36312 Vigo, Spain; (I.D.C.-C.); (R.A.-N.); (E.M.L.-C.)
- Faculty of Physiotherapy, Campus A Xunqueira s/n, University of Vigo, 36005 Pontevedra, Spain
| | - Eva M. Lantarón-Caeiro
- Clinic Physiotherapy Group, Galicia South Health Research Institute, Servicio Galego de Saúde, 36312 Vigo, Spain; (I.D.C.-C.); (R.A.-N.); (E.M.L.-C.)
- Faculty of Physiotherapy, Campus A Xunqueira s/n, University of Vigo, 36005 Pontevedra, Spain
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Angst F, Benz T, Lehmann S, Sándor PS, Wagner S. Effects of Inpatient Rehabilitation in Leg Lymphedema: A Naturalistic Prospective Cohort Study With Intra-individual Control of Effects. Arch Phys Med Rehabil 2023; 104:2035-2042. [PMID: 37329968 DOI: 10.1016/j.apmr.2023.06.001] [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: 01/03/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To quantify therapy-attributable effects of a comprehensive inpatient rehabilitation program for lower limb lymphedema (LLL) and to compare the levels of health-related quality of life (HRQL) to population-based norms. DESIGN Naturalistic prospective cohort study with intra-individual control of effects. SETTING Rehabilitation hospital. PARTICIPANTS Patients with LLL (N=67; 46 women). INTERVENTIONS Comprehensive, multidisciplinary inpatient rehabilitation with 45-60 hours of therapy. MAIN OUTCOME MEASURES Short Form 36 (SF-36) for HRQL, lymphedema-specific Freiburg Quality of Life Assessment for lymphatic disorders, Short Version (FLQA-lk), knee-specific Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), and Symptom Checklist-90Standard (SCL-90S). Observed pre/post rehabilitation effects were individually corrected by subtracting the home waiting-time effects and expressed as standardized effect sizes (ESs) and standardized response means (SRMs). Score differences to norms were quantified by standardized mean differences (SMDs). RESULTS Participants were on average aged 60.5 years, not yet obese, and had 3 comorbidities (n=67). The greatest improvement was in HRQL on the FLQA-lk with ES=0.767/SRM=0.718, followed by improvements in pain and function with ES/SRM=0.430-0.495 on the SF-36, FLQA-lk, and KOS-ADL (all P<.001). Vitality, mental health, emotional well-being, and interpersonal sensitivity improved most by ES/SRM=0.341-0.456 on all 4 measures (all P≤.003). Post rehabilitation scores were significantly higher than population norms on SF-36 bodily pain (SMD=1.140), vitality (SMD=0.886), mental health (SMD=0.815), and general health (SMD=0.444) (all P<.001), and comparable on the other scales. CONCLUSIONS Those affected by LLL stages II and III benefited substantially from the intervention, attaining equal or higher levels of HRQL than expected compared with the general population norms. Multidisciplinary, inpatient rehabilitation should be recommended for LLL management.
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Affiliation(s)
- Felix Angst
- Research Department, Rehaklinik Bad Zurzach, ZURZACH Care Group, Bad Zurzach, Switzerland.
| | - Thomas Benz
- Research Department, Rehaklinik Bad Zurzach, ZURZACH Care Group, Bad Zurzach, Switzerland; ZHAW Zurich University of Applied Sciences, School of Health Sciences, Institute of Physiotherapy, Winterthur, Switzerland
| | - Susanne Lehmann
- Research Department, Rehaklinik Bad Zurzach, ZURZACH Care Group, Bad Zurzach, Switzerland
| | - Peter S Sándor
- Research Department, Rehaklinik Bad Zurzach, ZURZACH Care Group, Bad Zurzach, Switzerland
| | - Stephan Wagner
- Department of Angiology, Rehaklinik Bad Zurzach, ZURZACH Care Group, Bad Zurzach, Switzerland
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Sierla R, Dylke E, Poon S, Shaw T, Kilbreath S. Attaining consensus on a core dataset for upper limb lymphoedema using the Delphi method: A foundational step in creating a clinical support system. HEALTH INF MANAG J 2023:18333583231188396. [PMID: 37653585 DOI: 10.1177/18333583231188396] [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: 09/02/2023]
Abstract
Background: Lymphoedema is a condition of localised swelling caused by a compromised lymphatic system. The protein-rich fluid accumulating in the interstitial tissue can create inflammation and irreversible changes to the skin and underlying tissue. An array of methods has been used to assess and report these changes. Heterogeneity is evident in the clinic and in the literature for the domains assessed, outcomes and outcome measures selected, measurement protocols followed, methods of analysis, and descriptors used to report change. Objective: This study seeks consensus on the required items for inclusion in a core data set for upper limb lymphoedema to digitise the monitoring and reporting of upper limb lymphoedema. Methods: The breadth of outcomes and descriptors in common use were captured in prior studies by this research group. This list was refined by frequency and proposed to experts in the field (n = 70) through a two-round online modified Delphi study. These participants rated the importance of each item for inclusion in the dataset and identified outcomes or descriptors they felt were missing in Round 1. In Round 2, participants rated any new outcomes or descriptors proposed and preference for how numeric data is displayed. Results: The core dataset was confirmed on completion of Round 2. Interlimb difference as a percentage, and limb volume were preferred for graphed display over time; and descriptors for observed and palpated change narrowed from 42 to 20. Conclusion: This dataset provides the foundation to create a clinical support system for upper limb lymphoedema.
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Affiliation(s)
- Robyn Sierla
- The University of Sydney, Australia
- Royal Prince Alfred Hospital, Australia
| | | | | | - Tim Shaw
- The University of Sydney, Australia
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Ruliffson BNK, Whittington CF. Regulating Lymphatic Vasculature in Fibrosis: Understanding the Biology to Improve the Modeling. Adv Biol (Weinh) 2023; 7:e2200158. [PMID: 36792967 DOI: 10.1002/adbi.202200158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/19/2022] [Indexed: 02/17/2023]
Abstract
Fibrosis occurs in many chronic diseases with lymphatic vascular insufficiency (e.g., kidney disease, tumors, and lymphedema). New lymphatic capillary growth can be triggered by fibrosis-related tissue stiffening and soluble factors, but questions remain for how related biomechanical, biophysical, and biochemical cues affect lymphatic vascular growth and function. The current preclinical standard for studying lymphatics is animal modeling, but in vitro and in vivo outcomes often do not align. In vitro models can also be limited in their ability to separate vascular growth and function as individual outcomes, and fibrosis is not traditionally included in model design. Tissue engineering provides an opportunity to address in vitro limitations and mimic microenvironmental features that impact lymphatic vasculature. This review discusses fibrosis-related lymphatic vascular growth and function in disease and the current state of in vitro lymphatic vascular models while highlighting relevant knowledge gaps. Additional insights into the future of in vitro lymphatic vascular models demonstrate how prioritizing fibrosis alongside lymphatics will help capture the complexity and dynamics of lymphatics in disease. Overall, this review aims to emphasize that an advanced understanding of lymphatics within a fibrotic disease-enabled through more accurate preclinical modeling-will significantly impact therapeutic development toward restoring lymphatic vessel growth and function in patients.
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Affiliation(s)
- Brian N K Ruliffson
- Department of Biomedical Engineering, Worcester Polytechnic Institute, 100 Institute Rd., Worcester, MA, 01609, USA
| | - Catherine F Whittington
- Department of Biomedical Engineering, Worcester Polytechnic Institute, 100 Institute Rd., Worcester, MA, 01609, USA
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A Novel Dressing Composed of Adipose Stem Cells and Decellularized Wharton's Jelly Facilitated Wound Healing and Relieved Lymphedema by Enhancing Angiogenesis and Lymphangiogenesis in a Rat Model. J Funct Biomater 2023; 14:jfb14020104. [PMID: 36826903 PMCID: PMC9960849 DOI: 10.3390/jfb14020104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
Lymphedema causes tissue swelling due to the accumulation of lymphatic fluid in the tissue, which delays the process of wound-healing. Developing effective treatment options of lymphedema is still an urgent issue. In this study, we aim to fabricate tissue-engineered moist wound dressings with adipose stem cells (ASCs) and decellularized Wharton's jelly (dWJ) from the human umbilical cord in order to ameliorate lymphedema. Rat ASCs were proliferated and an apparent layer was observed on dWJ at day 7 and 14. A rat tail lymphedema model was developed to evaluate the efficacy of the treatment. Approximately 1 cm of skin near the base of the rat tail was circularly excised. The wounds were treated by secondary healing (control) (n = 5), decellularized Wharton's jelly (n = 5) and ASC-seeded dWJ (n = 5). The wound-healing rate and the tail volume were recorded once a week from week one to week five. Angiogenesis and lymphangiogenesis were assessed by immunochemistry staining with anti-CD31 and anti-LYVE1. The results showed that the wound-healing rate was faster and the tail volume was lesser in the ASC-seeded dWJ group than in the control group. More CD31+ and LYVE-1+ cells were observed at the wound-healing area in the ASC-seeded dWJ group than in the control group. This proves that tissue-engineered moist wound dressings can accelerate wound-healing and reduce lymphedema by promoting angiogenesis and lymphangiogenesis.
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Martone P, Marshall G, Davidoff C, Maltser S. Opportunities to Incorporate Osteopathic Manipulative Treatment Within Cancer Rehabilitation and the Current State of the Evidence. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00371-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Tsai KY, Liao SF, Chen KL, Tang HW, Huang HY. Effect of early interventions with manual lymphatic drainage and rehabilitation exercise on morbidity and lymphedema in patients with oral cavity cancer. Medicine (Baltimore) 2022; 101:e30910. [PMID: 36281150 PMCID: PMC9592419 DOI: 10.1097/md.0000000000030910] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There are clinical and statistical inconsistencies regarding early intervention with manual lymphatic drainage (MLD). The purpose of this study was to compare the short-term effect of early interventions with rehabilitation exercise versus MLD and rehabilitation exercise in terms of pain, range of motion (ROM) and lymphedema in patients with oral cancer after surgery. METHODS A total of 39 patients who underwent surgery from December 2014 to December 2018 participated in this randomized single-blind study. There were 20 patients in the rehabilitation (R) group and 19 in the MLD (M) plus rehabilitation group. The R group received 30 minutes of rehabilitation intervention; and the M group received 30 minutes of MLD, in addition to 30 minutes of rehabilitation intervention in a work day. Clinical measures, including the visual analog pain scale (VAS), ROM of the neck and shoulder, ultrasonography and face distance for lymphedema, and the Földi and Miller lymphedema scales, were assessed before surgery, before intervention and when discharged from the hospital. RESULTS The VAS pain score, ROM of the neck, and internal and external rotation of the right shoulder were significantly improved after the interventions. Right-face distance (P = .005), and skin-to-bone distance (SBD) of the bilateral horizontal mandible and left ascending mandibular ramus were significantly improved after the interventions. Left lateral flexion of the neck (P = .038) and SBD of the right ascending mandibular ramus (P < .001) in the MLD group showed more improvement than that of the rehabilitation group. CONCLUSION Early intervention with MLD and the rehabilitation program were effective in improving ROM of the neck and controlling lymphedema in acute-phase rehabilitation. The preliminary findings suggest a potential therapeutic role for early intervention with MLD, in addition to rehabilitation exercise, in that they yielded more benefits in lymphedema control and improvement of ROM of the neck in acute care.
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Affiliation(s)
- Kuo-Yang Tsai
- Department of Oral and Maxillofacial Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Su-Fen Liao
- Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan
- Division of Pediatric Rehabilitation, Changhua Christian Children’s Hospital, Changhua, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- * Correspondence: Su-Fen Liao, Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, No.135 Nanxiao Street, Changhua, 500 Taiwan (e-mail: )
| | - Kuan-Lin Chen
- Department of Physical Medicine and Rehabilitation, Yuan Rung Medical Corporation Yuan Sheng Hospital, Yuanlin city, Changhua County, Taiwan
| | - Hao-Wei Tang
- Department of Physical Medicine and Rehabilitation, Yumin Medical Corporation Yumin Hospital, Caotun Town, Nantou County, Taiwan
| | - Hsin-Ya Huang
- Branch of Physical therapy, Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan
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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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Cho SC, Kwak SG, Cho HK. Effectiveness of Mobiderm® bandages in the treatment of cancer-related secondary lymphedema: A pilot study. Medicine (Baltimore) 2022; 101:e30198. [PMID: 36107527 PMCID: PMC9439736 DOI: 10.1097/md.0000000000030198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Secondary lymphedema is a clinically incurable disease that commonly occurs following surgical cancer treatment and/or radiation. One of the most common forms of lymphedema treatment is complete decongestive therapy (CDT). This study aimed to investigate the clinical effects of new compression bandages (Mobiderm® bandages) in patients with secondary lymphedema after cancer treatment. This study included 17 patients with ipsilateral limb lymphedema after cancer treatment (one male and 16 female patients; age, 45-80 years). Patients were divided into the Mobiderm® bandage group (n = 9) and classical bandage group (n = 8). The International Society of Lymphology (ISL) stage was also evaluated. Limb circumference was measured at 5 to 6 sites per limb to identify the maximal circumference difference (MCD) between the affected and unaffected limbs. Pre-and posttreatment MCD were analyzed. After intensive CDT, both the Mobiderm® bandage group (1.2 ± 0.56 cm) and classical bandage group (0.85 ± 0.40 cm) had a significant decrease in MCD compared to pretreatment (P < .05). However, in patients with ISL stage 2, the mean MCD decrease rate was greater in the Mobiderm® bandage group (22.82 ± 10.92 %) than in the classical bandage group (12.18 ± 8.1 1%)(P = .045). Both new bandages (Mobiderm® bandages and classical bandages) reduced the circumference of limb edema in patients with secondary lymphedema after cancer treatment. This study findings suggest that Mobiderm® bandages as an alternative modality for controlling ISL stage 2 lymphedema.
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Affiliation(s)
- Sung Cheol Cho
- Department of Physical Medicine and Rehabilitation, Catholic University of Daegu School of Medicine, Republic of Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, Catholic University of Daegu School of Medicine, Republic of Korea
| | - Hee Kyung Cho
- Department of Physical Medicine and Rehabilitation, Catholic University of Daegu School of Medicine, Republic of Korea
- *Correspondence: Hee Kyung Cho, Department of Physical Medicine and Rehabilitation, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-Gu, Daegu, 42472, Republic of Korea (e-mail: )
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Pajero Otero V, García Delgado E, Martín Cortijo C, Rodríguez Ramos ML, De Carlos Iriarte E, Gil García A, Romay‐Barrero H, Avendaño‐Coy J. Intensive complex physical therapy combined with intermittent pneumatic compression versus Kinesio taping for treating breast cancer-related lymphedema of the upper limb: A randomised cross-over clinical trial. Eur J Cancer Care (Engl) 2022; 31:e13625. [PMID: 35642305 PMCID: PMC9540766 DOI: 10.1111/ecc.13625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/01/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study is to compare the effectiveness of complex physical therapy combined with intermittent pneumatic compression (CPT + IPC) versus Kinesio taping (KT) for breast cancer-related lymphedema. METHODS A cross-over clinical trial was conducted in 43 women with lymphedema. All participants received two interventions: CPT + IPC and KT, both lasting 3 weeks and a washout period. The main outcome variable was the relative volume change (RVC). The secondary variables were Satisfaction Questionnaire about Textile Therapeutic Devices used for Breast Cancer-Related Lymphedema, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, motion range of upper limb and lymphedema-related symptoms. RESULTS The RVC reduction was greater with CPT + IPC (-2.2%, SD = 4.7) versus KT (-0.9%, SD = 1.7) (P = 0.002). KT was more satisfactory than multilayer bandaging (8.9 points difference, P < 0.001) and improved DASH score more than CPT + IPC (14.3 points difference, P = 0.002). Regarding motion ranges, only shoulder movements showed significant improvement with CPT + IPC compared with KT (differences between 5.6° and 11.4°). Of the symptoms assessed, only pain reduction showed a significant improvement with KT versus CPT + IPC (0.5 points, P = 0.035). CONCLUSIONS CPT + IPC achieved higher RVC and greater improvement in th shoulder motion range than KT. Conversely, KT was more satisfactory than multilayer bandaging, obtained better DASH scores and relieved pain more than CPT + IPC. CLINICAL REGISTRATION ClinicalTrial registration number: NCT03051750 (date of registration 14 February 2017).
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Affiliation(s)
- Violeta Pajero Otero
- University Hospital Infanta SofíaSan Sebastián de los ReyesSpain
- Foundation for Biomedical Research and Innovation of the University Hospital Infanta Sofía and University Hospital de Henares (FIIB HUIS HHEN)MadridSpain
- Faculty of NursingPhysiotherapy and Podiatry of the Complutense UniversityMadridSpain
- Research Institute i + 12 of Hospital October 12MadridSpain
| | - Esther García Delgado
- University Hospital 12 de OctubreMadridSpain
- Faculty of Nursing, Physical Therapy and ChiropodyComplutense University of MadridMadridSpain
| | - Concepción Martín Cortijo
- University Hospital 12 de OctubreMadridSpain
- Faculty of Nursing, Physical Therapy and ChiropodyComplutense University of MadridMadridSpain
| | | | | | | | | | - Juan Avendaño‐Coy
- Faculty of Physical Therapy and NursingCastilla‐La Mancha UniversityToledoSpain
- Toledo Physiotherapy Research Group (GIFTO)ToledoSpain
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Lee S, Lee DG, Kim KT. Temporal Changes in Subcutaneous Fibrosis in Patients with Lower Extremity Lymphedema Following Surgery for Gynecologic Cancer: A Computed Tomography-Based Quantitative Analysis. Diagnostics (Basel) 2022; 12:diagnostics12081949. [PMID: 36010297 PMCID: PMC9406798 DOI: 10.3390/diagnostics12081949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Lymphedema causes inflammation, which provokes fibrosis within the epifascial tissue. Temporal change in fibrosis according to severity of the lymphedema has not been widely investigated. We aimed to study the quantitative changes in epifascial fibrosis during lymphedema treatment using computed tomography (CT). Forty-five patients (mean age: 57.75 ± 11.12 years) who developed lymphedema following gynecologic surgery were included in this retrospective study. Two weeks of complete decongestive therapy and continued self-bandaging or compression garments were prescribed under regular follow-up monitoring. Lower-extremity epifascial fibrosis was quantitatively analyzed on the initial and follow-up CT scans. Circumference, skin fibrosis, subcutaneous tissue, and fibrosis ratio were calculated in the axial scan. Based on the change in lymphedema severity, we divided subjects into ‘improved’ and ‘aggravated’ groups. The affected lower extremities showed higher circumference, more skin fibrosis and subcutaneous tissue, and higher fibrosis ratio than the unaffected sides on initial CT scan. At follow-up, compared to the aggravated group, the improved group showed significant decreases in fibrosis of skin and subcutaneous tissue and fibrosis ratio. Subcutaneous fibrosis was reversible with volume resolution of lymphedema. Therapeutic approaches should be established on the basis of the reversible nature of fibrotic changes in patients with lower extremity lymphedema.
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Affiliation(s)
- Soyoung Lee
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea
| | - Dong Gyu Lee
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu 42415, Korea
| | - Kyoung Tae Kim
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea
- Correspondence: ; Tel.: +82-53-258-7692
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14
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Chima C, George S, Murray B, Moore Z, Costello M. Health-related quality of life and assessment in patients with lower limb lymphoedema: a systematic review. J Wound Care 2022; 31:690-699. [PMID: 36001703 DOI: 10.12968/jowc.2022.31.8.690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the impact of lower limb lymphoedema (LLL) on health-related quality of life (HRQoL), and to identify the methodologies used to assess HRQoL and their adherence to the World Health Organization (WHO)-recommended HRQoL dimensions. METHOD A systematic review was used following the PRISMA guidance. Studies were eligible if they assessed HRQoL in adult patients with LLL. The search was conducted between September 2019 and February 2020 using CINAHL, PubMed, Scopus, EMBASE and the Cochrane Library database. Data were placed onto a pre-developed data extraction table and analysed using a narrative synthesis. Evidence-based Librarianship (EBL) was used for quality appraisal. RESULTS A total of 18 studies were identified, among which 10 were cross-sectional and eight were longitudinal studies. Twelve HRQoL questionnaires were identified and the Lymphoedema Quality of Life tool (LYMQoL) was the most commonly used. All of the studies except one had an EBL validity score of ≥75%. Although LLL causes a considerable impairment in HRQoL, the findings varied across the studies. All the studies considered at least four of the six WHO recommended dimensions, with none considering the spirituality dimension. Furthermore, physical functioning and wellbeing were discovered to be the worst affected HRQoL dimensions. CONCLUSION LLL adversely affects physical function, wellbeing and thus the HRQoL. The LYMQoL is the most commonly used questionnaire; despite this, all elements of the WHO recommendations were not captured in the included studies. However, accurate information on HRQoL indicating the impact of the disease on survivors' lives and complete wellbeing is needed to inform evidence-based decision-making. Furthermore, having a universally accepted, disease-specific methodology will facilitate comparison and contrasting of HRQoL in patients with LLL. DECLARATION OF INTEREST The authors have no conflicts of interest.
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Affiliation(s)
- Comfort Chima
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland University of Medicine and Health Science.,School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Health Science
| | - Sherly George
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland University of Medicine and Health Science.,School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Health Science
| | - Bridget Murray
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland University of Medicine and Health Science.,School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Health Science
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland University of Medicine and Health Science.,School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland University of Medicine and Health Science.,Faculty of Science, Medicine and Health, University of Wollongong, Australia.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,Lida Institute, Shanghai.,Monash University, Melbourne, Australia.,Faculty of Medicine and Health Sciences, Ghent University.,Cardiff University, Wales
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15
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Lunny C, Thirugnanasampanthar SS, Kanji S, Ferri N, Thabet P, Pieper D, Tasnim S, Nelson H, Reid E, Zhang JHJ, Kalkat B, Chi Y, Thompson J, Abdoulrezzak R, Zheng DWW, Pangka L, Wang DXR, Safavi P, Sooch A, Kang K, Whitelaw S, Tricco AC. Identifying and addressing conflicting results across multiple discordant systematic reviews on the same question: protocol for a replication study of the Jadad algorithm. BMJ Open 2022; 12:e054223. [PMID: 35443948 PMCID: PMC9021774 DOI: 10.1136/bmjopen-2021-054223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 02/01/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION An increasing growth of systematic reviews (SRs) presents notable challenges for decision-makers seeking to answer clinical questions. In 1997, an algorithm was created by Jadad to assess discordance in results across SRs on the same question. Our study aims to (1) replicate assessments done in a sample of studies using the Jadad algorithm to determine if the same SR would have been chosen, (2) evaluate the Jadad algorithm in terms of utility, efficiency and comprehensiveness, and (3) describe how authors address discordance in results across multiple SRs. METHODS AND ANALYSIS We will use a database of 1218 overviews (2000-2020) created from a bibliometric study as the basis of our search for studies assessing discordance (called discordant reviews). This bibliometric study searched MEDLINE (Ovid), Epistemonikos and Cochrane Database of Systematic Reviews for overviews. We will include any study using Jadad (1997) or another method to assess discordance. The first 30 studies screened at the full-text stage by two independent reviewers will be included. We will replicate the authors' Jadad assessments. We will compare our outcomes qualitatively and evaluate the differences between our Jadad assessment of discordance and the authors' assessment. ETHICS AND DISSEMINATION No ethics approval was required as no human subjects were involved. In addition to publishing in an open-access journal, we will disseminate evidence summaries through formal and informal conferences, academic websites, and across social media platforms. This is the first study to comprehensively evaluate and replicate Jadad algorithm assessments of discordance across multiple SRs.
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Affiliation(s)
- Carole Lunny
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sai Surabi Thirugnanasampanthar
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Salmaan Kanji
- Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola Ferri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Dawid Pieper
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str. 200, Cologne, Germany
| | - Sara Tasnim
- Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harrison Nelson
- Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Emma Reid
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | | | - Banveer Kalkat
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Yuan Chi
- Yealth Network, Beijing Yealth Technology Co., Ltd, Beijing, China
| | - Jacqueline Thompson
- University of Birmingham Institute of Applied Health Research, Birmingham, UK
| | - Reema Abdoulrezzak
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Di Wen Wendy Zheng
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindy Pangka
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Dian Xin Ran Wang
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Parisa Safavi
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Anmol Sooch
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Kang
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sera Whitelaw
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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16
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Finkelstein ER, Ha M, Hanwright P, Ngaage LM, Yoon JS, Liang F, Nam AJ, Rasko YM. A Review of American Insurance Coverage and Criteria for the Conservative Management of Lymphedema. J Vasc Surg Venous Lymphat Disord 2022; 10:929-936. [DOI: 10.1016/j.jvsv.2022.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/01/2022] [Indexed: 11/15/2022]
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17
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Kitamura K, Iwase S, Komoike Y, Ogawa Y, Utsugi K, Yamamoto D, Odagiri H. Evidence-Based Practice Guideline for the Management of Lymphedema Proposed by the Japanese Lymphedema Society. Lymphat Res Biol 2022; 20:539-547. [PMID: 34981970 DOI: 10.1089/lrb.2021.0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Secondary lymphedema mostly occurs as an aftereffect of cancer treatment, and it is estimated that 100,000-150,000 patients are affected in Japan. An estimated 3500 patients, develop lymphedema of the lower and upper extremities each year secondary to uterine and breast cancer treatment. Medical reimbursement was first instituted in April 2008 by the Ministry of Health, Labour and Welfare in Japan. Since 2008, we have developed guidelines regarding treatment options for patients with lymphedema based on scientific evidence. This is the third edition of the guidelines established by the Japanese Lymphedema Society (JLES), published in 2018. The JLES Practice Guideline-Making Committee (PGMC) developed 21 clinical questions (CQs). Methods and Results: A review of these 15 CQs was performed in accordance with the methodology for establishing clinical guidelines. The 15 recommendations for each of these CQs were developed and discussed until consensus by the PGMC was reached. Moreover, outside members who had no involvement in these guidelines evaluated the contents using the Appraisal of Guidelines for Research and Evaluation (AGREE) II reporting checklist. Conclusion: These guidelines have been produced for the adequate management of lymphedema by doctors and other medical staff on the lymphedema management team of medical institutes, including nurses, physical technicians, and occupational therapists.
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Affiliation(s)
- Kaoru Kitamura
- Medical Corporation, Department of Breast Surgery, Fukuoka, Japan
| | - Satoru Iwase
- Department of Emergency and Palliative Medicine, Saitama Medical University, Moroyama, Japan
| | - Yoshifumi Komoike
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yoshinari Ogawa
- Department of Breast Surgical Oncology, Osaka City General Hospital, Osaka, Japan
| | - Kuniko Utsugi
- Cancer Screening Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto, Japan
| | | | - Hiroki Odagiri
- Division of Breast Surgery, National Hirosaki Hospital, Hirosaki, Japan
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18
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What do lymphedema patients expect from a treatment and what do they achieve? A descriptive study. JOURNAL OF VASCULAR NURSING 2022; 40:59-65. [DOI: 10.1016/j.jvn.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/02/2021] [Accepted: 01/01/2022] [Indexed: 11/18/2022]
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19
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Fearn NR, Dylke ES, Bailey D, Kilbreath SL. Lymphoscintigraphy as an Outcome Measurement for Conservative Upper Limb Lymphedema Treatments: A Systematic Review. Lymphat Res Biol 2021; 20:248-259. [PMID: 34748419 DOI: 10.1089/lrb.2021.0050] [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
Introduction: The impact of conservative interventions on lymphatic function and the relationship to clinical outcomes is currently unknown. A systematic review was undertaken to evaluate studies that used lymphoscintigraphy to measure outcomes from conservative intervention for secondary arm lymphedema and to explore the relationship between changes in the lymphoscintigraphy and clinical outcomes. Methods and Results: Five databases were systematically searched using the selection criteria: randomized controlled trials (RCTs); quasi-RCTs; pre/post and cohort studies; upper limb secondary lymphedema; use of lymphoscintigraphy as an outcome measure; and conservative intervention. Seven articles met the inclusion criteria. Compression, exercise, hyperbaric oxygen therapy, and pharmacological interventions were evaluated using lymphoscintigraphy. There was heterogeneity with all aspects of the lymphoscintigraphy techniques, including radioisotope used, injection location, use of exercise, and imaging sequence between the studies as well as the outcome analysis. Also most studies did not show a relationship between the clinical and lymphoscintigraphy outcomes measured. Conclusions: Lymphoscintigraphy has not been used regularly or recently to evaluate conservative upper limb lymphedema treatment outcomes. Lack of standardization of lymphoscintigraphy protocols and lack of consensus and understanding of the lymphoscintigraphy analyses used to measure the outcomes of diverse conservative lymphedema interventions currently limit the use of lymphoscintigraphy as an outcome measure. Further research adopting recent guidelines to standardize lymphoscintigraphy and use of reliable analysis techniques that measure the physiological impact of the chosen conservative lymphedema intervention is recommended to evaluate the impact of conservative interventions on lymphatic function.
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Affiliation(s)
- Nicola R Fearn
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Elizabeth S Dylke
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Dale Bailey
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal North Shore Hospital, Sydney, Australia
| | - Sharon L Kilbreath
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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20
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Rosalia L, Lamberti KK, Landry MK, Leclerc CM, Shuler FD, Hanumara NC, Roche ET. A Soft Robotic Sleeve for Compression Therapy of the Lower Limb. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1280-1283. [PMID: 34891519 DOI: 10.1109/embc46164.2021.9630924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
'We present the development of a soft robotic-inspired device for lower limb compression therapy with application in the treatment of lymphedema. This device integrates the control capabilities of pneumatic devices with the wearability and low cost of compression garments. The design consists of a three-layered soft robotic sleeve that ensures safe skin contact, controls compression, and secures the device to the patient limb. The expandable component is made of interconnected pockets of various heights, which passively create a graduated compression profile along the lower limb. The system is inflated by a pump and a microcontroller-actuated valve, with force sensors embedded in the sleeve that monitor the pressure applied to the limb. Testing on healthy individualsq demonstrated the ability to reach clinically relevant target pressures (30, 40, 50 mmHg) and establish a distal-to-proximal descending pressure gradient of approximately 40 mmHg. Device function was shown to be robust against variations in subject anatomy.Clinical Relevance- This system provides controllable, graduated, compression therapy to lymphedema patients in an economical, portable, and customizable package.
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21
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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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22
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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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23
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Forner-Cordero I, Muñoz-Langa J, DeMiguel-Jimeno JM, Rel-Monzó P. Physical therapies in the decongestive treatment of lymphedema: A randomized, non-inferiority controlled study. Clin Rehabil 2021; 35:1743-1756. [PMID: 34514891 DOI: 10.1177/02692155211032651] [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: 11/16/2022]
Abstract
OBJECTIVE To assess whether the treatment with intermittent pneumatic compression plus multilayer bandages is not inferior to classical trimodal therapy with manual lymphatic drainage in the decongestive lymphedema treatment. STUDY DESIGN Randomized, non-inferiority, controlled study to compare the efficacy of three physical therapies' regimens in the Decongestive Lymphatic Therapy. PARTICIPANTS 194 lymphedema patients, stage II-III with excess volume > 10% were stratified within upper and lower limb and then randomized to one of the three treatment groups. Baseline characteristics were comparable between the groups. INTERVENTION all patients were prescribed 20 sessions of the following regimens: Group A (control group): manual lymphatic drainage + Intermittent Pneumatic Compression + Bandages; Group B: pneumatic lymphatic drainage + Intermittent Pneumatic Compression + Bandages; and Group C: only Intermittent Pneumatic Compression + Bandages. END-POINT Percentage reduction in excess volume (PREV). RESULTS All patients improved after treatment. Global mean of PREV was 63.9%, without significant differences between the groups. The lower confidence interval of the mean difference in PREV between group B and group A, and between group C and group A were below 15%, thus meeting the non-inferiority criterion. Most frequent adverse events were discomfort and lymphangitis, without differences between groups. A greater baseline edema, an upper-limb lymphedema and a history of dermatolymphangitis were independent predictive factors of worse response in the multivariate analysis. CONCLUSIONS Decongestive lymphatic therapy performed only with intermittent pneumatic compression plus bandages is not inferior to the traditional trimodal therapy with manual lymphatic drainage. This approach did not increase adverse events.
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Affiliation(s)
- Isabel Forner-Cordero
- Lymphedema Unit, Rehabilitation Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - José Muñoz-Langa
- Medical Oncology Department, Hospital Arnau de Vilanova, Valencia, Spain
| | | | - Pilar Rel-Monzó
- Phyisiotherapy Service, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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24
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Rangon FB, da Silva J, Dibai-Filho AV, Guirro RRDJ, Guirro ECDO. Effects of Complex Physical Therapy and Multimodal Approaches on Lymphedema Secondary to Breast Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2021; 103:353-363. [PMID: 34407446 DOI: 10.1016/j.apmr.2021.06.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE What are the immediate, short-term, and long-term effects of complex physical therapy and multimodal approaches on lymphedema secondary to breast cancer? DATA SOURCES Four electronic databases (MEDLINE, Embase, Cochrane Library, Physiotherapy Evidence Database) were searched from inception up to August 2020. STUDY SELECTION Randomized controlled trials comparing complex physical therapy and multimodal approaches to the conservative treatment of lymphedema secondary to breast cancer. DATA EXTRACTION Two independent researchers performed data extraction and assessed the risk of bias, respectively, using the predefined form and Cochrane Collaboration of Risk of Bias. The determination of evidence quality was carried out using the Grading of Recommendations Assessment, Development, and Evaluation tools. DATA SYNTHESIS Fourteen studies were identified for the systematic review and 11 studies for the meta-analysis with standardized mean difference (SMD), 95% CI, and random-effect model. The common outcomes involved total volume, pain, and physical function of the upper limb. Complex physical therapy has shown a favorable tendency to control outcomes in the short- and long-term. The meta-analysis indicated a small effect for volume reduction (SMD, -0.18; 95% confidence interval [CI], -0.35 to 0.00) and a moderate effect for short-term pain reduction (SMD, -0.61; 95% CI, -1.19 to -0.02). CONCLUSIONS High-quality evidence suggests a more significant effect of complex physical therapy on multimodal approaches to the control of the upper limb total volume, substantiating the absence of changes in the current clinical practice in the management of lymphedema secondary to breast cancer. Future research should aim to identify concrete effect of therapeutic modalities in the immediate-, short-, and long-term.
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Affiliation(s)
- Flávia Belavenuto Rangon
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo.
| | - Jéssica da Silva
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo
| | - Almir Vieira Dibai-Filho
- Postgraduate Program in Physical Education, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Rinaldo Roberto de Jesus Guirro
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo
| | - Elaine Caldeira de Oliveira Guirro
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, São Paulo
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The use of manual lymphatic drainage on clinical presentation of musculoskeletal injuries: A systematic review. Complement Ther Clin Pract 2021; 45:101469. [PMID: 34343761 DOI: 10.1016/j.ctcp.2021.101469] [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: 03/30/2021] [Revised: 06/15/2021] [Accepted: 07/28/2021] [Indexed: 11/20/2022]
Abstract
The aim of this study was to provide a systematic review on the applicability of manual lymphatic drainage (MLD) in improving edema and clinical presentation postmusculoskeletal injuries. A review of the literature was performed in CINAHL, MANTIS, Medline, SPORTDiscus and Google Scholar, yielding a total of 8 articles. Half of the studies showed a strong quality assessment. Results from our work support the use of MLD for reducing edema reduction and pain as well as enhancing range of motion and patients' quality of life and satisfaction. Further research is needed to apply these findings to a broader range of musculoskeletal injuries and conditions.
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Omar MTA, Al-Dhwayan NM, Gwada RFM, Armer JM. Lymphedema rehabilitation: Provision and practice patterns among service providers: National survey. Int Wound J 2021; 19:339-350. [PMID: 34075723 PMCID: PMC8762547 DOI: 10.1111/iwj.13634] [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: 04/01/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 02/05/2023] Open
Abstract
Information on the current practices and quantification of lymphedema service may be beneficial to promote and improve the current health care system. Therefore, this study aimed to describe the characteristics of lymphedema practitioners, and lymphedema patients' profiles, and provide a comprehensive picture of lymphedema service provision in Saudi Arabia. A cross‐sectional study design used an online survey to gather data. The survey included information about demographic and professional characteristics of lymphedema practitioners, lymphedema profiles, questions on the services provided, and perceived barriers in providing services. Eighteen lymphedema practitioners (38%) responded to the survey. Most of the respondents were physical therapists (94%), who had completed 135 hours of basic training course, and were certified as lymphedema therapists (89%). Most of these practitioners were in Riyadh (58%), Jeddah (25%), and Dammam (17%). About 75% of patients seen by practitioners had secondary lymphedema, predominately breast cancer‐related lymphedema (47%). The average number of lymphedema practitioners per service is three. The perceived barriers reported included an inadequate number of certified therapists (100%), difficulties with transportation and lack of financial support (each; 72%), and limited space for lymphedema practice/management (89%). The results suggest lymphedema practitioners provide reasonable services for lymphedema patients; however, services are still limited and needs are unmet. Therefore, more staffing is required to promote awareness of the condition and related services, to develop and implement appropriate educational strategies, and improve geographical and multidisciplinary coordination of the services in Saudi Arabia.
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Affiliation(s)
- Mohammed T A Omar
- Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.,Physical Therapy Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Nouf M Al-Dhwayan
- Physical Therapy Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Rehab F M Gwada
- Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.,Physical Therapy Department, National Heart Institute, Giza, Egypt
| | - Jane M Armer
- University of Missouri, Sinclair School of Nursing, Columbia, Missouri, USA
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Sundrasekaran A, Abdalla E, Sobani S, Shafi M, Al-Mudahka NR. Physiotherapy Management Response for Patients With Lymphedema Amid the COVID-19 Pandemic in the State of Qatar: A Perspective Study. REHABILITATION ONCOLOGY 2021. [DOI: 10.1097/01.reo.0000000000000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Hoppenot C, Littell RD, DeEulis T, Hartenbach EM. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Patients with Cervical Cancer. J Palliat Med 2021; 24:438-442. [PMID: 33513069 DOI: 10.1089/jpm.2021.0006] [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: 11/12/2022] Open
Abstract
Cervical cancer is the most common gynecologic cancer worldwide. Almost all are related to human papillomavirus exposure. Cervical cancer treatment is associated with significant morbidity that is likely to require support from palliative care teams. In these pearls on cervical cancer, we hope to inform providers about the common treatments and issues for cervical cancer patients. Treatment modalities include surgery for early-stage disease, radiation therapy for locally advanced disease, and pelvic exenteration, chemotherapy, or immunotherapy for recurrent disease. Cervical cancer causes pain and bleeding. Radiation can affect ovarian, urinary, and bowel function. Chemotherapy and immunotherapy are associated with fatigue and nausea. Fistulas between the vagina and bowel or bladder can occur due to cancer or to cancer treatments. Physical and emotional supportive care is important for women with cervical cancer.
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Affiliation(s)
- Claire Hoppenot
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Ramey D Littell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, San Francisco, California, USA
| | - Timothy DeEulis
- Division of Gynecologic Oncology, Huntington, West Virginia, USA
| | - Ellen M Hartenbach
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin, USA
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Klein I, Tidhar D, Kalichman L. Lymphatic treatments after orthopedic surgery or injury: A systematic review. J Bodyw Mov Ther 2020; 24:109-117. [PMID: 33218497 DOI: 10.1016/j.jbmt.2020.06.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 04/05/2020] [Accepted: 06/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Orthopedic injuries in conjunction with extensive damage to tissues, bones and blood vessels, usually require a long recovery. Associated consequences are pain, movement limitations, decreased function and occasionally, prolonged edema, which can delay or interfere with the healing process. Lymphatic and compression therapy have become increasingly common, intending to reduce edema and pain, thus, promoting the recovery process. AIMS To examine the efficacy of methods commonly used to reduce edema after orthopedic injury or surgery, i.e. decongestive therapy, manual lymphatic drainage, and compression bandaging. METHODS English literature search was undertaken in January 2019, in the following databases: Cochrane Library, MEDLINE, PEDro. INCLUSION CRITERIA randomized controlled or quasi-controlled trials in adults who have edema or pain after recent limb trauma or surgery. Two independent assessors rated study quality and risk of bias using the PRISMA recommendations and PEDro score. RESULTS We evaluated 71 papers. After excluding duplicated and irrelevant papers, 15 met the eligibility criteria (6 on lymphatic treatment and 9 on compression). Quality of papers ranged from 3 to 7 on PEDro score; of them, 13 were 1b Level of Evidence and two were 1c. CONCLUSION After elective surgeries, when the significant edema appears or persists beyond recovery time, complex decongestive therapy and manual edema mobilization should be recommended in addition to conventional physical therapy. In acute injuries such as ankle or distal radius fractures, lymphatic treatments and compression bandaging should be considered as part of the therapeutic protocol. Nine studies evaluated different compression modalities found that only multilayer and long stretch compression significantly reduce edema.
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Affiliation(s)
- Ifat Klein
- Department of Physical Therapy, Assuta Hospital, Tel Aviv, Israel.
| | - Dorit Tidhar
- Department of Physical Therapy, Maccabi Healthcare Services, Netivot, Israel.
| | - Leonid Kalichman
- Department of, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Lee KW, Kim SB, Lee JH, Kim YS. Effects of Extracorporeal Shockwave Therapy on Improvements in Lymphedema, Quality of Life, and Fibrous Tissue in Breast Cancer-Related Lymphedema. Ann Rehabil Med 2020; 44:386-392. [PMID: 32986941 PMCID: PMC7655225 DOI: 10.5535/arm.19213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/04/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the effects of extracorporeal shockwave therapy (ESWT) on improving lymphedema, quality of life, and fibrous tissue in patients with stage 2 lymphedema. METHODS Breast cancer-related lymphedema patients referred to the rehabilitation center were recruited. We enrolled stage 2 lymphedema patients who had firmness of the skin at their forearm, a circumference difference of more than 2 cm between each arm, or a volume difference between upper extremities greater than 200 mL, confirmed by lymphoscintigraphy. The patients were randomly divided into the ESWT group and the control group. ESWT was performed for 3 weeks (two sessions per week); both groups received complex decongestive physical therapy. All patients were evaluated at baseline and at 3 weeks after treatment. The measurements performed included visual analog scale score, volume, circumference, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) score, bioelectrical impedance, and skin thickness. RESULTS The patients in both groups (n=15 in each group) completed the 3-week therapy experiment. No significant differences were observed in demographic characteristics between groups. After the 3-week treatment period, improvement was noted in the circumference difference below the elbow, volume, ratio of extracellular water to total body water, and skin thickness in the ESWT group. A significant difference was found in all the above-mentioned areas except in circumference below the elbow in the ESWT group. CONCLUSION ESWT reduced edema and skin fibrosis without significant complications. Therefore, ESWT can be used together with complex decongestive physical therapy for treating lymphedema.
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Affiliation(s)
- Kyeong Woo Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Sang Beom Kim
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Young Sam Kim
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
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Lytvyn L, Zeraatkar D, Anbari A, Ginex P, Zoratti M, Niburski K, Sadeghirad B, Siedler M, Thabane L, Morgan R. Conservative Intervention Strategies for Adult Cancer-Related Lymphedema: A Systematic Review and Network Meta-Analysis. Oncol Nurs Forum 2020; 47:E171-E189. [DOI: 10.1188/20.onf.e171-e189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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32
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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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Río-González Á, Molina-Rueda F, Palacios-Ceña D, Alguacil-Diego IM. Comparing the experience of individuals with primary and secondary lymphoedema: A qualitative study. Braz J Phys Ther 2020; 25:203-213. [PMID: 32518025 DOI: 10.1016/j.bjpt.2020.05.009] [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: 11/04/2019] [Revised: 04/09/2020] [Accepted: 05/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lymphoedema is a chronic condition that has significant detrimental impact on patients' quality of life. Secondary lymphoedema often results from anti-tumour treatment, in contrast to primary lymphoedema which is the result of genetic abnormalities that leads to an abnormal development of the lymphatic system. OBJECTIVE To describe and compare the experience of individuals with primary and secondary lymphoedema. METHODS A total of 19 patients (mean ± standard deviation age: 56.7 ± 16.2 years), 8 with primary and 11 with secondary lymphoedema, participated in this qualitative phenomenological study. Purposeful sampling method was applied. We recruited participants from specialised lymphoedema units of two physical therapy clinics and the Lymphoedema Patient Association in Spain. Data collection methods included unstructured and semi-structured interviews. An inductive thematic analysis was used. RESULTS The findings suggest differences between the experience of living with primary or secondary lymphoedema. Also, those with lower extremity lymphoedema have more pain, fatigue, and functional limitations. Three primary themes emerged: "Emotional challenge", "Adapting your life to a new situation," and "lymphoedema management". CONCLUSIONS The experience of living with lymphoedema involves aspects of fear, suffering, coping, and management of the disease and differs between secondary and primary causes. However, it seems to be more dependent on its location than its cause.
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Affiliation(s)
- Ángela Río-González
- School of Sport Science and Physical Therapy, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Francisco Molina-Rueda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - Isabel Mª Alguacil-Diego
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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O'Donnell TF, Izhakoff J, Gaebler JA, Niecko T, Iafrati MD. Correlation of disease comorbidity with prescribed treatment among insured U.S. lymphedema patients. J Vasc Surg Venous Lymphat Disord 2020; 9:461-470. [PMID: 32470618 DOI: 10.1016/j.jvsv.2020.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective of this study was to define the current forms of treatment in a contemporary population of lymphedema (LED) patients for LED related to breast cancer, the most prevalently diagnosed LED comorbidity in Western countries, and phlebolymphedema with venous leg ulcer (PLEDU), a sequela of chronic venous disease. The goals of LED therapy are to reduce edema, thereby improving function and related symptoms, and to improve skin integrity to prevent development of infection. Treatment is generally nonsurgical: conservative care, including complex physical therapy, manual lymphatic drainage, and compression bandaging; or pneumatic compression device (PCD) therapy by a simple nonprogrammable device or an advanced programmable device. METHODS To determine the frequency of individual types of treatment for LED and their relationship to breast cancer-related lymphedema (BCRL) and PLEDU, we queried claims from a deidentified Health Insurance Portability and Accountability Act-compliant commercial administrative insurance database with >165 million members. A total of 26,902 patients identified with LED who had been enrolled with continuous medical benefits for 12 months before and after the index date for the complete years 2012 through 2016 were separated into four treatment categories: no treatment, conservative care, simple PCD (SPCD), and advanced PCD. LED treatment was related to the BCRL and PLEDU comorbidities. RESULTS BCRL patients, who represented 32.1% of all study patients, made up 41% of all patients receiving conservative care and 24% of patients receiving PCD therapy. By contrast, PLEDU patients (9.6% of study patients) were proportionally under-represented in the conservative care group (7.8%) but composed a disproportionately high share of the PCD therapy group (17.7%). PLEDU patients represented 23.5% of all LED patients prescribed SPCD therapy, whereas BCRL patients composed 10.3% of total LED patient SPCD prescriptions (P < .001). CONCLUSIONS Our analysis of a large health care administrative database showed clear differences between the way BCRL and PLEDU patients are treated. Compared with BCRL patients, PLEDU patients were less likely to receive conservative care and more likely to be prescribed SPCDs for pneumatic compression therapy. These differences suggest that lymphatic therapy may be undervalued for treatment of chronic venous swelling and prevention and treatment of PLEDU.
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Affiliation(s)
- Thomas F O'Donnell
- The Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass.
| | | | | | | | - Mark D Iafrati
- The Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass
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Hörmann J, Vach W, Jakob M, Seghers S, Saxer F. Kinesiotaping for postoperative oedema - what is the evidence? A systematic review. BMC Sports Sci Med Rehabil 2020; 12:14. [PMID: 32158546 PMCID: PMC7052984 DOI: 10.1186/s13102-020-00162-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/20/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Postoperative oedema is a common condition affecting wound healing and function. Traditionally, manual lymphatic drainage is employed to reduce swelling. Kinesiotaping might be an alternative resource-sparing approach. This article explores current evidence for the effectiveness of kinesiotaping for the reduction of oedema in the postoperative setting. METHODS A systematic literature search was performed on the basis of five databases (Pubmed, CINAHL, Embase, Cochrane Library, and Clinicaltrials.gov) for studies published between January 2000 and October 2019.Only prospective controlled trials were included. Case studies, uncontrolled case series, studies on oedema caused by other etiologies than by surgery, as well as studies on malignant disease related oedema (especially breast cancer related oedema) were excluded.Articles were screened by title, abstract, and full text and the references were searched for further publications on the topic. A narrative and quantitative (using STATA) analysis was performed. RESULTS One thousand two hundred sixty-three articles were screened, twelve were included in the analysis. All studies evaluated either oedema after extremity surgery or maxillofacial interventions, and showed relevant methodological flaws. Only three studies employed an active comparator. Of the twelve included studies ten found positive evidence for kinesiotape application for the reduction of swelling and beneficial effects on secondary outcome parameters such as pain and patient satisfaction. The available trials were heterogenic in pathology and all were compromised by a high risk of bias. CONCLUSION There is some evidence for the efficacy of kinesiotaping for the treatment of postoperative oedema. This evidence is, however, not yet convincing given the limitations of the published trials. Methodologically sound comparison to standard of care or an active comparator is indispensable for an evaluation of effectiveness. In addition, assessments of patient comfort and cost-benefit analyses are necessary to evaluate the potential relevance of this novel technique in daily practice. SYSTEMATIC REVIEW REGISTRATION NUMBER International prospective register of systematic reviews (PROSPERO) ID 114129).
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Affiliation(s)
- Julie Hörmann
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Werner Vach
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Marcel Jakob
- Crossklinik AG Swiss Olympic Medical Centre, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Saskia Seghers
- Department of Physical Therapy, University Hospital Basel, Basel, Switzerland
| | - Franziska Saxer
- Crossklinik AG Swiss Olympic Medical Centre, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Kröger K, Schulz T, Santosa F, von Beckerath O, Gäbel G, Juntermanns B. Correlation between obesity and manual lymphatic drainage in Germany - a retrospective analysis from 2008 to 2016. VASA 2019; 49:115-120. [PMID: 31808380 DOI: 10.1024/0301-1526/a000822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Backgrounds: Costs for manual lymphatic drainage (MLD) paid by the Statutory Health Insurances (SHI) have increased disproportionately in Germany in the last decade. There is no obvious reason that this increase is due to an increasing number of patients with lymph edema. We therefore assume that there are large numbers of patients with obesity and obesity-associated dependency syndrome who drive the cost of MLD and did a retrospective analysis of the correlation between hospitalization rates for lymph edema and obesity and MLD prescription rates in outpatients. PATIENTS AND METHODS Roughly 90 % of the German population is insured by the Statutory Health Insurance. From its reports we extracted data regarding costs and numbers of MLD session prescribed annually. Hospitalization rates for lymph edema (codes I89.*, I97.2 and Q82.0) and for obesity (ICD E66.*) were provided by the Federal Statistical Office after a specific remote analyses. RESULTS In the years 2008 to 2016, the MLD prescriptions in the individual federal states increased by + 43.5 % in Berlin to + 109.3 % in Mecklenburg-Western Pomerania. Number of hospitalizations with the principal diagnosis (condition, which caused the admission) hereditary and postmastectomy lymph edema are low and decreased in most federal states. Number of hospitalizations with the additional diagnosis (conditions that coexist at the time of admission or develop subsequently) obesity increased with a range from + 4.8 % in Baden-Württemberg to + 86.4 % in Mecklenburg-Western Pomerania. The correlation between the increase in prescribed MLD in the individual federal state and the increase in hospitalization rates per 1000 inhabitants of cases with obesity is greater (R2 0.4696) than with lymph edema (R2 0.0987). CONCLUSIONS Our analysis is in line with the hypothesis that there is a correlation between the increasing prescription rate of MLD and the increasing burden of obesity in Germany.
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Affiliation(s)
- Knut Kröger
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Germany
| | - Tino Schulz
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Germany
| | - Frans Santosa
- Medical Faculty Universitas Pembangunan Nasional Veteran Jakarta, Indonesia
| | | | - Gabor Gäbel
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Germany
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Pajero Otero V, García Delgado E, Martín Cortijo C, Romay Barrero HM, de Carlos Iriarte E, Avendaño-Coy J. Kinesio taping versus compression garments for treating breast cancer-related lymphedema: a randomized, cross-over, controlled trial. Clin Rehabil 2019; 33:1887-1897. [PMID: 31495192 DOI: 10.1177/0269215519874107] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the effectiveness of Kinesio taping compared to compression garments during maintenance phase of complex decongestive therapy for breast cancer-related lymphedema. DESIGN Randomized, cross-over, controlled trial. SETTING Outpatient tertiary-level hospital rehabilitation setting. SUBJECTS Randomized sample of 30 women with breast cancer-related lymphedema. INTERVENTIONS Participants received two interventions, Kinesio taping and compression garment, both lasting four weeks, whose order was randomized by blocks. A four-week washout period was established prior to the interventions and between them. MEASUREMENTS The main outcome was the lymphedema Relative Volume Change. Secondary outcomes were range of motion of arm joints, self-perception of comfort, and lymphedema-related symptoms (pain, tightness, heaviness, and hardness). RESULTS The decrease in the Relative Volume Change was greater in the Kinesio taping intervention (-5.7%, SD = 2.0) compared to that observed using compression garments (-3.4%, SD = 2.9) (P < 0.001). The range of motion of five upper-limb movements increased after applying taping (between 5.8° and 16.7°) (P < 0.05), but not after compression (P > 0.05). In addition, taping was perceived as more comfortable by patients (between 2.4 and 3 points better than compression in four questions with a 5-point scale (P < 0.001)) and further reduced lymphedema-related symptoms compared to compression (between 0.96 and 1.40 points better in four questions with a 6-point scale (P < 0.05)). CONCLUSION Kinesio taping was more effective than compression garments for reducing the lymphedema volume, with less severe lymphedema-related symptoms, better improvement of upper-limb mobility, and more comfort.
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Affiliation(s)
- Violeta Pajero Otero
- Rehabilitation of Breast Pathology Unit, University Hospital 12 de Octubre, Madrid, Spain.,Faculty of Nursing, Physiotherapy and Chiropody, Complutense University of Madrid, Madrid, Spain
| | - Esther García Delgado
- Faculty of Nursing, Physiotherapy and Chiropody, Complutense University of Madrid, Madrid, Spain.,University Hospital 12 de Octubre, Madrid, Spain
| | - Concepción Martín Cortijo
- Faculty of Nursing, Physiotherapy and Chiropody, Complutense University of Madrid, Madrid, Spain.,University Hospital 12 de Octubre, Madrid, Spain
| | | | - Esperanza de Carlos Iriarte
- Rehabilitation of Breast Pathology Unit, University Hospital 12 de Octubre, Madrid, Spain.,Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Juan Avendaño-Coy
- Faculty of Physiotherapy and Nursing, Castilla-La Mancha University, Toledo, Spain
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Schwahn-Schreiber C, Breu FX, Rabe E, Buschmann I, Döller W, Lulay GR, Miller A, Valesky E, Reich-Schupke S. [S1 guideline on intermittent pneumatic compression (IPC)]. Hautarzt 2019; 69:662-673. [PMID: 29951853 DOI: 10.1007/s00105-018-4219-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Under the direction of the German Society of Phlebology (Deutsche Gesellschaft für Phlebologie) and in cooperation with other specialist associations, the S1 guideline on intermittent pneumatic compression (IPC) was adopted in January 2018. It replaces the previous guideline from March 2005. The aim of the guideline is to optimize the indication and therapeutic use of IPC in vascular diseases and edema. An extensive literature search of MEDLINE, existing guidelines, and work relevant to the topic was performed. In view of the often methodologically weak study quality with often small numbers of cases and heterogeneous treatment protocols, recommendations can often only be derived from the available data using good clinical practice/expert consensus. Intermittent pneumatic compression is used for thromboembolism prophylaxis, decongestive therapy for edema, and to positively influence arterial and venous circulation to improve clinical symptoms and accelerate ulcer healing in both the outpatient and inpatient care setting. The therapy regimens and devices used depend on the indication and target location. They can be used as outpatient and inpatient devices as well as at home for long-term indications. A target indication is thrombosis prophylaxis. IPC should be used in severe chronic venous insufficiency (stages C4b to C6), in extremity lymphedema as an add-on therapy and in peripheral arterial occlusive disease (PAOD) with stable intermittent claudication or critical ischemia. IPC can be used in post-traumatic edema, therapy-resistant venous edema, lipedema and hemiplegia with sensory deficits and edema. Absolute and relative contraindications to IPC must be taken into account and risks considered and avoided as far as possible. Adverse events are extremely rare if IPC is used correctly. If the indication and application are correct-also as an add-on therapy-it is a safe and effective treatment method, especially for the treatment of the described vascular diseases and edema as well as thrombosis prophylaxis.
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Affiliation(s)
| | - F X Breu
- Venenzentrum am Tegernsee, Tegernseerstr.3, 83703, Gmund am Tegernsee, Deutschland
| | - E Rabe
- Klinik und Poliklinik für Dermatologie, Sigmund Freud Str. 25, 53105, Bonn, Deutschland
| | - I Buschmann
- Klinik für Innere Medizin I - Kardiologie, Pulmologie, Angiologie, Städtisches Klinikum Brandenburg GmbH, Hochstr. 29, 14770, Brandenburg an der Havel, Deutschland
| | - W Döller
- , Ingeborg Bachmann-Weg 11, 9400, Wolfsberg, Österreich
| | - G R Lulay
- Klinik für Gefäß- und Endovaskularchirurgie - Phlebologie - Lymphologie - Gefäß- und Lymphzentrum Nord-West, Klinikum Rheine/Mathias-Spital, Frankenburgstr. 31, 48341, Rheine, Deutschland
| | - A Miller
- die hautexperten, Praxis, Wilmersdorfer Str. 62, 10627, Berlin, Deutschland
| | - E Valesky
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - S Reich-Schupke
- Klinik für Dermatologie, Venerologie und Allergologie, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Ruhr-Universität Bochum, Hiltroper Landwehr 11-13, 44805, Bochum, Deutschland
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Inchauste S, Zelones J, Rochlin D, Nguyen DH. Successful treatment of lymphedema in a vasculopath and neuropathic patient. J Surg Oncol 2019; 121:182-186. [PMID: 31228351 DOI: 10.1002/jso.25590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/01/2019] [Indexed: 11/06/2022]
Abstract
This is a case report of a 68-year-old male with stage III right lower extremity lymphedema following right inguinal lymph node dissection and adjuvant chemoradiotherapy for Hodgkin's lymphoma. He developed peripheral neuropathy and radiation-induced right femoral artery thrombosis, treated with saphenous vein graft. He underwent three vascularized lymph node transfers (VLNTs) to the upper medial thigh, posterior calf, and ankle with placement of nanofibrillar collagen scaffolds. Three months after surgery, he had volume reduction, less neuropathic pain, and improved ambulation.
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Affiliation(s)
- Suzanne Inchauste
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California
| | - Justin Zelones
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California
| | - Danielle Rochlin
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California
| | - Dung H Nguyen
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California
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Kilmartin L, Denham T, Fu MR, Yu G, Kuo TT, Axelrod D, Guth AA. Complementary low-level laser therapy for breast cancer-related lymphedema: a pilot, double-blind, randomized, placebo-controlled study. Lasers Med Sci 2019; 35:95-105. [DOI: 10.1007/s10103-019-02798-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022]
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Zhang X, Wang X, Zhang B, Yang S, Liu D. Effects of acupuncture on breast cancer-related lymphoedema: a systematic review and meta-analysis of randomised controlled trials. Acupunct Med 2019; 37:16-24. [PMID: 30845813 DOI: 10.1136/acupmed-2018-011668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Breast cancer-related lymphoedema (BCRL) is a common complication after breast cancer treatment. We investigated whether acupuncture could be used to manage limb oedema in women after breast cancer surgery. METHODS The Cochrane Library, PubMed, Embase, Web of Science, CINAHL, and four Chinese databases were electronically searched for papers published through November 2017. Randomised controlled trials (RCTs) of acupuncture for BCRL were included. RESULTS In total, six RCTs with 318 patients were identified. The main analysis revealed a positive overall effect of acupuncture intervention on pre/post-treatment differences in the diameter of the elbow joint, reductions in upper limb lymphoedema and effectiveness index based on arm measurement data in patients with breast cancer. Two studies evaluating the outcome of acupuncture on the diameter of the elbow joint found a significant reduction in diameter between the acupuncture and control groups (weighted mean difference (WMD) 6 cm, 95% CI 5.11 to 6.89 cm; P<0.001). The same two studies investigated the effect of acupuncture on upper limb lymphoedema reduction and found a significant difference between the acupuncture and control groups (risk ratio 1.4, 95% CI 1.17 to 1.67; P<0.001). Two other studies used the effectiveness index to assess the arm and found a significant difference between the acupuncture and control groups (WMD 23.34, 95% CI 10.74 to 35.94; P<0.001). The fifth study used bioelectrical impedance spectroscopy to assess lymphoedema at several points on the arm before and after acupuncture; this study also reported a significant reduction in lymphoedema. The sixth study reported no significant difference in bioimpedance between the groups. CONCLUSIONS The present meta-analysis and systematic review suggests that acupuncture is effective at reducing BCRL in patients after breast cancer treatment.
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Affiliation(s)
- Xinyan Zhang
- 1 School of Nursing, Jilin University,Changchun, Jilin, China
| | - Xiuli Wang
- 2 Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Bingyan Zhang
- 1 School of Nursing, Jilin University,Changchun, Jilin, China
| | - Sa Yang
- 1 School of Nursing, Jilin University,Changchun, Jilin, China
| | - Dongling Liu
- 1 School of Nursing, Jilin University,Changchun, Jilin, China
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Ligabue MB, Campanini I, Veroni P, Cepelli A, Lusuardi M, Merlo A. Efficacy of self-administered complex decongestive therapy on breast cancer-related lymphedema: a single-blind randomized controlled trial. Breast Cancer Res Treat 2019; 175:191-201. [PMID: 30712198 DOI: 10.1007/s10549-019-05136-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/11/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE After surgery, breast cancer-related lymphedema (BCRL) is a frequent chronic condition. The complex decongestive therapy (CDT) delivered by physiotherapists at hospitals is the state-of-the-art treatment choice. As lymphedema requires continuous management, we designed a 1-month-long course to train women to professionally carry out a self-administered CDT (saCDT) and tested its efficacy while keeping the benefits of CDT. METHODS Consecutive patients treated with CDT over a 1-year period at an Italian facility were randomly assigned to either experimental (EXP, saCDT course) or control (CTRL, usual care) group. Women were assessed before, at 1, and 6 months from enrolment. Pain assessed by the numerical pain rating scale (NPRS) was the primary outcome. Arm asymmetry assessed by the excess limb volume (ELV) was the secondary outcome. Outcome variations were compared to their MCID to classify women as improved, stable, or worsened. RESULTS Forty-one women were included. The proportion of stable or improved women was significantly different between EXP and CTRL groups at 6 months after enrolment for both arm pain (p = 0.01) and asymmetry (p < 0.01). Noteworthy, only one EXP woman had worsened after 6 months. NPRS significantly decreased in the EXP group only, with a median variation of 2 points. Arm ELV significantly decreased with respect to the baseline value in the EXP group only, with a median reduction of 8%. CONCLUSIONS Teaching saCDT to women with BCRL is effective in maintaining or improving the benefits of CDT and can be used as a self-care tool in the management of BCRL.
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Affiliation(s)
- M B Ligabue
- Functional Rehabilitation and Recovery Service, San Sebastiano Hospital, Correggio, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - I Campanini
- LAM-Motion Analysis Laboratory, San Sebastiano Hospital, Correggio, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy. .,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | - P Veroni
- Functional Rehabilitation and Recovery Service, San Sebastiano Hospital, Correggio, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A Cepelli
- Functional Rehabilitation and Recovery Service, San Sebastiano Hospital, Correggio, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Lusuardi
- Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A Merlo
- LAM-Motion Analysis Laboratory, San Sebastiano Hospital, Correggio, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Sierla R, Dylke ES, Kilbreath S. A Systematic Review of the Outcomes Used to Assess Upper Body Lymphedema. Cancer Invest 2018; 36:458-473. [PMID: 30289283 DOI: 10.1080/07357907.2018.1517362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To ascertain how change in upper body lymphedema is assessed and understand how clinically significant change is determined. METHOD A systematic search of the literature resulted in 55 eligible studies for analysis. RESULTS A range of assessment methods, measurement protocols, and outcomes were used in the literature. Of the 21 studies in which thresholds for change were set a priori, 20 different thresholds were reported. CONCLUSION How data was measured, analysed and reported was inconsistent across studies. Consensus on a core outcome set with standardised assessment protocols and reporting; and investigation into empirically based minimum important differences (MID) is needed.
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Affiliation(s)
- Robyn Sierla
- a Faculty of Health Sciences , University of Sydney , Sydeny , Australia.,b Occupational Therapy Department , Royal Prince Alfred Hospital , Sydney , Australia
| | - Elizabeth Sian Dylke
- c Discipline of Physiotherapy, Faculty of Health Sciences , University of Sydney , Sydney , Australia
| | - Sharon Kilbreath
- d Faculty of Health Sciences , University of Sydney , Sydney , Australia
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Deng J, Sinard RJ, Murphy B. Patient experience of head and neck lymphedema therapy: a qualitative study. Support Care Cancer 2018; 27:1811-1823. [PMID: 30167789 DOI: 10.1007/s00520-018-4428-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 08/15/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE Lymphedema is a common late effect from head and neck cancer and/or its treatment. Guidelines recommend that patients with lymphedema should be referred for therapy in a timely manner to maximize control of lymphedema-related symptoms. However, there is paucity of information regarding treatment outcomes in the head and neck cancer population. To address this gap, we conducted a qualitative study to gain understanding of head and neck cancer patients' experience pertaining to lymphedema therapy, barriers to treatment, perceptions concerning physical and psychological benefits, opinions about therapists, and suggestions to enhance outcomes. METHODS Twenty head and neck cancer patients who underwent lymphedema therapy completed semi-structured face-to-face interviews. Interviews were audio-recorded, and verbatim transcriptions were completed. Thematic analysis was employed to analyze the interview data. RESULTS A majority of the participants (n = 15, 75%) completed a full course of lymphedema treatment. Most participants expressed physical (n = 18, 90%) and psychological (n = 14, 70%) benefits about the lymphedema therapy, e.g., decreased swelling, increased swallowing function, and multi-faceted healing. More than one third of the participants described barriers hampering their lymphedema therapy, e.g., insurance coverage, return to work, and availability of lymphedema therapy. Many participants proposed suggestions for improvement of lymphedema therapy, e.g., personalized education, longer treatment time, and caregiver education. CONCLUSIONS The study has underscored the potential benefit of lymphedema therapy in the head and neck cancer population. Substantial barriers to therapy were reported and need to be addressed. Opportunities to improve lymphedema therapy outcomes were suggested. Personalized strategies should be considered for ensuring optimal patient outcomes.
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Affiliation(s)
- Jie Deng
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104-4217, USA.
| | - Robert J Sinard
- Vanderbilt-Ingram Cancer Center, Vanderbilt Medical Center, Nashville, TN, USA
| | - Barbara Murphy
- Vanderbilt-Ingram Cancer Center, Vanderbilt Medical Center, Nashville, TN, USA
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Abstract
BACKGROUND Lymphedema occurs commonly in cancer survivors. It is crucial to properly assess cancer patients in order to distinguish lymphedema from general edema and to initiate evidence based treatment. PURPOSE To provide evidence based recommendations for screening, evaluating, and treating lymphedema and to establish the role of the nurse in the care of patients with lymphedema. METHODOLOGY Comprehensive overview with narrative literature review of evidence based lymphedema diagnosis and treatment. FINDINGS Cancer-related edema represents numerous complex conditions. A variety of interventions are needed to address prevention, early detection, patient education, and effective treatment. CONCLUSION Lymphedema treatment is complex and multimodal, and is provided by an interdisciplinary team of properly trained professionals. Nurses play a major role in evaluating, treating and educating patients on the signs and symptoms of cancer-related edema and patient self-management. CLINICAL IMPLICATIONS Evidence-based assessment and treatment should be initiated early to improve outcomes and quality of life in patients with cancer-related lymphedema.
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Woldman A, Kaneti N, Carmeli E. Evaluation of Pressure-Applying Accuracy in Multilayer Bandaging Among Physiotherapists Who Treat Lymphedema. Lymphat Res Biol 2018; 16:453-457. [PMID: 29862912 DOI: 10.1089/lrb.2017.0066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Compression therapy is the only conservative treatment that has been shown to be effective for patients with lymphedema in randomized controlled trials. A commonly used classification system divides pressure into four categories ranging from mild to very strong. For lower limb edema, bandages with strong pressure were shown to be most effective. Recent studies indicate that many health care professionals use inadequate pressure. No study thus far has focused on therapists who are trained in lymphatic treatment. METHODS AND RESULTS Thirty-seven physiotherapists trained in lymphatic treatment were recruited. Each participant received a questionnaire concerning their competence in compression bandaging. The subjects were asked to apply bandages using strong and medium pressure in two practical trials. Using a PicoPress® device, pressure was measured both directly after bandaging and 2 hours later; 75.68% of participants successfully applied the bandaging with moderate pressure, correctly at least once, and 62.16% managed to do so with high pressure. A trend in the results shows that the higher the sub-bandage pressure at the beginning, the more it dropped after 2 hours. There was high consistency in pressure application for strong and moderate pressure. No correlation was found between the parameters of the questionnaire and correct bandaging pressure. CONCLUSIONS Most of the physiotherapists were successful, at least once, in applying bandages with the proper amount of pressure. It is possible that the nature of the lymphatic treatment contributes to their success. Participants were most accurate in applying moderate pressure; however, it is unclear what impact this pressure has on a leg with lymphedema.
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Affiliation(s)
| | | | - Eli Carmeli
- 2 Physical Therapy Department, University of Haifa , Haifa, Israel
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Cobbe S, Nugent K, Real S. Pilot Study: The Effectiveness of Complex Decongestive Therapy for Lymphedema in Palliative Care Patients with Advanced Cancer. J Palliat Med 2018; 21:473-478. [DOI: 10.1089/jpm.2017.0235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Longhurst E, Dylke ES, Kilbreath SL. Use of compression garments by women with lymphoedema secondary to breast cancer treatment. Support Care Cancer 2018; 26:2625-2632. [PMID: 29460193 DOI: 10.1007/s00520-018-4093-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/04/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE This aim of this study was to determine the use of compression garments by women with lymphoedema secondary to breast cancer treatment and factors which underpin use. METHODS An online survey was distributed to the Survey and Review group of the Breast Cancer Network Australia. The survey included questions related to the participants' demographics, breast cancer and lymphoedema medical history, prescription and use of compression garments and their beliefs about compression and lymphoedema. Data were analysed using principal component analysis and multivariable logistic regression. RESULTS Compression garments had been prescribed to 83% of 201 women with lymphoedema within the last 5 years, although 37 women had discontinued their use. Even when accounting for severity of swelling, type of garment(s) and advice given for use varied across participants. Use of compression garments was driven by women's beliefs that they were vulnerable to progression of their disease and that compression would prevent its worsening. Common reasons given as to why women had discontinued their use included discomfort, and their lymphoedema was stable. Participant characteristics associated with discontinuance of compression garments included their belief that (i) the garments were not effective in managing their condition, (ii) experienced mild-moderate swelling and/or (iii) had experienced swelling for greater than 5 years. CONCLUSION The prescription of compression garments for lymphoedema is highly varied and may be due to lack of underpinning evidence to inform treatment.
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Affiliation(s)
- E Longhurst
- Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW, Australia
| | - E S Dylke
- Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW, Australia
| | - S L Kilbreath
- Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW, Australia.
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Jeffs E, Ream E, Taylor C, Bick D. Clinical effectiveness of decongestive treatments on excess arm volume and patient-centered outcomes in women with early breast cancer-related arm lymphedema: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:453-506. [PMID: 29419623 PMCID: PMC5828398 DOI: 10.11124/jbisrir-2016-003185] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To identify the effect of decongestive lymphedema treatment on excess arm volume or patient-centered outcomes in women presenting within either 12 months or a mean nine months of developing arm lymphedema following breast cancer treatment. INTRODUCTION Lymphedema is a common consequence of breast cancer treatment requiring life-long treatment to reduce symptoms and prevent complications. Currently, evidence to inform the optimal decongestive lymphedema treatment package is lacking. INCLUSION CRITERIA The review included studies on women who received lymphedema treatment within either 12 months or a mean of nine months of developing unilateral breast cancer-related arm lymphedema. The intervention was any decongestive lymphedema treatment delivered with the purpose of reducing arm lymphedema, compared to another form of lymphedema treatment (whether self or practitioner-administered), placebo or no treatment. The clinical outcome was excess arm volume; patient-centered outcomes were health-related quality of life, arm heaviness, arm function, patient-perceived benefit and satisfaction with treatment. Experimental study designs were eligible, including randomized and non-randomized controlled trials, quasi-experimental, prospective and retrospective before and after studies were considered. METHODS A three-step search strategy was utilized to find published and unpublished studies. The search identified studies published from the inception of each database to July 6, 2016. Reference lists were scanned to identify further eligible studies. Studies were critically appraised using appropriate standardized critical appraisal instruments from the Joanna Briggs Institute. Details describing each study and treatment results regarding outcomes of interest were extracted from papers included in the review using appropriate standardized data extraction tools from the Joanna Briggs Institute. Due to heterogeneity in included studies, results for similar outcome measures were not pooled in statistical meta-analysis. A narrative and tabular format was used to synthesize results from identified and included studies. RESULTS Seven studies reporting results for outcomes of interest were critically appraised and included in the review: five randomized controlled trials and two descriptive (uncontrolled) studies. Reported outcomes included excess arm volume (five studies), health-related quality of life (three studies), arm heaviness (one study), arm function (two studies) and patient-perceived benefit (two studies). There was some evidence that decongestive treatments were effective for women presenting within either 12 months or a mean of nine months of developing breast cancer-related arm lymphedema, but the wide range of data prevented comparison of treatment findings which limited our ability to answer the review questions. CONCLUSIONS Weak evidence (grade B) for the impact of decongestive lymphedema treatment on women with early lymphedema (i.e. less than 12 months duration of BCRL symptoms) did not allow any conclusions to be drawn about the most effective treatment to be offered when these women first present for treatment. Findings provided no justification to support change to current practice.Future primary research needs to focus on the most effective treatment for women when they first present with lymphedema symptoms, e.g. treatment provided within 12 months of developing symptoms. Studies should be adequately powered and recruit women exclusively with less than 12 months duration of breast cancer-related lymphedema symptoms, provide longer follow-up to monitor treatment effect over time, with comparable treatment protocols, outcome measures and reporting methods.
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Affiliation(s)
- Eunice Jeffs
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom
- The Nottingham Centre for Evidence Based Healthcare: a Joanna Briggs Institute Centre of Excellence
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Cath Taylor
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Debra Bick
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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Integrating Edema Management Into Entry-Level Doctor of Physical Therapy Curriculum: A Case Report. REHABILITATION ONCOLOGY 2018. [DOI: 10.1097/01.reo.0000000000000092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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