Manual lymphatic drainage improves the quality of life in patients with chronic venous disease: a randomized controlled trial

Combined effect of yoga and naturopathy in uncomplicated varicose vein disease - a prospective randomized controlled trial

BACKGROUND

Though the treatment of uncomplicated varicose vein (UVV) might prevent late complications such as skin change or ulceration, but, there are limited studies available to justify this concept. Yoga and Naturopathy being a proficient tool in managing non communicable diseases including many cardiovascular diseases; no attempt was made to study its potential effect in Varicose Vein diseases.

OBJECTIVE

The present study aims to study the combination of Yoga and Naturopathy in uncomplicated varicose vein patients.

MATERIALS AND METHODS

50 UVV participants were prospectively recruited and randomly divided into two groups, Experimental and Active control groups. Both the groups practiced their respective interventions, and follow up was done after 1 and 3 months of active intervention. Finally study was completed with 46 participants (2 dropouts in each groups). The sample size was calculated based on the previous study, considering power as 0.8 and 'α' as 0.05, using 'G' power software. The variables such as Body weight, BMI, Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Heart rate (HR), high-sensitivity C-reactive protein (hs-CRP), homocysteine (HCy) were recorded before and after the intervention, but Aberdeen Varicose Vein Questionnaire (AVVQ) and Visual analogue heaviness scale (VAHS) were recorded on 60 and 120 days of the follow up in addition to active intervention period.

RESULTS

There was a significant decrease in hs-CRP (p < 0.05) in the experimental group as compared to the control group. Body weight, BMI, SBP, HR, hs-CRP, HCy (p < 0.001) and DBP (p < 0.05) significantly decreases following the Combined Yoga and Naturopathy (CYN) intervention for a month in the experimental group. Also, the AVVQ (p < 0.01) and VAHS (p < 0.05) decreases following active intervention and two consecutive follow up. No adverse event was noted during or after the trial.

CONCLUSION

The combined effect of Yoga and Naturopathy reduced blood pressure and inflammatory markers suggestive of potential of recovery in inflammation in the endothelial tissue of the microvascular system in UVV patients.

TRIAL REGISTRY NUMBER

CTRI/2018/10/015895; Clinical Trials Registry- India; www.ctri.nic.in.

Effects of lymphatic drainage therapy on autonomic nervous system responses in healthy subjects: A single blind randomized controlled trial

OBJECTIVES

This study aimed to determine effects of lymphatic drainage therapy (LDT) on autonomic nervous system (ANS) responses by comparing including Hoffmann reflex (H reflex), heart rate variability (HRV), salivary alpha-amylase (sAA) and muscle tone (via straight leg raise (SLR)) in healthy participants.

METHODS

A single blind randomized controlled trial evaluating sixty-six healthy participants including 58 females and 8 males aged between 40 and 65 years. All participants were blinded and randomized to either experimental group (EXP: LDT) or control group (CT: rest). LDT was applied to participants 45 min in experimental group. The LDT is light movement applied by an experienced physical therapist, starting from neck, deep abdomen, and along to the leg. While for the control group, participants received 45 min supine on the treatment table. Tests for evaluating ANS such as Hoffmann reflex (H reflex), heart rate variability (HRV), salivary alpha-amylase (sAA) and straight leg raise (SLR) were assessed at pre and post intervention.

RESULTS

The findings demonstrated that H reflex decreased significantly after applying LDT; within and between groups (p < 0.05). Whereas, it increased significantly in control group. First tension (R1) indicated by participants during SLR significantly improved within both groups. However, there were no significant differences of HRV and sAA in either LDT or control groups.

CONCLUSION

This study demonstrated that LDT decreased autonomic activity via decreased spinal reflex excitability and tension in healthy participants.

Capacidade funcional e qualidade de vida de pacientes com feridas crônicas

Objective: To evaluate functional capacity and quality of life (QoL) of patients with chronic wounds. Methods: A cross-sectional analytical study composed of 74 patients with chronic wounds accompanied at a reference center for the treatment of complex wounds in Teresina, state of Piaui. Data were collected using the Katz index and the Cardiff Wound Impact Schedule. Results: Among the domains, the “well-being” had a lower mean score and the degree of dependence obtained a significant association with the well-being and “social life” domains. The bathing, dressing, personal hygiene and locomotion activities showed an association between the domains of QoL. Conclusion: The degree of independence in performing the basic activities of daily living, especially bathing, dressing and personal hygiene, presented higher scores between domains, indicating a better QoL. It is expected that the implantation of measures that help to preserve the functional capacity will improve the patients’ QoL.

Functional capacity and quality of life of patients with chronic wounds

Objective: To evaluate functional capacity and quality of life (QoL) of patients with chronic wounds. Methods: A cross-sectional analytical study composed of 74 patients with chronic wounds accompanied at a reference center for the treatment of complex wounds in Teresina, state of Piaui. Data were collected using the Katz index and the Cardiff Wound Impact Schedule. Results: Among the domains, the “well-being” had a lower mean score and the degree of dependence obtained a significant association with the well-being and “social life” domains. The bathing, dressing, personal hygiene and locomotion activities showed an association between the domains of QoL. Conclusion: The degree of independence in performing the basic activities of daily living, especially bathing, dressing and personal hygiene, presented higher scores between domains, indicating a better QoL. It is expected that the implantation of measures that help to preserve the functional capacity will improve the patients’ QoL.

Manual lymphatic drainage and quality of life in patients with lymphoedema and mixed oedema: a systematic review of randomised controlled trials

Purpose

To assess the impact of manual lymphatic drainage (MLD) on the health-related quality of life (HRQoL) of adults with lymphoedema or mixed oedema, through a systematic review of randomised controlled trials (RCTs).

Methods

MEDLINE, EMBASE, PsycINFO, CENTRAL, the Cochrane Database of Systematic Reviews and ClinicalTrials.gov were searched to identify RCTs evaluating HRQoL after a MLD intervention compared to non-MLD interventions (PROSPERO 2016:CRD42016042255). We extracted the effect of the interventions on the HRQoL (primary outcome) as well as data on volume and functional changes, and adverse events when available (secondary outcomes).

Results

Eight studies were eligible. The studies were heterogeneous in the aetiology of oedema, schemes of MLD applied, additional treatments offered with MLD, length of follow-up, instruments used to assess HRQoL and interventions offered to the control group. Five studies included patients with breast cancer-related arm lymphoedema; one study reported increased HRQoL among patients randomised to the MLD group. The two RCTs that involved patients with leg mixed oedema due to chronic venous insufficiency did not find between-group differences in the overall HRQoL. One trial included patients with hand oedema from systemic sclerosis and showed higher HRQoL in the group that received MLD. No studies reported reductions in HRQoL, or severe adverse events after MLD. The small numbers of patients analysed in all studies may have resulted in lack of power to detect between-group differences in HRQoL.

Conclusions

The effect of MLD on the HRQoL of patients with chronic oedema is unclear.

Electronic supplementary material

The online version of this article (10.1007/s11136-018-1796-5) contains supplementary material, which is available to authorized users.

Evaluation of the quality of life of postmenopausal osteoporotic and osteopenic women with or without fractures

INTRODUCTION

Most studies concerned with the quality of life (QoL) of women with reduced bone mineral density (BMD) focus on patients with vertebral and non-vertebral fractures. Our objective was to evaluate QoL among patients with reduced BMD regardless of their fracture history compared to women with normal BMD.

MATERIAL AND METHODS

Eighty-five patients in the study group were classified as osteoporotic, with BMD results measured by densitometry and expressed by T-score ≤ -2.5 SD, 122 women were osteopenic, with -2.5 < T-score ≤ -1.0 SD, and 97 subjects were assessed as normal, with T-score > -1.0 SD. Mean ages of women according to groups were 59.90, 57.67 and 55.68, respectively. Assessment of life quality was conducted using the Polish version of the QUALEFFO-41 scale.

RESULTS

The ratings in the assessment (QUALEFFO-41) of QoL were lower for osteoporotic and osteopenic women than for the normal BMD group with regard to pain (p = 0.006), social function (p = 0.001), health perception (p = 0.001), and mental function (p = 0.001). For total QUALEFFO-41 the associated factors were: secondary and higher education (OR = 0.49; 95% CI: 0.29-0.82), self-perceived deformity of the back (OR = 4.09; 95% CI: 1.88-8.93), previous fractures (OR = 2.52; 95% CI: 1.09-5.82), reduced height (OR = 2.48; 95% CI: 1.13-5.39) and anxiety (OR = 1.42; 95% CI: 1.21-1.66).

CONCLUSIONS

It seems necessary to evaluate QoL of women with reduced BMD before fractures occur, to aid development of health education aiming to reduce the incidence of osteoporosis and prevent fractures.

Manual lymphatic drainage and multilayer compression therapy for vulvar edema: a case series

BACKGROUND AND OBJECTIVE

Vulvar edema is a condition rarely reported and without defined treatment that may result in functional limitation. The aim of the report is to describe a case series of patients with disabling vulvar edema of different etiologies that were treated with manual lymphatic drainage (MLD) and multilayer compression therapy (MCT).

CASE SERIES

Four cases of vulvar edema are described: one in a woman with cervical cancer; one in a woman in the postoperative period of bilateral adrenalectomy for pheocromocytoma; and two in pregnant women with preeclampsia. All cases were treated with MLD and MCT during hospitalization.

OUTCOMES

Total resolution of the edema occurred in 2 to 5 d of treatment.

CONCLUSION

The present case series is the first to report the use of the MLD and MCT in the successful management of female genital edema. This report suggests that the vulvar edemas for these four patients treated with MLD and MCT seem to resolve faster than expected based on previously reported untreated edemas or edemas treated with different therapeutic approaches.

Quality of life in patients with leg ulcers or skin lesions - a pilot study

Introduction

Attempts to determine the quality of life are advisable in patients with ulcers as the group affected with this problem is relatively large. According to one Polish randomized trial, approximately 0.3–2% of the adult population suffers from active or healed venous ulcers.

Aim

To compare the quality of life of patients with leg ulcers of venous and arterial etiology and those with lower limb skin lesions due to chronic venous insufficiency.

Material and methods

This study included 90 consecutive patients with ulcers of venous (n = 30) or arterial etiology (n = 30), or patients with trophic disorders of the skin associated with chronic venous insufficiency (n = 30) treated at the Venous Ulceration Outpatient Clinic and at the Department and Clinic of General Surgery, Dr. J. Biziel Memorial University Hospital No. 2, in Bydgoszcz. This study was designed as a questionnaire survey and included the Skindex-29 instrument for the assessment of quality of life in patients with dermatological conditions.

Results

Overall, the global Skinndex-29 scores of all studied participants ranged between 37 and 136 points, 23.93 points on average. The analyzed groups of patients differed significantly with respect to the average level of the global quality of life determined using the Skindex-29 questionnaire.

Conclusions

Significant differences were observed in the global quality of life of patients who suffered from venous or arterial leg ulcers or skin lesions resulting from chronic venous insufficiency.

Health-related quality-of-life scales specific for chronic venous disorders of the lower limbs

OBJECTIVE

We conducted a systematic review of the literature about quality-of-life (QOL) scales in chronic venous disorders (CVDs) comprising leg ulcers to identify the respective advantages and deficits of existing tools.

METHODS

A research protocol was built following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the PICO (population, intervention, comparator, and outcome) criteria. The following databases were screened: MEDLINE, SCOPUS, EMBASE, CINHAL, and Cochrane. Psychometric and linguistic validation studies in English were included, as were clinical trials that have used QOL scales in CVDs. The data search was up to date as of October 31, 2013.

RESULTS

Inclusion criteria were met in 103 of the 511 recorded references, in which 10 scales were identified: two for the full spectrum of CVDs, three for patients with CVDs without leg ulceration, four for leg ulcers, and one exclusively for patients with varicose veins. Among them, the ChronIc Venous Insufficiency Questionnaire (CIVIQ), Aberdeen Varicose Vein Questionnaire (AVVQ), and VEnous INsufficiency Epidemiological and Economic Study on Quality of Life (VEINES-QOL) scales were the most highly used according to the literature, and CIVIQ and VEINES-QOL were the most extensively validated scales and had the longest iterative validation process. A total of 31 psychometric and linguistic validations of the 10 QOL scales and 66 clinical trials that have used these scales were identified. The validation studies were based on acceptability, content validity, construct validity, reliability, and responsiveness. The clinical trials were composed of 25 randomized controlled trials and 41 observational studies. Only the randomized controlled trials are considered in the present article.

CONCLUSIONS

This systematic review confirmed that CVDs have an important effect on QOL. The majority of the studies addressed the application rather than the validation of the 10 identified scales. Two scales, CIVIQ and VEINES-QOL, emerged as being thoroughly validated instruments, although factorial stability was not demonstrated for the VEINES-QOL. Our findings confirm a paucity of validation studies.

Overview of guidelines for the prevention and treatment of venous leg ulcers: a US perspective

Comprehensive care of chronic venous insufficiency and associated ulcers requires a multipronged and interprofessional approach to care. A comprehensive treatment approach includes exercise, nutritional assessment, compression therapy, vascular reconstruction, and advanced treatment modalities. National guidelines, meta-analyses, and original research studies provide evidence for the inclusion of these approaches in the patient plan of care. The purpose of this paper is to review present guidelines for prevention and treatment of venous leg ulcers as followed in the US. The paper further explores evidence-based yet pragmatic tools for the interprofessional team to use in the management of this complex disorder.