Results of home-based modified combined decongestive therapy in patients with lower extremity lymphedema
Results of home-based modified combined decongestive therapy in patients with lower extremity lymphedema
Background/aim: The aim of this study is to present the results of modified combined decongestive therapy (CDT) in patients withlower extremity lymphedema (LEL).Materials and methods: We retrospectively reviewed 95 patients aged 55.84 ± 15.70 years who had been diagnosed with LEL betweenMay 2015 and May 2017. The patients were treated for 4 weeks with modified CDT, including self-manual lymphatic drainage, selfbandaging, decongestive exercises, and skin care.Results: The mean reduction amounts of edema volume before and after treatment were 296.05, 784.92, and 1038.50 mL for stages 1,2, and 3 respectively (P = 0.001). There were significant differences between the values before and after treatment in excess extremityvolume (EEV) at all stages (P = 0.001). The EEV percentages of the secondary LEL patients were higher than those of the primary LELpatients (P = 0.04). There was no correlation between BMI and treatment response in terms of EEV percentages (r = –0.99; P = 0.36).Conclusion: Our results revealed that home-based modified CDT is more effective in reducing extremity edema volume in secondaryLEL than primary LEL. It should be an available method for self-management of LEL at all stages.
___
- 1. Huggenberger K, Wagner S, Lehmann S, Aeschlimann A,
Amann-Vesti B et al. Health and quality of life in patients with
primary and secondary lymphedema of the lower extremity.
Vasa 2015; 44 (2): 129-137.
- 2. Rockson SG, Rivera KK. Estimating the population burden of
lymphedema. Annals of the New York Academy of Sciences
2008; 1131 (1): 147-154.
- 3. Williams AF, Franks PJ, Moffatt CJ. Lymphoedema: estimating
the size of the problem. Palliative Medicine 2005; 19 (4): 300-313.
- 4. Murdaca G, Cagnati P, Gulli R, Spanò F, Puppo F et al. Current
views on diagnostic approach and treatment of lymphedema.
American Journal of Medicine 2012; 125 (2): 134-140.
- 5. Jensen MR, Simonsen L, Karlsmark T, Bülow J. Lymphoedema
of the lower extremities background, pathophysiology and
diagnostic considerations. Clinical Physiology and Functional
Imaging 2010; 30 (6): 389-398.
- 6. International Society of Lymphology. The diagnosis and
treatment of peripheral lymphedema: 2013 Consensus
Document of the International Society of Lymphology.
Lymphology 2013; 46 (1): 1-11.
- 7. Fu MR, Kang Y. Psychosocial impact of living with cancerrelated lymphedema. Semin Oncol Nurs 2013; 29: 50-60.
- 8. Oremus M, Dayes I, Walker K, Raina P. Systematic review:
conservative treatments for secondary lymphedema. BMC
Cancer 2012; 12 (1): 6.
- 9. McNeely ML, Peddle CJ, Yurick JL, Dayes IS, Mackey JR.
Conservative and dietary interventions for cancer-related
lymphedema. Cancer 2011; 117 (6): 1136-1148.
- 10. Kim SJ, Park YD. Effects of complex decongestive physiotherapy
on the oedema and the quality of life of lower unilateral
lymphoedema following treatment for gynecological cancer.
European Journal of Cancer Care 2008; 17 (5): 463-468.
- 11. Liao SF, Li SH, Huang HY. The efficacy of complex decongestive
physiotherapy (CDT) and predictive factors of response to
CDT in lower limb lymphedema (LLL) after pelvic cancer
treatment. Gynecologic Oncology 2012; 125 (3): 712-715.
- 12. Földi E. Treatment of lymphedema and patient rehabilitation.
Anticancer Research 1998; 18 (3C): 2211-2212.
- 13. Andersen L, Højris I, Erlandsen M, Andersen, J. Treatment
of breast-cancer related lymphedema with or without manual
lymphatic drainage: a randomized study. Acta Oncologica
2000; 39 (3): 399-405.
- 14. Mosti G, Partsch H. Bandages or double stockings for the
initial therapy of venous oedema? A randomized, controlled
pilot study. European Journal of Vascular and Endovascular
Surgery 2013; 46 (1): 142-148.
- 15. Kuhnke E. Volumenbestimmung aus Umfangmessungen. Folia
Biologica 1976; 24: 224-232 (in German).
- 16. ILF. Best Practice for the Management of Lymphoedema.
International Consensus. London: MEP Ltd.; 2006.
- 17. Lasinski BB, Thrift KM, Squire D, Austin MK, Smith KM et al.
A systematic review of the evidence for complete decongestive
therapy in the treatment of lymphedema from 2004 to 2011.
PM&R 2012; 4 (8): 580-601.
- 18. Coleman MT, Newton KS. Supporting self-management in
patients with chronic illness. American Family Physician 2005;
72 (8): 1503-1510.
- 19. Clark NM, Becker MH, Janz NK, Lorig K, Rakowski W et al.
Self- management of chronic disease by older adults: a review
and questions for research. Journal of Aging and Health 1991; 3
(1): 3-27.
- 20. Kuroda K, Yamamoto Y, Yanagisawa M, Kawata A, Akiba N et al.
Risk factors and a prediction model for lower limb lymphedema
following lymphadenectomy in gynecologic cancer: a hospitalbased retrospective cohort study. BMC Women’s Health 2017;
17 (1): 50.
- 21. Graf N, Rufibach K, Schmidt AM, Fehr M, Fink D et al.
Frequency and risk factors of lower limb lymphedema following
lymphadenectomy in patients with gynecological malignancies.
European Journal of Gynaecological Oncology 2013; 34 (1): 23-
27.
- 22. Frumovitz M, Jhingran A, Soliman PT, Klopp AH, Schmeler K
et al. Morbid obesity as an independent risk factor for diseasespecific mortality in women with cervical cancer. Obstetrics and
Gynecology 2014; 124 (6): 1098.
- 23. Kizer NT, Thaker PH, Gao F, Zighelboim I, Powell MA et al.
The effects of body mass index on complications and survival
outcomes in patients with cervical carcinoma undergoing
curative chemoradiation therapy. Cancer 2011; 117 (5): 948-956.
- 24. Zhang L, Fan A, Yan J, He Y, Zhang H et al. Combining manual
lymph drainage with physical exercise after modified radical
mastectomy effectively prevents upper limb lymphedema.
Lymphatic Research and Biology 2016; 14 (2): 104-108.
- 25. Bernhard L, Bernhard P, Magnussen P. Management of patients
with lymphoedema caused by filariasis in north-eastern
Tanzania. Physiotherapy 2003; 89 (12): 743-749.
- 26. Barclay J, Vestey J, Lambert A, Balmer C. Reducing the
symptoms of lymphoedema: is there a role for aromatherapy?
European Journal of Oncology Nursing 2006; 10 (2): 140-149.
- 27. Tidhar D, Hodgson P, Shay C, Towers A. A lymphedema selfmanagement programme: report on 30 cases. Physiotherapy
Canada 2014; 66: 404-412.
- 28. Sherman KA, Koelmeyer L. Psychosocial predictors of
adherence to lymphedema risk minimization guidelines
among women with breast cancer. Psycho-Oncology 2013; 22
(5): 1120-1126.
- 29. Faett BL, Brienza DM, Geyer MJ, Hoffman LA. Teaching selfmanagement skills in persons with chronic lower limb swelling
and limited mobility: evidence for usability of telerehabilitation.
International Journal of Telerehabilitation 2013; 5 (1): 17.