Head and neck lymphedema management: Evaluation of a therapy program
Amanda Pigott, Jodie Nixon, Jennifer Fleming, Sandro Porceddu. Head& Neck. 2018;40:1131-1137
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Head and neck lymphedema management: Evaluation of a therapy program
Amanda Pigott, Jodie Nixon, Jennifer Fleming, Sandro Porceddu. Head& Neck. 2018;40:1131–1137
Background: The purpose of this pilot study was to examine a therapeutic intervention for head and neck lymphedema. The 22-week intervention involved therapist-led care and participant self-management. Effectiveness was evaluated using a previously described lymphedema assessment tool, the Assessment of Lymphedema of the Head and Neck (ALOHA) to detect change over the course of the 22 weeks of treatment, and before and after a single treatment session.
Methods: A prospective observational pilot study was conducted with a cohort of 10 participants assessed. Measurements of size (tape measurements) and water content (tissue dielectric constant [TDC]) were used, per the ALOHA protocol. Participants received 13 lymphedema therapy treatments at reducing frequencies over 22 weeks and daily self-management.
Results: There was an overall significant reduction in lower neck circumference (F [2.15,19.35]57.11; P5.004), upper neck circumference (F [5,45]57.27; P<.001) and TDC (F (5,45)58.92; P<.001) over time. There were no significant differences over the course of treatment for mean ear-to-ear measurements or before and after a single session of treatment.
Conclusion: This pilot study found a reduction in head and neck lymphedema over the 22-week lymphedema treatment course. This intervention may be successful in reducing head and neck lymphedema; however, further studies are needed to investigate these findings in a larger sample with the use of a control group to negate improvements from healing over time.
Main findings
- Small sample size.
- Participants received 13 lymphedema therapy treatments over 22 weeks supplemented by daily self-management.
- Treatments provided included:
- (1) therapist-administered treatments, which included education about head and neck lymphedema using a consistent presentation detailing the role of the lymphatics; the impact of cancer treatment; and the development and treatment of lymphedema;
- (2) performance of manual lymphatic drainage for 30 minutes during treatment appointments using the pattern of drainage developed for self-lymphatic drainage;
- (3) application of Kinesiotape was provided after every treatment appointment in the pattern of drainage developed for self-lymphatic drainage;
- (4) instruction in self-management and instruction in self-lymphatic drainage;
- (5) instruction in neck active range of motion exercises, including flexion/extension, rotation ,and lateral flexion; and
- (6) provision of compression( liopmed® facecompression with a flat foam insert), which the participants were instructed to wear and insert initially during the day for 4 hours then to increase to overnight wear as soon as tolerated. Additionally, they were instructed to use a textured foam insert under the compression for 30 minutes before self-lymphatic drainage/ manual lymphatic drainage
- The results indicated that approximately 14 weeks after starting lymphedema treatment, a significant change had occurred in head and neck lymphedema. Further testing is required to determine whether it is the number of sessions (11 prior treatment sessions) or the duration from initial treatment (14 weeks), which is more important for achieving change.
