Hot of the Press December 2020

We have collated some great articles and material published over the last month. Click on the links below to read the abstract or download the full paper.

Anatomy / Physiology /Pathophysiology

Inflammation Precedes Fat Deposition in an Experimental Model of Lymphedema - click for abstract

Inflammation Precedes Fat Deposition in an Experimental Model of Lymphedema

Guilherme A Cuadrado, Mauro F C de Andrade, Suely K Ariga, Thais M de Lima, Heraldo P Souza

Lymphat Res Biol. 2020 Nov 19

Chronic lymphedema is a common complication of lymphatic obstruction, particularly after cancer treatment, characterized by an increased volume of the affected extremity, partly caused by the accumulation of excessive adipose tissue. The relationship between lymph vessels’ obstruction and fat deposit is, however, poorly understood. Objective: Our central hypothesis was that the inflammatory process caused by lymph stasis precedes the adipocyte differentiation and fat deposition. Methods and Results: We used a modified mouse tail model to produce secondary lymphedema. Animals were treated with dexamethasone, or the procedure was performed in nitric oxide synthase 2 (NOS2)-deficient mice to evaluate the role of inflammation in lymphedema formation. Adipose tissue (Lipin) and inflammatory markers (IL-6, MCP-1, and F4-80) were analyzed in histological samples and by quantitative polymerase chain reaction. We observed an increased deposition of fat into the affected area that starts 3 weeks after lymph vessel ligation; it further increased after 6 weeks. Genes involved in the inflammatory process were upregulated before adipocyte maturation. Treatment with dexamethasone or the use of inducible nitric oxide synthase knockout mice blocked the inflammatory reaction and inhibited the accumulation of fat distal to the lymphatic obstruction. Conclusion: In the modified mouse tail lymphedema, inflammation precedes adipogenesis. Our data suggest that MCP-1 and nitric oxide may be potential targets for lymphedema management.

Prevalence and Risk Factors

Reduced lymphedema after sentinel lymph node biopsy versus lymphadenectomy for endometrial cancer - click for abstract

Reduced lymphedema after sentinel lymph node biopsy versus lymphadenectomy for endometrial cancer

Gretchen Glaser, Giorgia Dinoi, Francesco Multinu, Kathleen Yost, Mariam Al Hilli, Alyssa Larish, Amanika Kumar, Michaela McGree, Amy L Weaver, Andrea L. Cheville, Sean Dowdy, Andrea Mariani. Int J Gynecol Cancer. 2020 Nov 26

OBJECTIVE: Endometrial cancer surgical staging includes lymph node assessment which can lead to lower extremity lymphedema. The aim of this study was to estimate prevalence after sentinel lymph node biopsy versus lymphadenectomy.

METHODS: Consecutive patients who underwent minimally invasive surgery at the Mayo Clinic, Rochester, Minnesota, USA, between January 2009 and June 2016 for newly diagnosed endometrial cancer were mailed our validated 13 item lower extremity lymphedema screening questionnaire. We also ascertained via questionnaire whether the patient was ever diagnosed with lower extremity lymphedema.

RESULTS: Among 378 patients included in the analysis, 127 (33.5%) had sentinel lymph node biopsy with or without side specific lymphadenectomy (sentinel lymph node cohort) and 251 (66.4%) underwent bilateral lymphadenectomy prior to sentinel lymph node biopsy implementation at our institution or as ‘backup’ after sentinel lymph node mapping (lymphadenectomy cohort). The prevalence of lower extremity lymphedema was 41.5% (157/378), with 69 patients (18.3%) self-reporting a lower extremity lymphedema diagnosis after their endometrial cancer surgery at a median of 54.3 months (interquartile range 31.2-70.1 months), and an additional 88 patients (23.3%) identified by the screening questionnaire. The prevalence of lower extremity lymphedema was significantly higher in the lymphadenectomy cohort compared with the sentinel lymph node group (49.4% (124/251) vs 26.0% (33/127); p<0.001). When the cohorts were restricted to patients surgically managed after the introduction of sentinel lymph node, the prevalence of lower extremity lymphedema was still significantly higher in the lymphadenectomy cohort compared with the sentinel lymph node cohort (39.0% (41/105) vs 26.0% (33/127); p=0.03). In a multivariable analysis adjusted for body mass index, receipt of adjuvant external beam radiation, diabetes, congestive heart failure, and International Federation of Gynecology and Obstetrics grade, the adjusted odds ratio for the association between type of nodal sampling (lymphadenectomy cohort vs sentinel lymph node cohort) and lower extremity lymphedema was 2.75 (95% confidence interval 1.69 to 4.47, p<0.001). CONCLUSIONS: Sentinel lymph node biopsy was associated with a decreased risk of post-treatment lymphedema compared with lymphadenectomy in patients who underwent surgical staging for endometrial carcinoma.

Assessment

Lymphedema Symptom Intensity and Distress Surveys-Truncal and Head and Neck, Version 2.0 - click for abstract

Lymphedema Symptom Intensity and Distress Surveys-Truncal and Head and Neck, Version 2.0

Sheila H Ridner, Jie Deng, Jennifer K Doersam, Mary S Dietrich

Lymphat Res Biol. 2020 Nov 12

A comparison of symptom prevalence, intensity, and distress for participants with truncal lymphedema, head and neck lymphedema, and no lymphedema identified a need for a truncal-specific, lymphedema-related symptom assessment tool and a revision of the Lymphedema Symptom Intensity and Distress Survey-Head and Neck (LSIDS-H&N). The purpose of this study was to institute the development of the Lymphedema Symptom Intensity and Distress Survey-Truncal (LSIDS-T) and revise the LSIDS-H&N. Methods and Results: A comprehensive midline measure and subsequent series of analyses were used to develop the LSIDS-T and revise the initial LSIDS-H&N. Participants included 97 without lymphedema, 82 with truncal lymphedema, and 72 with head and neck lymphedema. Cluster analysis for the LSIDS-T resulted in five clusters with a total of 21 items. Cluster analysis for the LSIDS-H&N resulted in seven clusters with a total of 31 items. Key correlations in expected directions were found with the validated measures for both surveys, and correlations with the Marlowe Crown Social Desirability Scale did not indicate issues with social desirability of response. Conclusion: The 24-item LSIDS-T and the 31-item revised LSIDS-H&N v.2 are promising additions to the suite of other LSIDS measures for use in clinical environments

Limb Volume Changes and Activities of Daily Living: A Prospective Study – Download full paper

Jae Hyung Park, John Merriman, Abraham Brody, Jason Fletcher, Gary Yu, Eunjung Ko, Alejandra Yancey, Mei R. Fu. Lymphat Res Biol. 2020 Nov 13

Who Will Continuously Depend on Compression to Control Persistent or Progressive Breast Cancer-Related Lymphedema Despite 2 Years of Conservative Care? – Download full paper

Chul Jung, JaYoung Kim, Yu Jin Seo, Kyeong Joo Song, Ma Nessa Gelvosa, Jin Geun Kwon, Changsik John Pak, Hyunsuk Peter Suh, Joon Pio Hong, Hwa Jung Kim, Jae Yong Jeon. J Clin Med. 2020 Nov 12;9(11)

The Correlation Between Fluid Distribution and Swelling or Subjective Symptoms of the Trunk in Lymphedema Patients: A Preliminary Observational Study click for abstract

The Correlation Between Fluid Distribution and Swelling or Subjective Symptoms of the Trunk in Lymphedema Patients: A Preliminary Observational Study

Fumiya Hisano, Shiori Niwa, Keisuke Nakanishi, Ayana Mawaki, Kaoru Murota, Atsushi Fukuyama, Yukari Takeno, Sachiyo Watanabe, Etsuko Fujimoto, Chika Oshima. Lymphat Res Biol. 2020 Nov 13

Manual lymph drainage (MLD) is one of the common treatments for breast cancer-related lymphedema (BCRL). Although the primary goal of MLD is to drain the excessive fluid accumulated in the affected upper limb and trunk to an area of the body that drains usually, the use of MLD is decided based on swelling and subjective symptoms, without assessing whether there is fluid accumulated in the affected region. The purpose of this study was to examine truncal fluid distribution in a sample of BCRL patients and investigate any correlation between such fluid distribution and swelling or subjective symptoms. Methods and Results: An observational study was conducted with 13 women who had unilateral, upper extremity BCRL. Fluid distribution was evaluated by using two magnetic resonance imaging (MRI) sequences: half-Fourier acquisition single-shot turbo spin echo and three-dimensional double-echo steady-state. The presence of swelling was determined by lymphedema therapists, and subjective symptoms were measured by using a visual analog scale. On MRI, no participants had any free water signals in the trunk. However, seven had swelling and all 13 had some kind of subjective symptoms on the affected side of their trunk. Conclusions: These results suggest that swelling and subjective symptoms do not correlate with the presence of truncal fluid. For such cases, a different approach than MLD may be needed to address truncal swelling and related subjective symptoms. Checking for the presence of fluid in the truncal region may help MLD be used more appropriately.

Comparison of Shoulder-Arm Complex Pain, Function, and Scapular Dyskinesia in Women With and Without Unilateral Lymphedema After Breast Cancer Surgery - click for abstract

Comparison of Shoulder-Arm Complex Pain, Function, and Scapular Dyskinesia in Women With and Without Unilateral Lymphedema After Breast Cancer Surgery

Tugce Sirin Korucu, Sevtap Gunay Ucurum, Engin Tastaban, Hedef Ozgun, Derya Ozer Kaya

Clin Breast Cancer. 2020 Oct 29:S1526-8209(20)30267-6

INTRODUCTION: Lymphedema is the most important complication seen after breast cancer surgery. The study aimed to evaluate pain, shoulder-arm complex function, and scapular function in women who developed lymphedema after breast cancer surgery and to compare these with women without lymphedema.

MATERIALS AND METHODS: Fifty women with lymphedema (age, 54.34 ± 9.08 years; body mass index, 30.10 ± 4.03 kg/cm2) and 57 women without lymphedema (age, 53.68 ± 9.41 years; body mass index, 29.0 ± 5.44 kg/cm2) after unilateral surgery for breast cancer were included. Clinical and demographic information was noted. The severity of lymphedema with perimeter measurements (Frustum model), level of heaviness discomfort sensation with a visual analog scale, pain threshold with a digital algometer, shoulder-arm complex functionality with the Disabilities of the Arm, Shoulder, Hand Problems Survey (DASH), and scapular function with observational scapular dyskinesia and lateral scapular sliding tests were assessed. The t test, χ2 test, and Mann-Whitney U test were used for analyses.

RESULTS: The follow-up duration after the surgery was 4.24 ± 2.97 years and 3.19 ± 1.76 years, and the upper extremity volume was 2106.65 ± 510.82 cm3 and 1725.92 ± 342.49 cm³ in the lymphedema group and in the no-lymphedema group, respectively. In the lymphedema group, arm-heaviness discomfort, pain threshold levels in the trapezius and deltoid muscles, and DASH scores were worse (P < .05). The rate of scapular dyskinesia (70.0%) and type 2 scapula (32%) in the surgical side was higher in patients with lymphedema. CONCLUSION: The pain pressure threshold in the trapezius and deltoid muscles, heaviness sensation level, and inadequate upper extremity function are significantly higher in patients with lymphedema, and the scapular dyskinesia rate was higher.

Extracellular Water Ratio as an Indicator of the Development and Severity of Leg Lymphedema Using Bioelectrical Impedance Analysis - click for abstract

Extracellular Water Ratio as an Indicator of the Development and Severity of Leg Lymphedema Using Bioelectrical Impedance Analysis

Yoshichika Yasunaga, Saeko Kondoh, Yuta Nakajima, Shinei Mimura, Miharu Kobayashi, Shunsuke Yuzuriha, Shoji Kondoh. Lymphat Res Biol. 2020 Nov 13

This case-control retrospective study focused on the extracellular water ratio (%ECW) of lymphedemic limbs measured by bioelectrical impedance analysis (BIA) as a possible indicator of the development and severity of unilateral and bilateral leg lymphedema. Methods and Results: BIA was used to evaluate changes in %ECW due to lymphedema in female patients with unilateral secondary leg lymphedema and in healthy controls. Receiver operating characteristic (ROC) analysis was employed to assess the diagnostic ability of %ECW to distinguish leg lymphedema patients from controls. Thirty-eight female patients were eligible for inclusion along with an equal number of healthy control volunteers. The %ECW of the affected leg correlated with leg body water volume (R2 = 0.28) and the water volume difference between affected and unaffected legs (R2 = 0.58). The ROC analysis showed that %ECW had a high diagnostic ability as a screening tool for the development of leg lymphedema (area under the ROC curve = 0.96). A cutoff %ECW value of 40.0% could predict the presence of leg lymphedema with a sensitivity of 81.6% and specificity of 97.4%. Conclusions: %ECW value may be a simple and useful indicator of the development and severity of leg lymphedema. As a screening test, %ECW measurement can predict the presence of unilateral or bilateral leg lymphedema in a single measurement without the need for arm, contralateral leg, or previous measurements as controls.

The role of ultrasonography in follow-up of effectiveness of Complex Decongestive Therapy (CDT) in different subgroups of patients with breast cancer-related lymphoedema - click for abstract

The role of ultrasonography in follow-up of effectiveness of Complex Decongestive Therapy (CDT) in different subgroups of patients with breast cancer-related lymphoedema

Burcu Duyur Çakıt, F Figen Ayhan, Sefa Gümrük Aslan, Hakan Genç. Eur J Cancer Care (Engl). 2020 Nov 2

OBJECTIVE: To determine the role of ultrasonography in the follow-up of effectiveness of complex decongestive therapy (CDT) in different subgroups of patients with breast cancer-related lymphoedema (BCRL).

METHODS: Forty-seven patients with unilateral upper BCRL were enrolled in the study. The patient group was divided into two subgroups according to body mass index (BMI) as obese and non-obese and three subgroups according to International Society of Lymphology staging. All patients underwent CDT, the circumference measurements and ultrasonographic soft tissue thicknesses evaluations were performed at two anatomic sites, and upper extremity limb volumes were calculated using the truncated cone formula before and after CDT.

RESULTS: There were significant decreases in both circumferential measurements and ultrasonographic soft tissue thicknesses in non-obese patients and stage 2 lymphoedema patients after 15 sessions of CDT. The ultrasonographic soft tissue thickness values were correlated with the upper arm and forearm circumference values before (r = 0.491, p < .001, r = 0.841, p < .001, respectively) and after (r = 0.535, p < .001, r = 0.714, p < .001, respectively) CDT.

CONCLUSIONS: Ultrasonography presents as a reliable method to measure the soft tissue thickness and treatment efficacy after CDT in only non-obese and stage 2 patients with BCRL

Cancer-related fatigue in head and neck cancer survivors: Energy and functional impacts - click for abstract

Cancer-related fatigue in head and neck cancer survivors: Energy and functional impacts

Naomi D. Dolgoy, Patricia O’Krafka, Margaret McNeely. Cancer Treat Res Commun. 2020 Nov 21;25

BACKGROUND: Survivors with head and neck cancer (HNC) report cancer-related fatigue (CRF) as a devastating, prevalent health issue that limits activity engagement and adversely influences quality of life.

OBJECTIVE: To explore HNC survivors’ written responses and descriptors regarding CRF, and offer potential healthcare strategies based on findings.

METHODOLOGY: In written format, similar to responses on intake forms in outpatient-clinics, 25 HNC survivors provided descriptions of their CRF experiences and their perspectives on its impact. An exploratory descriptive research design was utilized, drawing on social theory for content analysis and thematic development. RESULTS: Two main themes regarding CRF arose from the data: (1) CRF as a barrier to daily function; and (2) uncontrollable and unpredictable energy fluctuations.

CONCLUSIONS: To enhance outcomes of CRF symptom management in HNC survivors, a healthcare approach that targets the functional implications of CRF, and utilizes energy cultivation strategies when communicating about the negative impacts of CRF (including limited function and fluctuating energy levels) may be beneficial for HNC survivors. Further research into the effects of CRF on function for HNC survivors is warranted.

Patient-Reported Outcome Measures in Lymphedema: A Systematic Review and COSMIN Analysis - click for abstract

Patient-Reported Outcome Measures in Lymphedema: A Systematic Review and COSMIN Analysis

Louise Marie Beelen, Anne-Margreet van Dishoeck, Elena Tsangaris, Michelle Coriddi, Joseph H Dayan, Andrea L Pusic, Anne Klassen, Dalibor Vasilic. Ann Surg Oncol. 2020 Nov 28.

BACKGROUND: Lymphedema is a chronic and debilitating condition that affects many cancer survivors. Patient-reported outcome measures (PROMs) can give valuable insight into the impact of lymphedema on a patient’s quality of life and can play an essential role in treatment decisions. This study aims to (1) identify PROMs used to assess health-related quality of life (HRQoL) in patients with lymphedema; and (2) assess the quality of the lymphedema-specific PROMs.

METHODS: We performed a systematic search to identify articles on lymphedema, quality of life, and PROMs. An overview was created of all PROMs used to assess HRQoL in patients with lymphedema. The methodological quality of the lymphedema-specific PROMs was assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria.

RESULTS: A total of 235 articles met the inclusion criteria, of which 200 described studies using one or more PROMs as an outcome measure in patients with lymphedema. The other 35 studies described the development and/or validation of a lymphedema-specific PROM. The COSMIN assessment demonstrated that none of these PROMs met all quality standards for development.

CONCLUSION: The use of PROMs in lymphedema is increasing; however, based on our findings, we cannot fully support the use of any of the existing instruments. A well-developed lymphedema-specific PROM, based on patient input, is needed to gain better insight into the impact of this condition, and can be used to measure the effect of possible medical and surgical treatments.

The impact of monitoring techniques on progression to chronic breast cancer-related lymphedema: a meta-analysis comparing bioimpedance spectroscopy versus circumferential measurements - click for abstract

The impact of monitoring techniques on progression to chronic breast cancer-related lymphedema: a meta-analysis comparing bioimpedance spectroscopy versus circumferential measurements

Chirag Shah, April Zambelli-Weiner, Nicole Delgado, Ashley Sier, Robert Bauserman, Jerrod Nelms. Breast Cancer Res Treat. 2020 Nov 27.

BACKGROUND: Chronic breast cancer-related lymphedema (BCRL) is a potentially serious complication following treatment. Monitoring for progression to BCRL may allow for earlier detection and intervention, reducing the rate of progression to chronic BCRL. Therefore, the purpose of this meta-analysis is to evaluate the impact of monitoring techniques on the incidence of chronic BCRL among patients monitored by bioimpedance spectroscopy (BIS) and circumference as compared to background rates.

METHODS: Eligible peer-reviewed studies from PubMed, CINHAL, or Google Scholar that were published in English from 2013 onward and conducted in North America, Europe, or Oceania. Incidence rates abstracted from studies were classified by BCRL monitoring method: background (no standardized BIS or circumference assessments), BIS or circumference. A random-effects model was used to calculate a pooled annualized estimate of BCRL incidence while accounting for clinical and methodological heterogeneity. Subgroup analyses examined differences in duration of follow-up as well as breast and axillary surgery.

RESULTS: 50 studies were included, representing over 67,000 women. The annualized incidence of BCRL was 4.9% (95% CI: 4.3-5.5) for background studies (n = 35), 1.5% (95% CI: 0.6-2.4) for BIS-monitored studies (n = 7), and 7.7% (95% CI: 5.6-9.8) for circumference-monitored studies (n = 11). The cumulative BCRL incidence rate in BIS-monitored patients was 3.1% as compared to 12.9% with background monitoring (69% reduction) and 17.0% with circumference-monitored patients (81% reduction).

CONCLUSIONS: Evidence suggests that monitoring with BIS allowing for early intervention significantly reduces the relative risk of chronic BCRL with a 69% and 81% reduction compared to background and circumference, respectively. Circumference monitoring did not appear to provide a benefit with respect to chronic BCRL incidence. Based on these results, BIS should be considered for BCRL screening in order to detect subclinical BCRL and reduce rates of chronic BCRL, particularly in high-risk patients.

Personalizing Conservative Lymphedema Management Using Indocyanine Green-Guided Manual Lymphatic Drainage - click for abstract

Personalizing Conservative Lymphedema Management Using Indocyanine Green-Guided Manual Lymphatic Drainage

Louise A Koelmeyer, Belinda M Thompson, Helen Mackie, Robbie Blackwell, Asha Heydon-White, Emma Moloney, Katrina Gaitatzis, John Boyages, Hiroo Suami. Lymphat Res Biol. 2020 Dec 2

The Australian Lymphoedema Education, Research and Treatment Program (ALERT) at Macquarie University in Sydney, Australia is one of the flagship programs of Australia’s first fully integrated academic health sciences centre, MQ Health. The aim of this study was to describe our findings of compensatory drainage demonstrated by indocyanine green (ICG) lymphography in cancer-related upper and lower limb lymphedema and how this may be translated into clinical practice. Methods and Results: Retrospective data from 339 patients aged between 18 and 90 years with secondary cancer-related unilateral or bilateral lymphedema of the upper or lower limb who underwent ICG lymphography assessment at the ALERT clinic between February 2017 and March 2020 were analyzed. In patients with upper limb lymphedema, the ipsilateral axilla was the most frequent drainage region (74.9%), followed by clavicular (41.8%) and parasternal (11.3%). For patients with mild upper limb lymphedema, 94.4% drained to the ipsilateral axilla. No patients drained to the ipsilateral inguinal region. For lower limb lymphedema, drainage to the ipsilateral inguinal was most common (52.3%), followed by contralateral inguinal (30.7%), popliteal (26.1%), and gluteal (21.6%) regions. Three main patterns of superficial lymphatic compensation were identified based on which anatomical structure carried lymph fluid. Manual lymphatic drainage (MLD) was used to facilitate movement of the dye. A light/effleurage technique was sufficient to move the dye through patent lymphatic vessels; a slow and firmer technique was required to move the dye through areas of bridging dermal backflow. Conclusion: The introduction of ICG lymphography to our program and its use in guiding personalized conservative management plans, including facilitative MLD techniques, has translated into clinical practice and changed research and educational priorities within the ALERT program.

The Early Detection of Breast Cancer Treatment-Related Lymphedema of the Arm - click for abstract

The Early Detection of Breast Cancer Treatment-Related Lymphedema of the Arm

Vaughan L. Keeley. Lymphat Res Biol. 2020 Dec 2

It is recognized that the early detection of breast cancer treatment related lymphedema (BCRL) leading to earlier intervention may improve long-term outcomes. This study aimed to determine whether limb volume measurement or bioimpedance spectroscopy (BIS) was the better tool for the early detection of BCRL. It also aimed to identify factors, which may be used to assess the risk of development of BCRL for individual patients. Methods and Results: This was a large prospective multicenter study of 1100 patients, who had had axillary node clearance for breast cancer, carried out in the United Kingdom. Limb volumes (by Perometer) and BIS (L-Dex by Impedimed U400) measurements were taken preoperatively and postsurgery with a follow-up period of 5 years. Details of the cancer, its treatment, body mass index (BMI), and age were recorded. BCRL was defined by relative arm volume increase (RAVI) ≥10%. At 24 months, the incidence of BCRL defined by RAVI was 22.8% and that defined by L-Dex >10 was 45.6%. Independent risk factors for the development of BCRL at 36 months were RAVI ≥5%-<10%, at 1 month, 10 or more positive nodes, BMI >30 and taxane chemotherapy. A risk assessment tool based on these was developed. Conclusions: Limb volume measurements performed better than BIS in the early detection of BCRL. Pre- and postoperative monitoring of limb volume measurements is useful in the early detection of, and prediction of those likely to develop, BCRL and allow early intervention.

Management Strategies

A historical account of the role of exercise in the prevention and treatment of cancer-related lymphedema - click for abstract

A historical account of the role of exercise in the prevention and treatment of cancer-related lymphedema

Karin Johansson, S Hayes. Lymphology. 2020;53(2):55-62

In the absence of guidance from scientific evidence, a range of lymphedema prevention and management, guidelines were developed by relevant organizations around the world. These became publicly available, promoted and endorsed, particularly to women with breast cancer. The recommendations advised avoidance of any activity that could overload or restrict the lymphatic system and need for caution when participating in specific physical activities. However, over the past 20 years evidence has accumulated which has significantly challenged the safety of these recommendations, in particular for those with cancer. There now exists consistent and compelling evidence in support of exercise following a diagnosis of cancer. Participating in exercise during and following cancer treatment improves function and quality of life, reduces treatment-related morbidity, and may improve survival. Further, exercise, including resistance exercise at moderate or high load, is considered safe for those at risk- or with lymphedema. That is, exercise has not been shown to cause or worsen cancer-related lymphedema. This article provides a historical account of the advice given to patients in the prevention and management of lymphedema and how this advice has evolved.

Treatment of male genital lymphedema with non-elastic fabric – Download full paper

José Maria Pereira de Godoy, Maria de Fátima G Godoy, Maria F Warick Facio, Germano José F Arruda, Ana Clara N Spessoto, Luís Cesar F Spessoto, Fernando N Facio

AME Case Rep. 2020 Oct 30;4:29. eCollection 2020.

Compression Therapy Is Not Contraindicated in Diabetic Patients with Venous or Mixed Leg Ulcer – Download full paper

Giovanni Mosti, Attilio Cavezzi, Luca Bastiani, Hugo Partsch. J Clin Med. 2020 Nov 19;9(11

Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients – Download full paper

Bianca Brix, Gert Apich, Andreas Roessler, Christian Ure, Karin Schmid-Zalaudek, Helmut Hinghofer-Szalkay, Nandu Goswami. J Clin Med. 2020 Nov 16;9(11)

Physiotherapy and rehabilitation applications in lipedema management: A literature review - click for abstract

Physiotherapy and rehabilitation applications in lipedema management: A literature review

M Esmer, F J Schingale, D Unal, M V Yazıcı, N A Güzel. Lymphology. 2020;53(2):88-95

Lipedema is a chronic and progressive disease of adipose tissue caused by abnormal fat accumulation in subcutaneous tissue. Although there is no known cure for lipedema, possible complications can be prevented with conservative and surgical treatments. One of the conservative treatment options is physiotherapy and rehabilitation (PR). When the literature is examined, few studies focusing on the efficacy of PR were found for this patient group. The purpose of this review is to provide a better understanding of the effectiveness of PR applications by compiling existing studies. A bibliographic PubMed search was performed for published studies regarding PR in lipedema management in June 2019 including the last 58 years (1951-2019). Articles were chosen by reading the abstracts and subsequently data were analyzed by reading the entire text through full-text resources. A total of 15 studies met inclusion criteria. Results document how lipedema patients are benefited by PR and the effectiveness of different types of PR programs. The current review also showed that complex decongestive physiotherapy, gait training, hydrotherapy, aerobic exercise, and resistance exercise training each have value in the management of lipedema. The effects of PR for the treatment of lipedema are variable among studies, although overall PR seems to be effective in lipedema management. Although physiotherapy applications have a potentially important role in the management of lipedema, they should be used in combination with other treatment modalities. More studies with higher quality are needed to fully demonstrate the effect and efficacy of PR in lipedema patients.

Lymphatic treatments after orthopedic surgery or injury: A systematic review - click for abstract

Lymphatic treatments after orthopedic surgery or injury: A systematic review

Ifat Klein, Dorit Tidhar, Leonid Kalichman. J Bodyw Mov Ther. 2020 Oct;24(4):109-117.

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.

Effect of Nonelastic Compression With an Adjustable Wrap After Total Knee Arthroplasty - click for abstract

Effect of Nonelastic Compression With an Adjustable Wrap After Total Knee Arthroplasty

Ad A Hendrickx, Wim P Krijnen, Richard Bimmel, Cees P van der Schans, Robert J. Damstra

Orthop Nurs. 2020 Nov/Dec;39(6):377-383.

Swelling is a common phenomenon after total knee arthroplasty, with potential for negative impact on the rehabilitation process and final outcome. The aim of this study was to investigate the effectiveness of a new compression protocol with a self-adjustable, nonelastic compression wrap for the knee region. This study was conducted as a prospective comparative study. Total leg volume and the circumference of the knee at three levels were compared between groups. The results of our study suggest that the application of the new compression protocol has no effect on swelling in the acute postoperative phase (0-2 days) but reduces swelling at Day 14 within the subacute phase. The observed positive effect of the compression protocol could be of clinical importance in the subacute phase as well as for a subgroup of patients suffering from aberrant quadriceps weakness concomitant with knee swelling.

Breast cancer-related lymphedema and its treatment: how big is the financial impact? - click for abstract

Breast cancer-related lymphedema and its treatment: how big is the financial impact?

Tessa De Vrieze, Nick Gebruers, Ines Nevelsteen, Wiebren A A Tjalma, Sarah Thomis, An De Groef, Lore Dams, Vincent Haenen, Nele Devoogdt. Support Care Cancer. 2020 Nov 24.

PURPOSE: Decongestive lymphatic treatment (DLT) is still the gold standard for treatment of breast cancer-related lymphedema (BCRL). With up to 17% of the patients treated for breast cancer developing BCRL, this morbidity imposes a tremendous financial burden for patients and society. Knowledge about this economic burden related to BCRL and its conservative treatment in a European setting is lacking. The aim of this prospective, longitudinal cohort study was to estimate the direct healthcare costs related to BCRL and its treatment in a European setting.

METHODS: Patients with BCRL were treated with DLT consisting of an intensive treatment phase of 3 weeks, followed by a maintenance treatment phase of 6 months. Additionally, the follow-up period comprised 6 months. During these 3 weeks and 12 months, all direct costs associated with the treatment of BCRL and its sequelae were documented through billing prices and a self-developed questionnaire which was administered after the intensive treatment phase, and subsequently 3-monthly during the entire period.

RESULTS: A total of 194 patients were enrolled in this study. Of these, 17% (n = 32) showed lymphedema stage I, 56% (n = 109) had lymphedema stage IIa, and 27% (n = 53) had lymphedema stage IIb. Total direct healthcare costs per patient were €2248.93 on average during the entire period of 3 weeks of intensive treatments and 12 months of maintenance decongestive therapy. Within these mean direct costs, €1803.35 (80%) was accounted for statutory health insurances, and €445.58 (20%) was out-of-pocket expenses for patients.

CONCLUSION: This study is one of the first standardized high-quality health economic analyses of BRCL treatment in Europe. The present study indicates that the price tag of BCRL treatment in Belgium is high not only for the health insurance but also for the patients Clinical trial registration number The study makes part of a double-blind, multi-center, randomized controlled trial (EFforT-BCRL trial), which is registered in clinicaltrials.gov