Hot of the Press May 2021

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

Biology of Lymphedema

Bianca Brix 1, Omar Sery 2, Alberto Onorato 3, Christian Ure 4, Andreas Roessler 1, Nandu Goswami 1 Biology (Basel). 2021 Mar 25;10(4):261

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Prospective Validation of Indocyanine Green Lymphangiography Staging of Breast Cancer-Related Lymphedema

Mads Gustaf Jørgensen, Navid Mohamadpour Toyserkani, Frederik Christopher Gulmark Hansen, Jørn Bo Thomsen, Jens Ahm Sørensen. Cancers (Basel). 2021 Mar 26;13(7):1540.

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Lymphedema alters lipolytic, lipogenic, immune and angiogenic properties of adipose tissue: a hypothesis-generating study in breast cancer survivors

Michal Koc, Martin Wald, Zuzana Varaliová, Barbora Ondrůjová, Terezie Čížková, Milan Brychta, Jana Kračmerová, Lenka Beranová, Jan Pala, Veronika Šrámková, Michaela Šiklová, Jan Gojda, Lenka Rossmeislová. Sci Rep. 2021 Apr 14;11(1):8171.

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Prevalence and Risk Factors

Factors associated with melanoma-related limb lymphoedema

Caroline A Gjorup, Karin Dahlstroem, Helle W Hendel, Krzysztof T Drzewiecki, Tobias W Klausen, Lisbet R Hölmich. Acta Oncol. 2021 Apr 1:1-6.

BACKGROUND: Melanoma-related limb lymphoedema is a well-known late effect following sentinel node biopsy (SNB), and lymph node dissection (LND) in patients treated of melanoma. However, data on associated risk factors are sparse. This study aimed to investigate factors associated with melanoma-related limb lymphoedema.

METHODS: The present cross-sectional single-center clinical study included patients between 18 and 75 years with American Joint Committee on Cancer Stages I-III melanoma treated with wide local excision (WLE) and unilateral axillary or inguinal SNB and/or completion LND (CLND) or therapeutic LND (TLND). The diagnosis of secondary unilateral limb lymphoedema was based on the history, symptoms, and physical examination and staged according to the International Society of Lymphology (ISL). Data on factors associated with lymphoedema were analysed with binary logistic regression models.

RESULTS: In total, 642 patients were eligible, of which 435 (68%) patients participated in the study. Among these 431 patients, 109 (25%) had lymphoedema of which 48 (44%), and 61 (56%) were classified with ISL Stages I and II-III, respectively. Multivariate analyses identified primary tumour on the limb (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.17-4.56; p value .017), inguinal surgery (OR, 6.91; 95% CI, 3.49-14.11; p value <.0001), LND (OR, 6.45; 95% CI, 3.18-13.57; p value <.0001), and persistent pain at the site of lymph node surgery as factors associated with lymphoedema (OR, 3.52; 95% CI, 1.54-8.19; p value .003). Multivariable analysis of ISL Stage II-III lymphoedema further identified limb cellulitis to be associated with lymphoedema (OR 5.74; 95% CI, 2.11-15.99; p value .0006). CONCLUSIONS: Melanoma-related limb lymphoedema is associated with inguinal surgery, LND, primary tumour on the limb, persistent pain at the site of lymph node surgery, and cellulitis of the limb. This study highlights the importance of increasing awareness, improving prevention, and treatment of melanoma-related limb lymphoedema

Correlation of older age with severity of lymphedema in breast cancer survivors: A systematic review

Gunel Guliyeva, Maria T Huayllani, Daniel Boczar, Francisco R Avila, Antonio J Forte. Breast Dis. 2021 Apr 7

BACKGROUND: Breast cancer is the most frequent cause of secondary lymphedema. Besides being progressive and chronic, lymphedema is usually hard to treat. That’s why the clinicians are more focused on the prevention of its development and progression.

OBJECTIVE: The aim of this study is to evaluate the possible relationship between the age of patients and the severity of breast cancer-related lymphedema (BCRL).

METHODS: PubMed, Scopus, and Ovid MEDLINE databases were searched for articles, which described the relationship between aging and BCRL development. Two authors searched for and selected articles independently.

RESULTS: Out of 562 studies selected, 8 studies met the inclusion criteria. However, 2 papers had the same study population, so only 7 were included in the final analysis. The total number of those 7 studies was 3,904 patients. Five out of 7 studies included in our review depicted the association of more severe forms of BCRL with older age.

CONCLUSION: The final analysis showed that aging is related to the severity of BCRL. However, due to heterogeneity in study outcome reporting, the cause and effect relationship could not be determined.

Development and Validation of an Intraoperative Nomogram to Predict Breast Cancer-Related Lymphedema Based on the Arm Lymphatics Distribution

Qianqian Yuan, Jinxuan Hou, Rui Zhou, Yiqin Liao, Lewei Zheng, Chong Jiao, Wenbo Zhou, Gaosong Wu
Ann Surg Oncol. 2021 Apr 23
 
BACKGROUND: Preoperatively determining those patients who are at high risk of encountering breast cancer-related lymphedema (BCRL) is still not well understood.
OBJECTIVE: This study aimed to develop a simple intraoperative nomogram for BCRL, incorporating a protective factor.
METHODS: Overall, 320 breast cancer patients at Zhongnan Hospital (training set) and 221 patients at Dongfeng General Hospital (external validation cohort) treated between November 2017 and December 2018 were included. Prior to axillary lymph node dissection (ALND), 1 mL (2.5 mg) of indocyanine green was administered to the area of the internal bicipital sulcus of the upper limb. The fluorescence image was obtained and the proportion of arm lymph flow above the level of the axillary vein was calculated. Multivariate logistic regression was performed using this proportion together with clinical data. A nomogram was then constructed and assessed for its discrimination and calibration ability and clinical utility in the training and external validation sets.
RESULTS: The cumulative incidence of BCRL was 18.7% (60/320), with a median follow-up of 29 months (20-34). In the multivariate logistic regression analysis, body mass index, taxane, radiotherapy, and proportion of arm lymph flow above the level of the axillary vein were identified as independent risk factors. In the training and validation cohorts, the calibration curve performed well (p = 0.721 and p = 0.315, respectively), and the area under the receiver operating characteristic curve values were 0.829 (95% confidence interval [CI] 0.773-0.885) and 0.804 (95% CI 0.732-0.877), respectively.
CONCLUSION: High-risk patients could be identified intraoperatively with this nomogram, and timely intervention could be performed with preservation of the arm lymphatics

The association of breast cancer-related lymphedema after unilateral mastectomy with shoulder girdle kinematics and upper extremity function

Emine Baran, Taha İbrahim Yildiz, Ceren Gursen, Esra Üzelpasaci, Serap Özgül, İrem Düzgün, Türkan Akbayrak. J Biomech. 2021 Apr 11;121:110432
 
The purpose of this study was to examine the association of breast cancer-related lymphedema on shoulder girdle kinematics and upper extremity function. The study included 67 breast cancer survivors with and without unilateral lymphedema. Individuals were divided into non-lymphedema, moderate and severe lymphedema groups according to the volumetric measurement difference between the affected and unaffected upper extremities. A three-dimensional motion monitor-electromagnetic system was used to analyze scapular movements during the elevation and depression phases of the upper extremity elevation in the scapular plane. Shoulder range of motion was assessed with a digital inclinometer. Upper extremity function was assessed with the ‘Disabilities of the Arm, Shoulder, and Hand Questionnaire-Short Form (Quick-DASH)’. The scapular upward rotation was lower for the severe lymphedema group than for the non-lymphedema group in the 90-60-30° depression phases of arm elevation (p < .05). The scapular anterior tilt was higher for the severe lymphedema group than for the non-lymphedema group in the 30° depression phase of arm elevation (p < .05). Shoulder abduction range of motion was the lowest in the severe lymphedema group (p < .05). The non-lymphedema group had the lowest quick-DASH score and the severe lymphedema group had the highest score (p < .05). There were statistically significant moderate associations between the quick-DASH scores and scapular movements in all groups (p < .05). The development, presence and/or severity of lymphedema were associated with impaired shoulder-girdle kinematics and decreased upper extremity function. However, a need exists for longitudinal studies comparing individuals with and without lymphedema and healthy controls.

Assessment

Quality-of-life outcomes after operative management of primary and secondary lymphoedema: a systematic review

Nicholas S J Tang, Anand Ramakrishnan, Ramin Shayan. ANZ J Surg. 2021 Apr 6.

BACKGROUND: Lymphoedema is an incurable and progressive disease that affects not only physical function but overall quality of life. Surgical treatment options for the management of lymphoedema are being increasingly performed. This study aims to review post-operative health-related quality of life (HRQOL) following surgical treatment of lymphoedema.

METHODS: A systematic search of the PubMed and Medline databases was performed from the date of their inception until September 2018 to evaluate HRQOL following different surgical options for the treatment of lymphoedema.

RESULTS: One hundred and thirteen articles were identified. Twenty-one articles were included in the final review, comprising a total of 736 patients. HRQOL improvements appear to be sustained for at least 6-12 months post-operatively. In particular, major benefits were noted in the domains based around physical functioning. Patient satisfaction similarly mirrors HRQOL improvements, following an initial dip in the immediate post-operative period.

CONCLUSION: All surgical treatment modalities for the management of lymphoedema confer significant HRQOL improvements across a diverse range of health domains, with this critical outcome of surgery an important pre-operative consideration. Recommendations for ongoing research are suggested.

From histo-anatomy to sonography in lymphedema: EURO-MUSCULUS/USPRM approach

Vincenzo Ricci, Costantino Ricci, Fabrizio Gervasoni, Arnaldo Andreoli, Levent Özҫakar. Eur J Phys Rehabil Med. 2021 Apr 16.

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Real-time electronic patient evaluation of lymphedema symptoms, referral, and satisfaction: a cross-sectional study

Jennifer L Nahum, Mei R. Fu, Joan Scagliola, Martha Rodorigo, Sandy Tobik, Amber Guth, Deborah Axelrod. Mhealth. 2021 Apr 20;7:20. eCollection 2021.

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It was just mind blowing to be honest: a qualitative phenomenological study exploring cancer survivor’s experiences of indocyanine green lymphography used to inform lymphedema therapy management

Amanda Pigott, Emmah Doig, Andrew McCann, Megan Trevethan. Support Care Cancer. 2021 Apr 22. 

PURPOSE: A diagnosis of secondary lymphedema following cancer treatment can necessitate lifelong therapy. Indocyanine green (ICG) lymphography is a technique for visualising lymphatics to enable individualised lymphedema diagnosis, staging and therapy prescription. The participant experience of undergoing the procedure and the impact of imaging findings on lymphedema management is unknown. This study aimed to explore participant’s experiences of ICG lymphography to inform cancer-related lymphedema therapy.

METHODS: A qualitative phenomenological study was conducted using semi-structured interviews with 17 adult participants who had undergone ICG lymphography for stage 0 to 2 upper or lower limb secondary cancer-related lymphedema (International Society of Lymphology, Lymphology 53(1):3-10, 2020).

RESULTS: Seventeen participants were included in the study ranging in age from 36 to 78 years (M = 53.8 years), the majority had a primary diagnosis of breast cancer (N = 7) or melanoma (N = 7). Three overarching themes emerged. Firstly, describing the experience of the ICG lymphography procedure. Secondly, the new knowledge explained symptoms and tailored treatment. Participants reflected on how seeing their lymphatic system helped in understanding about their lymphedema symptoms and guided changes towards more individualised lymphedema management. The final theme described the internal impact of self-knowledge, which included impacts of the new information on empowerment and motivation to self-manage participant’s condition as well as their feelings.

CONCLUSIONS: ICG lymphography had beneficial impacts on participant’s understanding of their lymphedema symptoms and often led to changes in management, positive outcomes in response to management changes and peace of mind about management plans, leading to feeling more empowered to self-manage their condition

Upper limb sensory evaluations and ultrasonographic skin measurements in breast cancer-related lymphedema receiving complex decongestive physiotherapy

Emine Baran, Levent Özçakar, Serap Özgül, Sercan Aksoy, Türkan Akbayrak. Support Care Cancer. 2021 Apr 29. 
PURPOSE: The aims of this study were to investigate if/how the presence of lymphedema affects the sensation of the upper limb and to assess whether complex decongestive physiotherapy (CDP) has a favorable impact on sensory testing.
METHODS: A total of 27 patients with unilateral stage 2 breast cancer-related lymphedema (BCRL) were included in the study. Bilateral circumferential measurements were taken with a tape measure at different levels. Based on these measurements, limb volumes were determined by summing segment volumes derived from the truncated cone formula. Circumferential measurements and ultrasonographic evaluations (epidermis, dermis, and subcutaneous fat thicknesses) were performed at 10 cm distal to the elbow crease. The Semmes-Weinstein monofilament (SWM), static and moving two-point discrimination, pressure pain threshold (PPT), and tactile localization tests were also applied at the same site. After an initial evaluation, all patients underwent CDP phase 1 program. All the evaluations were repeated at the end of the treatment period.
RESULTS: Before CDP, affected sides had significantly higher values than the unaffected sides in terms of SWM (p < 0.001), static (p = 0.002) and moving (p = 0.011) two-point discrimination, PPT (p = 0.001), and tactile localization (p < 0.001) values. After CDP, SWM (p = 0.002), static (p = 0.009) and moving (p = 0.024) two-point discrimination, PPT (p = 0.014), and tactile localization (p < 0.001) values decreased significantly on the affected sides.
CONCLUSION: BCRL seems to reduce light touch, static and moving two-point discrimination, PPT, and tactile localization sensations, whereas CDP seems to improve these sensory perceptions in women with BCRL. Ultrasonographic measurements also appear to be promising for prompt and convenient follow-up in the management of BCRL

Management Strategies

Rethinking decongestive lymphoedema treatment during the pandemic

Jeanne Everett, Sue Lawrance, Natalie Phillips. Br J Community Nurs. 2021 Apr 1;26(Sup4):S16-S22.

During the course of the COVID-19 pandemic, lymphoedema and community clinicians have had to modify how they implement intensive treatments for patients with lymphoedema and chronic oedema. Using novel approaches to treat and move patients towards self-management regimes has enabled patients to be in control of their condition, particularly if they are unable to attend normal clinic appointments. This article explores how using Haddenham easywrap instead of time- and resource-intensive bandaging regimes, alongside the Haddenham LymphFlow Advance, as part of self-management programmes, can benefit patients’ quality of life, reduce costs and resource use and enable patients to self-manage this long-term chronic condition more effectively.

Reducing Circumference and Volume in Upper Extremity Lipedema: The Role of Complex Decongestive Physiotherapy

Melek Volkan-Yazici, Murat Esmer. Lymphat Res Biol. 2021 Apr 5

Objective: The aim of this study is to investigate the effect of complex decongestive physiotherapy (CDP) plus intermittent pneumatic compression (IPC) applications on upper extremity circumference and volume in patients with lipedema.

Methods and Results: All participants included in the study were included in a treatment protocol consisting of CDP and IPC. The Perometer 400 NT was used in the measurement of upper extremity volume and circumference before and after treatment. The measurements were performed in four reference points. According to the Perometer results before and after CDP, statistically significant reduction was found in the circumference of 3 of the 4 points of measurements performed in each of the left and right upper extremities. When the volume assessments were compared, it was seen that statistically significant reduction was found in the volume of both limbs.

Conclusion: A treatment program consisting of CDP and IPC can be effective in reducing the circumference and volume of the arm in patients with upper extremity lipedema. So, CDP applications can help prevent the development of complications such as lipolymphedema, hypertension, and heart failure.

Lymphoedema after head and neck cancer treatment: an overview for clinical practice

Claire Jeans, Bena Brown, Elizabeth C Ward, Anne E Vertigan. Br J Community Nurs. 2021 Apr 1;26(Sup4)

Lymphoedema is a disorder of the lymphatic system that presents as an atypical swelling and accumulation of protein-rich fluid within the interstitial spaces. Head and neck lymphoedema (HNL) is highly prevalent in patients who have been treated for head and neck cancer (HNC) and may manifest externally on the face and neck; internally within the oral cavity, pharynx or larynx; or as a combination of both. HNL is known to contribute to a wide range of physical, functional and psychological issues, and presents several unique challenges in terms of its management. This review article provides an overview of HNL for clinicians and aims to improve awareness of this condition and the impact it has on patients.

Lymphoedema and oedema in palliative care patients

Sinéad Cobbe. Br J Community Nurs. 2021 Apr 1;26(Sup4):S6-S15.
Oedema and lymphoedema commonly occur in patients receiving palliative care. Community nurses frequently manage both in the home or must decide to refer for medical or specialist lymphoedema assessment. This article describes the types of oedema seen in palliative care and assists in clinical reasoning around the type of oedema presented and when to refer onwards. The treatments for palliative care oedema and lymphoedema are described, including how to adapt for complex cases and for patient comfort. Genital swelling, abdominal swelling, head and neck oedema and lymphorrhoea are also discussed

Long-Term Effectiveness of Combined Intermittent Pneumatic Compression Plus Low-Level Laser Therapy in Patients with Postmastectomy Lymphedema: A Randomized Controlled Trial

Erkan Kozanoglu, Neslihan Gokcen, Sibel Basaran, Semra Paydas. Lymphat Res Biol. 2021 Apr 7
Upper limb lymphedema may be revealed after breast cancer and its treatment. Among different treatment approaches, intermittent pneumatic compression (IPC) therapy and low-level laser therapy (LLLT) are reported as effective modalities in the treatment of postmastectomy upper limb lymphedema (PML). The aim of the current study is to investigate the long-term effectiveness of combined IPC plus LLLT versus IPC therapy alone in patients with PML. Methods and Results: The patients were allocated into two groups in this single-blinded, controlled clinical trial. Group I received combined treatment with IPC plus LLLT (n = 21) and group II received only IPC (n = 21). IPC treatment was given 5 sessions per week for 4 weeks (20 sessions). LLLT was also performed 5 sessions per week for 4 weeks (20 sessions). Clinical evaluations were performed before and after the treatment at the 3, 6, and 12-month follow-up visits. According to within-group analysis, statistically significant improvements in the circumference difference (Cdiff) and grip strength were observed in both groups (for Cdiff, p = 0.018 and p = 0.032, respectively; for grip strength, p = 0.001 and p = 0.046, respectively). Visual analog scale values for arm pain and shoulder pain during motion were decreased only in group I. Conclusion: Both interventions have positive effects on lymphedema, grip strength, and pain. Long-term effects of combined therapy, especially on pain, are slightly superior to the pneumatic compression alone.

Study on the Design and Optimization of a Portable Monitoring and Auxiliary Treatment Device for Upper Extremity Lymphedema-Focus on the Rehabilitation Function of the Device

Xue Yanmin, Zhang Xuyang, Yan Wen, Yu Suihuai, Li Sinan. Front Bioeng Biotechnol. 2021 Apr 1;9:656716.
Female patients suffer from the risk of upper limb lymphedema after breast cancer removal surgery. At present, the detection and the adjuvant treatment of this disease are not convenient enough, leading to delay of the disease and increase in the burden of patients. This paper presents a portable monitoring and treatment device for upper extremity lymphedema, enabling patients to monitor the symptoms of upper limb lymphedema and auxiliary rehabilitation. This design utilizes the arm circumference measurement and contrast method to realize symptom monitoring. The device realizes auxiliary rehabilitation using the regional pressure method to imitate traditional manual lymphatic drainage technology. According to the MRI images of volunteers’ upper limbs, the upper arm and forearm’s finite element models are reconstructed in ANSYS. The static simulation experiment is completed. The working mode and parameter design of each rehabilitation module of the device are obtained. The experimental results show that the integrated design principle of monitoring and treatment proposed in this paper has good feasibility, has auxiliary rehabilitation effect, and meets the principle of human comfort. The device can help patients find lymphedema in time and implement auxiliary treatment, which can effectively avoid the further deterioration of lymphedema

Treatment of breast cancer-related lymphedema using negative pressure massage: a pilot randomized controlled trial

Riikka Lampinen, Jeannette Q Lee, Janella Leano, Christine Miaskowski, Judy Mastick, Lisa Brinker, Kimberly Topp, Betty Smoot. Arch Phys Med Rehabil. 2021 Apr 16:S0003-9993(21)00303-8.
OBJECTIVE: Evaluate the efficacy of negative pressure massage treatment (NPMT) compared to manual lymphatic drainage (MLD) in women with chronic breast cancer-related lymphedema (LE). We hypothesized that NPMT would result in greater improvements in LE and upper limb function.
DESIGN: Pilot single-blinded randomized controlled trial (RCT)
SETTING: Health sciences university
PARTICIPANTS: Of 64 women screened, 28 met eligibility requirements (i.e., >18 years of age; completed active treatment for breast cancer; had unilateral arm LE for ≥one year; were not receiving LE care; had stable LE) and were randomized to NPMT (n=15) and control group (n-13).
INTERVENTIONS: Intervention group received NPMT and control group MLD; both received twelve 60-minute sessions over 4-6 weeks.
OUTCOME MEASURE(S): Bioimpedance (L-Dex units), limb volume (ml) calculated from limb circumference, and Disability of Arm, Shoulder, Hand (DASH) questionnaire score.
RESULTS: Outcomes were analyzed for 28 women. Compared to the MLD group, the NPMT group demonstrated greater improvement with large ES in L-Dex scores (p=0.001; standardized mean difference (SMD) =-1.15, 95% CI -1.96 – -0.35) and interlimb volume differences (p=0.038; SMD=-0.83, 95% CI -1.60 – -0.05). Differences in DASH scores were not statistically significant (0.067).
CONCLUSION(S): Compared to MLD, treatment with NPMT resulted in greater improvement in L-Dex scores and interlimb volume differences in women with unilateral upper limb LE of >1-year duration. Our findings need to be confirmed in a larger

Effect of Aqua Therapy Exercises on Postmastectomy Lymphedema: A Prospective Randomized Controlled Trial

Khadra Mohamed Ali, Eid Rizk El Gammal, Hadaya Mosaad Eladl. Ann Rehabil Med. 2021 Apr 14.
OBJECTIVE: To investigate the effect of aqua therapy resistance exercise on arm volume, pain, and shoulder range of movements in post-mastectomy lymphedema.
METHODS: This was a single-blind randomized controlled trial. Fifty eligible breast cancer survivors (median, 10 years after surgery) with lymphedema (median, 21% inter-limb difference) were assigned randomly to group A (n=25) or control group B (n=25). The study group underwent 60 minutes of aqua therapy exercise comprising of warm-up for 10 minutes, 40 minutes of strengthening exercises, and 10 minutes of cooling down, three times a week for 8 weeks. The control group underwent 60 minutes of land-based exercise three times a week for 8 weeks. Arm volume calculated by measuring the arm circumference, shoulder flexion, and abduction range of motion (ROM), and pain using a visual analog scale (VAS) were assessed at baseline and after 8 weeks of treatment.
RESULTS: There was a statistically significant difference in limb volume, shoulder flexion and abduction ROM, and VAS scores in favor of the study group (p<0.001) after 8 weeks of intervention. The mean±standard deviation for limb volume, shoulder flexion, abduction, and pain score were 2,108.71±200.97 mL, 169.68°±4.54°, 150.44°±3.92°, and 3.16±1.1 in the study group and 2,256.41±186.94 mL, 147.36°±5.32°, 131.32°±4.38°, and 5.68±0.94 in the control group, respectively.
CONCLUSION: Adding aqua therapy resistance exercise to routine physical therapy might be more effective in decreasing the limb volume and pain intensity and improving ROM of the shoulder in postmastectomy lymphedema.

Development and Evaluation of a Satisfaction Questionnaire About Therapeutic Textile Devices Used for Breast Cancer-Related Lymphedema

Violeta Pajero Otero, Esther García Delgado, Concepción Martín Cortijo, Virginia Toribio Rubio, María Jesús Guijarro Cano, Cristina Martín-Arriscado Arroba, Juan Avendaño Coy, Consuelo Calvo Bóveda. Lymphat Res Biol. 2021 Apr 26.
Background: There is a need for an appropriate instrument to measure the satisfaction of patients about therapeutic textile devices used for breast cancer-related lymphedema (BCRL).
Methods and Results: A new satisfaction questionnaire about therapeutic textile devices used for BCRL was developed and psychometrically tested. An approach to criterion validity by contrast of hypothesis was made. Different average scores were expected depending on the type of therapeutic textile device: Kinesio taping, compression garment, and multilayer low-stretch bandage. Items were analyzed in nine phases: apparent validity, missing responses, internal consistency, factor analysis, reproducibility, confirmation of factor analysis, contrast of hypothesis, variability, and time for completion. One hundred fifty women were sampled in a consecutive order. A final questionnaire was drafted that fulfilled the validation hypothesis, including 20 items that explored 4 dimensions: mood, patient comfort, patient compliance, and perceived benefits. The total Cronbach’s α was 0.87. The intraclass correlation coefficient was 0.93 for test-retest and 0.91 for inter-rater. Neither ceiling nor floor effects were observed. The average burden for the respondent and interviewer was 5.6 (standard deviation [SD] = 3.8) and 2.2 (SD = 1.3) minutes, respectively.
Conclusion: This preliminary analysis supports the content validity, reliability, and validity of construct of the questionnaire.

Postural differences in the immediate effects of active exercise with compression therapy on lower limb lymphedema

Kiriko Abe, Tetsuya Tsuji, Asako Oka, Junichi Shoji, Michiyo Kamisako, Hiroka Hohri, Aiko Ishikawa, Meigen Liu. Support Care Cancer. 2021 Apr 29.
PURPOSE: Although regarded as an important treatment for lymphedema, the therapeutic effects of active exercise with compression therapy (AECT) are supported by little evidence. The purpose of this study was to determine the relative benefits of AECT with different postures for patients with lower limb lymphedema (LLL).
METHODS: Eighteen women with LLL secondary to surgical treatment of gynecological cancer, completed (1) AECT in a seated position (seated AECT), (2) AECT in a supine position (supine AECT), and (3) compression-only therapy in a supine position (CT) in this randomized, controlled, crossover trial. AECT was performed on a bicycle ergometer while wearing elastic compression bandages. Each intervention was performed for 15 min, and the three conditions were separated by a 1-week washout period. Lower-limb volumes were evaluated using a PerometerTM sensor (Pero-system, Wuppertal, Germany), and symptom severity was assessed before and after each intervention using a visual analog scale (pain, heaviness) and palpation (pitting, stiffness). The effects of the interventions were estimated using linear mixed-effect models.
RESULTS: The magnitude of limb volume decreases differed significantly among the interventions, with a greater decrease after supine AECT than after CT. Pre-intervention pitting severity and skin stiffness were significantly correlated with the magnitude of volume decrease after all interventions and after AECT in the supine position, respectively.
CONCLUSIONS: Supine AECT using a bicycle ergometer has marked immediate effects to decrease the fluid volume of severe LLL.
5th ILF Webinar: Cellulitis in chronic oedemaLipoedema – The Great Debate