Hot off the Press February 2023
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
Lymphatic endothelial cell RXRα is critical for 9-cis-retinoic acid-mediated lymphangiogenesis and prevention of secondary lymphedema - click for abstract
Lymphatic endothelial cell RXRα is critical for 9-cis-retinoic acid-mediated lymphangiogenesis and prevention of secondary lymphedema
Physiological Roles of Lymph Flow-Mediated Nitric Oxide in Lymphatic System - click for abstract
Physiological Roles of Lymph Flow-Mediated Nitric Oxide in Lymphatic System
The Vicious Circle of Stasis, Inflammation, and Fibrosis in Lymphedema - click for abstract
The Vicious Circle of Stasis, Inflammation, and Fibrosis in Lymphedema
The Lymphatic System, Lymphoedema, and Medical Curricula-Survey of Australian Medical Graduates
Keratinocytes coordinate inflammatory responses and regulate development of secondary lymphedema
Prevalence and Risk Factors
Association of lower extremity lymphedema with pelvic floor functions, sleep quality, kinesiophobia, body image in patients with gynecological cancers - click for abstract
Association of lower extremity lymphedema with pelvic floor functions, sleep quality, kinesiophobia, body image in patients with gynecological cancers
Prevention of breast cancer-related lymphoedema: Quality of clinical practice guidelines and variations in recommendations - click for abstract
Prevention of breast cancer-related lymphoedema: Quality of clinical practice guidelines and variations in recommendations
Aim: We aimed to evaluate the quality of clinical practice guidelines (CPGs) for breast cancer related lymphoedema (BCRL) and compare the similarities and differences in recommendations.
Background: Many CPGs of BCRL have been developed; however, their recommendations and quality are controversial.
Methods: Relevant papers were retrieved from electronic databases, professional associations and guideline development organizations, from 1 January 2015 to 30 September 2021. The Appraisal of Guidelines Research and Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. Intraclass correlation coefficient (ICC) analysis was used to evaluate the overall consistency among evaluators.
Results: Eight CPGs were included. The ICC values evaluation for CPGs ranged from 0.76 to 0.95, with good consensus among evaluators. The highest median score was 68.75% (61.46, 72.22%) for clarity, and the lowest was 37.50% (25.78, 51.30%) for applicability. The NICE, ACS/ACSO and APTA CPGs were rated well in most areas. Professional health education, individualized exercise programme and regular surveillance are the main methods to prevent lymphoedema.
Conclusion: In the past 6 years, the quality of BCRL guidelines has varied greatly, especially in the domains of rigour and applicability. Interrater agreement was excellent, but recommendation showed some inconsistencies in the details.
Association between Immediate Breast Reconstruction and the Development of Breast Cancer-Related Lymphedema - click for abstract
Association between Immediate Breast Reconstruction and the Development of Breast Cancer-Related Lymphedema
Prevention of lymphoedema after axillary clearance by external compression sleeves PLACE randomised trial results. Effects of high BMI
Do Patient-Reported Upper-Body Symptoms Predict Breast Cancer-Related Lymphoedema: Results from a Population-Based, Longitudinal Breast Cancer Cohort Study
Assessment
The agreement between three classification systems used to grade the severity of lymphedema in patients with upper and lower extremity lymphedema: A retrospective study - click for abstract
The agreement between three classification systems used to grade the severity of lymphedema in patients with upper and lower extremity lymphedema: A retrospective study
Circumferential Measurements to Calculate Lower Limb Volume in Persons with Lymphedema: What Segment Length Is to Be Recommended? - click for abstract
Circumferential Measurements to Calculate Lower Limb Volume in Persons with Lymphedema: What Segment Length Is to Be Recommended?
Does Fear of Movement Affect Fatigue and Quality of Life in Lower Extremity Lymphedema? - click for abstract
Does Fear of Movement Affect Fatigue and Quality of Life in Lower Extremity Lymphedema?
Current Diagnostic Tools for Breast Cancer-Related Lymphedema - click for abstract
Current Diagnostic Tools for Breast Cancer-Related Lymphedema
Early Referral for Breast-Cancer-Related Lymphedema: Do We Follow the Evidence? A Two-Year Prospective Multicenter Cohort Study
A qualitative systematic review and meta-aggregation of the experiences of men diagnosed with chronic lymphoedema
Bioimpedance spectroscopy for breast cancer-related lymphedema assessment: clinical practice guidelines
Algorithm-Based Risk Identification in Patients with Breast Cancer-Related Lymphedema: A Cross-Sectional Study
Management Strategies
Acute Effects of Manual Lymphatic Drainage and Compression with Exercise Therapy on Breast Lymphedema Following Breast-Conserving Surgery and Radiotherapy- click for abstract
Acute Effects of Manual Lymphatic Drainage and Compression with Exercise Therapy on Breast Lymphedema Following Breast-Conserving Surgery and Radiotherapy
Comparison of compression therapy use, lower limb wound prevalence and nursing activity in England: a multisite audit - click for abstract
Comparison of compression therapy use, lower limb wound prevalence and nursing activity in England: a multisite audit
Objective: This audit was designed to identify the need of the population and the clinical activity associated with wounds and the management of lower limb swelling. The exploration focused on lower leg wound management, access to diagnostics and compression therapy across each audit site. The variation across the sites was explored to gather insight into the real-world barriers to providing evidence-based management for leg ulceration.
Method: We undertook wound prevalence audits across six diverse community provider sites in England. The audit was undertaken by the local providers, with the inclusion of tissue viability and podiatry leads and key local stakeholders, often local quality leads, primary care leads and nursing directors. Each audit was undertaken with full engagement of local clinicians. Data were collected centrally, and each audit site received their own local analysis and report, with additional analytical support from the local tissue viability lead to ensure the feedback was contextualised for their stakeholders. Analysis was provided by Accelerate CIC Lymphoedema & Leg Ulcer Clinic.
Results: A total of 2885 patients were reviewed via an online or a paper audit tool. In total, 2721 patients had one or more active wounds. However, 1350 patients had one or more lower leg wounds, with 164 patients being managed for lower limb swelling or prevention of leg ulceration; bilateral conditions ranged from 11-43% across audit sites. Of the six sites, two included both community and primary care providers, thus generating wound point prevalence data. The remaining four sites audited community nursing and podiatry services only, with two sites collecting data on lower limb wounds only rather than all wounds, generating point prevalence for their services only. Compression usage varied across care locations, with the greatest use being seen in community leg ulcer clinics, where it was >96% for 234 residents. Compression usage was lower in the home with a range of 14-62% among 692 residents. For 263 residents, where the cause of their lower leg wound was unknown, compression usage was very low at 12%. Compression usage decreased with age; for three audit sites this was noteworthy, with 65% of those aged >80 years not in receipt of compression. Compression usage had a direct impact on nursing activity; non-use of compression increased activity by 37%.
Conclusion: Through the identification of wound location, this series of wound prevalence audits identified a greater number of patients with lower limb wounds than those recognised and classified as a leg ulcer. Substantial variation in access to diagnostics and compression therapy was observed between audit sites, and also between locations within their boroughs. The factors that reduced access to compression therapy included not classifying the lower leg wound as a leg ulcer, being cared for in the home and increasing age of the patient. Lack of compression usage increased nursing activity. Where there is lack of access to therapeutic intervention, the resultant patient harm is not systematically recognised or documented.
Use a wrap instead: using compression wraps in lymphoedema and venous disease - click for abstract
Use a wrap instead: using compression wraps in lymphoedema and venous disease
Lymphoedema is more than ‘swollen legs’; it is an unpleasant condition that affects approximately 260 000 people in the UK. This article briefly looks at what the lymphatic system is and what lymphoedema is. It then looks at compression wraps and argues for wider use with patients, as they can promote self-care in patients.
The effect of complex decongestive therapy on spatio-temporal parameters and balance in women with breast cancer-related upper extremity unilateral lymphedema - click for abstract
The effect of complex decongestive therapy on spatio-temporal parameters and balance in women with breast cancer-related upper extremity unilateral lymphedema
Effect of Neural Tissue Mobilization on Sensory-Motor Impairments in Breast Cancer Survivors with Lymphedema: An Experimental Study - click for abstract
Effect of Neural Tissue Mobilization on Sensory-Motor Impairments in Breast Cancer Survivors with Lymphedema: An Experimental Study
Practice patterns of physical therapists and physical therapist assistants treating patients with breast cancer related lymphedema - click for abstract
Practice patterns of physical therapists and physical therapist assistants treating patients with breast cancer related lymphedema
Selecting appropriate compression for lymphedema patients: American Vein and Lymphatic Society position statement
The Randomized Controlled Study of Low-Level Laser Therapy, Kinesio-Taping and Manual Lymphatic Drainage in Patients With Stage II Breast Cancer-Related Lymphedema
Evaluating the cost of managing patients with cellulitis in Wales, UK: A 20-year population-scale study