Quality of Life Improvements in Patients with Lymphedema After Surgical or Nonsurgical Interventions with 1-Year Follow-Up

Pia Klerna¨s, RPT, PhD,1,2 Aina Johnsson, MSW, PhD,3,4 John Boyages, MBBS, PhD,5 Ha˚kan Brorson, MD, PhD,6,7 Alex Munnoch, MBChB, FRCSEd(Plast),5,8 and Karin Johansson, RPT, PhD1. Lymphatic Research Biology, 2019

Abstract

Quality of Life Improvements in Patients with Lymphedema After Surgical or Nonsurgical Interventions with 1-Year Follow-Up

Pia Klerna¨s, RPT, PhD,1,2 Aina Johnsson, MSW, PhD,3,4 John Boyages, MBBS, PhD,5 Ha˚kan Brorson, MD, PhD,6,7 Alex Munnoch, MBChB, FRCSEd(Plast),5,8 and Karin Johansson, RPT, PhD1. Lymphatic Research Biology, 2019.

Background: Lymphedema may impact patients’ health-related quality of life (HRQoL). The purpose of this study was to evaluate HRQoL after two different treatments to the 12-month follow-up point.

Methods and Results: Study participants were patients with moderate lymphedema in the upper or lower limb who attended a Swedish rehabilitation program (RP) undergoing conservative treatment, or those with severe, chronic lymphedema dominated by excess adipose tissue, who underwent liposuction (LS) combined with controlled compression therapy (CCT) in Australia, Scotland, or Sweden. The patients completed the Lymphedema Quality of Life Inventory (LyQLI) before intervention and after 1, 3, 6, and 12 months. Mean values and standard deviations were calculated for total limb volume and excess limb volume. Mean values were also calculated for the three LyQLI domains (physical, psychosocial, and practical). To detect and analyze differences in LyQLI responses in the three domains, the Wilcoxon signed rank test was performed. In the RP, 18 eligible patients completed the LyQLI. The results show improvements in HRQoL in physical (p=0.003) and psychosocial domains (p=0.002) at 1 month after the RP, with results remaining steady for 12 months for the physical domain (p=0.024). Fifty-seven eligible LS patients completed the LyQLI. The results show improvements in HRQoL in all three domains (p<0.001), with results remaining steady up to the 12-month follow-up (p<0.001). The total volume in affected limb and the excess volume decreased significantly in both patient groups 1 month after intervention (p<0.001).

Conclusions: Treatment with a conservative RP in moderate lymphedema or with LS combined with CCT in severe lymphedema improves HRQoL.

Main findings

  • The main purpose of this study was to examine changes in HRQoL in patients with lymphedema before and after two different lymphedema treatments up to 12 months after intervention. A second purpose was to evaluate the effect of the interventions on lymphedema and lymphedema-related concerns (identified as high-impact factors).
  • Rehabilitation program. In this study, patients diagnosed with pitting lymphedema in the upper or lower limb are defined as moderate lymphedema. The program included the most common components in CDT,16 such as MLD, skin care, and multilayered bandaging, which were performed individually every day during the week. The RP was performed 5 days a week, 5–6 hours per day in 2 or 3 weeks depending on the severity of the lymphedema. Other important components in the program were water-based exercises, weightlifting, Nordic walking, and relaxation exercises (e.g., yoga), with each activity performed once or twice a week in group settings. The program also included lectures about the lymphatic system, ergonomic matters depending on part of body with lymphedema, information about different kinds of garments, dietary information, and self-care instructions. At the end of the program the lymph therapists usually supplied the patients with new compression garments.
  • Patients who were operated on, had chronic lymphedema and had been treated conservatively, and thus showed minimal pitting (5–6mm), and were in this study defined as severe lymphedema.
  • Measurements included Lymphedema Quality of Life Inventory, Clinical–sociodemographic characteristics questionnaire, Visual analogue scale for tension and heaviness, cylinder form method for the rehab program the volume of the extremities was calculated using the cylinder form method with circumferential measurements taken at 4cm intervals and the contralateral arm/leg as control on each occasion. Truncated cone method to establish volume for patients in Australia and Scotland where as in Sweden water displacement was used.
  • Treatment with a conservative RP in moderate lymphedema or LS combined with CCT in severe lymphedema increases HRQoL in patients with limb lymphedema. The improvements were found in all three domains (the physical, psychosocial, and practical domain) of the LyQLI. The results remained stable in the physical domain in the RP patients and in all three domains in the LS patients up to the 12-month follow-up. For the LS patients, the percentage that experienced high impact on HRQoL decreased from 45% to 19% at 6 months to 5% at 12 months, indicating a sustainable impact on HRQoL.