What is the best method to determine excessive arm volume in patients with breast cancer–related lymphoedema in clinical practice? Reliability, time efficiency and clinical feasibility of five different methods
Tessa De Vrieze1,2 , Nick Gebruers2,3, Wiebren AA Tjalma3,4,5, Ines Nevelsteen6, Sarah Thomis7, An De Groef1 , Lore Dams1,2, Elien Van der Gucht1,2, Jean-Paul Belgrado8, Liesbeth Vandermeeren8 and Nele Devoogdt1,7. Clinical Rehabilitation 2019, Vol. 33(7) 1221 –1232
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What is the best method to determine excessive arm volume in patients with breast cancer–related lymphoedema in clinical practice? Reliability, time efficiency and clinical feasibility of five different methods
Tessa De Vrieze1,2 , Nick Gebruers2,3, Wiebren AA Tjalma3,4,5, Ines Nevelsteen6, Sarah Thomis7, An De Groef1 , Lore Dams1,2, Elien Van der Gucht1,2, Jean-Paul Belgrado8, Liesbeth Vandermeeren8 and Nele Devoogdt1,7. Clinical Rehabilitation 2019, Vol. 33(7) 1221 –1232
Objective: To investigate the reliability, time efficiency and clinical feasibility of five commonly used methods for assessing excessive arm volume in patients with breast cancer–related lymphoedema (BCRL). Design: Cross-sectional study. Setting: University Hospitals Leuven, Belgium. Subjects: 30 participants with unilateral BCRL.
Methods: Excessive arm volume was determined by five different methods: traditional volumetry with overflow, volumetry without overflow, inverse volumetry, optoelectronic volumetry and calculated volume based on circumference measurements. To investigate intra- and inter-rater reliability, measurements were performed twice by the same assessor and once by a different assessor. Intraclass correlation coefficients (ICCs), standard errors of the measurement (SEMs) and systematic changes between the means were calculated. To determine time efficiency, the mean setup time, execution time and total time were examined for each method. Furthermore, 12 limitations regarding clinical feasibility were listed and scored for each method. Finally, an overall ranking score was determined between the methods.
Results: Mean age was 65 (±8) years and mean body mass index was 28 (±4) kg/m2. Intra- and interrater reliability ranged between strong and very strong. Calculated arm volume based on circumferences (mean excessive arm volume: assessor A: 477 (±367) mL; assessor B: 470 (±367) mL; assessor A (second time): 493 (±362) mL) showed the highest intra- and inter-rater ICCs of .987 and .984, respectively. Optoelectronic volumetry was the fastest method, representing a mean total time of 1 minute and 43 (±26) seconds for performing a bilateral measurement. The least limitations were reported on the calculated volume based on the circumference method (3 out of 12 limitations).
Conclusion: Calculated volume based on arm circumferences is the best measurement method for evaluating excessive arm volume over time in terms of reliability, low error rate, low cost, few limitations and the time spent.
Main findings
- Small sample size N =30
- Measurements compared were:
- Traditional volumetry with overflow, in which the overflow of water is weighed;
- Volumetry without overflow, in which the volume of the upward displaced water is weighed when submerging the limb in the recipient;
- Inverse water volumetry, an alternative method for determining arm volume whereby the shortness of water is measured;
- Optoelectronic volumetry (or perometry), a method that makes use of an optoelectronic infrared device to detect volume differences (without considering hand volume);
- Calculated volume based on circumference measurements, whereby the total arm volume (without considering hand volume) can be calculated using geometric formulas, such as the truncated cone formula.
- In this study, optoelectronic volumetry showed the least total time required to complete a bilateral measurement (1 minute 42 seconds on average).
- In terms of reliability, low error rate, low cost, few limitations and time efficiency, volume calculation based on arm circumferences is the best measurement method for evaluating excessive arm volume in patients with BCRL over time in clinical practice. All five investigated methods showed good to very good reliability.
- Since the calculated arm volume based on the circumference method does not include an evaluation of hand volume, therapists should measure this separately, for instance, by making use of a hand volumeter30 or the figure-of-eight method.
