Predicting the Effect of Stellate Ganglion Block on the Lymphoscintigraphic Findings for Lymphedema in Post-Mastectomy Patients

OBJECTIVE: To evaluate the effect of stellate ganglion block (SGB) on the lymphoscintigraphic findings in patients with secondary lymphedema after breast cancer treatment. METHOD: Fourteen patients were included in this retrospective study. Consecutive SGBs were performed three times, once every two weeks. The parameters for the lymphoscintigraphic findings included the extent of dermal backflow (small extent/large extent group), the presence of a washout pattern (washout/non-washout group) and visualization of lymph nodes on the 3-hour image (visualized/non-visualized group). The upper arm and forearm circumferences were used as the outcome parameters. We investigated the relationship between the lymphoscintigraphic findings and the arm circumferences. RESULTS: Regardless of the extent of dermal backflow, significant decreases of the upper arm and forearm circumferences were observed between the initial and final follow-up data. The small extent group showed a significant decrease of the forearm circumference at the first follow-up. The large extent group showed a pattern of significant decrease of the forearm circumference since the second follow-up. The washout group showed a decrease in both the upper arm and forearm circumferences, while the non-washout group showed a decrease only in the forearm circumference at the last follow-up. No difference was observed between the visualized and the non-visualized group. CONCLUSION: The extent of dermal backflow and the presence of a washout pattern on lymphoscintigraphy showed correlation with the change of arm circumference. Lymphoscitigraphy prior to performance of SGB for lymphedema patients might be helpful to predict the outcome of SGB.

Physical Therapists' Recognition about Home-Based Rehabilitation Therapy Services

BACKGROUND: We were interested in getting feedback from physical therapists practicing in individualized home health programs about the present situation and the problems of home-based rehabilitation therapy services. METHODS: We recruited 110 physical therapists practicing in individualized home-visiting health programs offered at health centers. They each completed a 15-item self-administered questionnaire including personal information, therapy environments, characteristics of patients, treatment outcomes and suggestions. RESULTS: Of the 110 respondents, 66 (60%) were engaged in home-based rehabilitation therapy services with other duties. Sixty (54.5%) indicated that >25% of patients improved with home-based therapy and 90% of patients were satisfied with the services they received. Eighty-three (75.5%) respondents indicated that the amount of therapy provided was insufficient, 82 (74.5%) thought that there were no measurement tools to use except for the rehabilitation therapy services records and 27 (24.6%) had evaluation meetings with other medical service members for >50% of their patients. CONCLUSION: The majority of the physical therapists in our study indicated that the home-based rehabilitation therapy services satisfied the needs of patients and improved their functional abilities. However, amount of therapy, use of measurement tools for outcome evaluations and comprehensive team approach were indicated as insufficient. We conclude that increasing the number of physical therapists and systematizing the home-based rehabilitation therapy services would improve the present situation.