ABSTRACT
Background: Lymphedema, which is classified into primary and secondary origin, affects more than 100.000 patients in Japan. The cause for primary lymphedema—including that of congenital origin—is yet unknown. Secondary lymphedema mostly results due to an obstruction of lymph flow caused by surgery or radiotherapy for cancer. Complex Physical Therapy (CPT) has been determined as the standard therapy for lymphedema treatment by the International Society of Lymphology (ISL). CPT comprises skin care, manual lymphatic drainage (MLD), compression and exercises, which only administered in combination results in a maximum treatment effect. At present only prophylactic instructions for cancer patients and reimbursement of fees for compression garments or bandages are part of the health care insurance in Japan. MLD is not covered by insurance. This study was conducted with the aim to prove the effect of MLD as a single-modality therapy and to contribute to the process of getting MLD covered as health care insurance treatment. Methods: In 72 patients (mean age 60.46±13.00 years) with lymphedema of the extremities only, MLD was administered for 45 minutes in upper extremities and 60 minutes in lower extremities. Treatment effect was examined through measurement of volume change of the affected side before and after treatment. Data was processed statistically by normal distribution and Wilcoxon signed rank test. Result: Edema volume reduction in all patients (n=72) was 69.20ml±93.00ml (p<0.000), for upper extremities (n=16) 26.20ml±45.99ml (p<0.039) and lower extremities (n=56) 81.40ml±99.50ml (p<0.000). In the intensive treatment phase (Phase 1) volume was reduced in twelve patients (n=12) by 112.50ml±118.78ml (p=0.005) and in the maintenance phase (Phase 2) in sixty patients (n=60) by 60.50ml±85.56ml (p<0.000). Phase 2 patients were further separated into stages. Volume in Stage I (n=9) patients was reduced by 75.00ml±98.14ml (p=0.038) and in Stage II (n=46) patients by 56.90ml±88.17ml (p<0.000). Numbers for Stage 0 and III patients were less than five and therefore excluded from analysis. Conclusion: This study showed that edema volume of the affected extremity was statistically significantly reduced after MLD treatment. Based on this result, MLD including Complex Physical Therapy should be recommended to become part of the health insurance plan.
ABSTRACT
<B>Background:</B> Lymphedema, which is classified into primary and secondary origin, affects more than 100.000 patients in Japan. The cause for primary lymphedema—including that of congenital origin—is yet unknown. Secondary lymphedema mostly results due to an obstruction of lymph flow caused by surgery or radiotherapy for cancer. Complex Physical Therapy (CPT) has been determined as the standard therapy for lymphedema treatment by the International Society of Lymphology (ISL). CPT comprises skin care, manual lymphatic drainage (MLD), compression and exercises, which only administered in combination results in a maximum treatment effect. At present only prophylactic instructions for cancer patients and reimbursement of fees for compression garments or bandages are part of the health care insurance in Japan. MLD is not covered by insurance. This study was conducted with the aim to prove the effect of MLD as a single-modality therapy and to contribute to the process of getting MLD covered as health care insurance treatment.<BR><B>Methods:</B> In 72 patients (mean age 60.46±13.00 years) with lymphedema of the extremities only, MLD was administered for 45 minutes in upper extremities and 60 minutes in lower extremities. Treatment effect was examined through measurement of volume change of the affected side before and after treatment. Data was processed statistically by normal distribution and Wilcoxon signed rank test.<BR><B>Result:</B> Edema volume reduction in all patients (n=72) was 69.20ml±93.00ml (p<0.000), for upper extremities (n=16) 26.20ml±45.99ml (p<0.039) and lower extremities (n=56) 81.40ml±99.50ml (p<0.000). In the intensive treatment phase (Phase 1) volume was reduced in twelve patients (n=12) by 112.50ml±118.78ml (p=0.005) and in the maintenance phase (Phase 2) in sixty patients (n=60) by 60.50ml±85.56ml (p<0.000). Phase 2 patients were further separated into stages. Volume in Stage I (n=9) patients was reduced by 75.00ml±98.14ml (p=0.038) and in Stage II (n=46) patients by 56.90ml±88.17ml (p<0.000). Numbers for Stage 0 and III patients were less than five and therefore excluded from analysis.<BR><B>Conclusion:</B> This study showed that edema volume of the affected extremity was statistically significantly reduced after MLD treatment. Based on this result, MLD including Complex Physical Therapy should be recommended to become part of the health insurance plan.
ABSTRACT
PURPOSE: The purpose of this study was the development of a comprehensive nursing intervention program for the client with acute lymph stasis and stage I lymphedema. METHOD: The Quasi-experimental design using a non-equivalent control group was used. The subjects were 22 stroke patients with lymph stasis in the control group and 23 patients in the experimental group. The complex physical therapy of Casley-Smith was carried out to the control group for 10 hours, and comprehensive nursing intervention for the experimental group was carried out for 60 minutes. The data for this study was gathered from Feb. 2002 until June 2002 and pertains knowledge about lymphedema, self-care for managing lymphedema, and circumferences of affected limbs. Data was analyzed by mean, standard deviation, x2-test, and t-test. RESULT: The changes in knowledge about lymphedema, self-care practices, and circumference of affected limbs after nursing intervention did not show significant differences between control group and experiment group. CONCLUSION: It can be concluded that comprehensive nursing intervention had more efficiency than complex physical therapy in the treatment of edema for stroke patients because of it's simplicity and time saving. Thereby, the comprehensive nursing intervention program developed in this study would be a useful therapy for the clients with lymph stasis and early stage lymphedema.
Subject(s)
Humans , Edema , Extremities , Lymphedema , Nursing , Self Care , StrokeABSTRACT
OBJECTIVE: Lymphoscintigraphy is the diagnostic test of choice in patients with suspected lymphedema. This reveals functional information rather than anatomic details. We evaluated the improvement of lymphatic function after complex physical therapy(CPT) in patients with lymphedema via lymphoscintigraphic follow-up examination. METHOD: In 19 lymphedema patients(22 extremities) regardless of etiology, lymphoscintigraphy using Tc-99m antimony sulfide colloid was performed before and 3-month after CPT. Main lymphoscintigraphic findings of lymphedema and lymphoscintigraphic changes after CPT were evaluated. RESULTS: Main lymphoscintigraphic findings of lymphedema were the presence of dermal backflow(100%) and collateral vessels(68.2%), non-visualized or barely visualized lymph nodes (95.5%), and non-visualized or barely visualized lymphatic vessels(27.3%). The findings of lymphoscintigraphy suggesting improvement of lymphatic function after CPT were decreased dermal backflow(72.7%), increased radioisotope uptake of lymph nodes(9.1%) and increased radioisotope uptake of lymphatic vessels(27.3%). Increased dermal backflow itself with decreased total tissue pressure after CPT was not the finding implying deterioration of lymphatic function. There was no constant correlation between clinical improvement and lymphoscintigraphic improvement. CONCLUSION: The lymphoscintigraphic follow-up examination combined with volumetry is useful in assessing the improvement of lymphatic function in lymphedema.
Subject(s)
Humans , Antimony , Colloids , Diagnostic Tests, Routine , Follow-Up Studies , Lymph Nodes , Lymphedema , LymphoscintigraphyABSTRACT
Complex Physical Therapy (CPT) is one of the variable conservative methods of lymphedema and recently used in many countries with great success. The main concept of CPT is to improve central lymph flow by opening non-functioning lymphatic pathway and by stimulating collateral lymphatic channels to drain the swollen area into adjacent areas where lymph flow is normal. CPT consists of 4 main parts; 1. meticulous skin care, 2. manual lymph drainage, 3. multilayered non-stretching compression bandages and compression garments, 4. special exercise. We tried to assess the immediate and maintenance effects of CPT in patients with lymphedema. CPT was used on 25 patients (male 5, female 20) with 10 upper and 15 lower extremity edemas for 2weeks such as 5 days per week, 1.5 hours per day at out-patient clinic. Immediately, the reduction of edema volume was 25.5+/-13.8% at the upper extremity and 27.5+/-15.5% at lower extremity in 2 weeks after treatment. All these were well maintained following 3 months without any significant variation. In comparison between proximal and distal parts, there was no significant difference except the immediate post-treatment result of the lower extremity. But the maintenance of volume reduction of distal part was better than proximal part through 3 months after treatment. We also found the reduction of skin subcutaneous thickness according to the volume reduction. In conclusion, CPT is a effective treatment method for patients with lymphedema but follow up study will be needed for identifying long term maintenance effect.