Résumé
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.
Résumé
<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.