Investigation of physical activity, fear of falling, and functionality in individuals with lower extremity lymphedema

Reliability and validity of skin elasticity meter to measure skin mechanical properties in patients with lower extremity cancer-related edema

[Purpose] This study aimed to clarify the reliability and validity of a skin elasticity meter for evaluating the skin mechanical properties. [Participants and Methods] We conducted a prospective observational study using data from 35 patients diagnosed with unilateral lower extremity edema caused by cancer-related. We evaluated the skin's mechanical properties (relative parameter; R0, distensibility; R2, gross elasticity; R5, net elasticity; R6, viscoelasticity; R7, biological elasticity) of the thigh and lower leg using a skin elasticity meter. Intra-rater reliability was calculated using interclass correlation (ICC). Validity was also examined by comparing the edema and non-edema sides of the data obtained using a skin elasticity meter and correlating them with the circumferential diameter difference. [Results] ICC values ranged from 0.787 to 0.997 for each site. A significant difference in skin mechanical properties (offset + R0, R2, R6, and R7) of the upper extremities was observed between the lymphedema and non-lymphedema groups. A correlation was found between the R0 + offset between the R0 + offset parameter and the difference in circumference. [Conclusion] This study suggested that the skin elasticity meter is a reliable and valid method for evaluating the mechanical properties of the skin in patients with lower extremity cancer-related edema.

Validity and reliability study of the Turkish version of the Lower Extremity Functional Scale in elderly adults

BACKGROUND

The World Health Organization's disability and health model implicates activity limitation based on the International Classification of Functioning, Disability, and Health (ICF). The Lower Extremity Functional Scale (LEFS) was developed in the framework of the ICF to define the functional status of the lower extremities as an important indicator of the health, activity, and participation of the elderly.

OBJECTIVE

To analyze the psychometric properties of the Turkish version of LEFS (LEFS-T) in older individuals.

METHODS

A total of 214 older individuals were included in the study and the LEFS-T, Five-Times-Sit-to-Stand Test (FTSTS), and Falls Efficacy Scale-International (FES-I) were administered. Reliability and validity were evaluated according to Cronbach's alpha internal consistency coefficients (ICC), spearman correlation analysis, and confirmatory factor analysis (CFA).

RESULTS

LEFS-T was feasible, had good internal consistency (0.93), good reliability (ICC = 0.98), good construct, and discriminant validity, and showed no floor or ceiling effects. The results of CFA are at excellent levels (Root Mean Square Error of Approximation = 0.004, Goodness of Fit = 0.974, Comparative Fit Index = 0.991, Non-Normed Fit Index = 0.990). For construct validity, LEFS-T showed a better correlation with FTSTS (r = -0.555, p < 0.001) and FES-I (r = -0.756, p < 0.001).

CONCLUSION

The Turkish version of LEFS has good psychometric properties to evaluate functional capacity in older adults without lower extremity musculoskeletal disorders. LEFS-T can be used in future studies to evaluate and follow changes in lower extremity functional capacity as well as strength problems and fall prevention interventions, as it is a valid, reliable, and easily applicable scale with self-report.

The effect of exercise in patients with lower limb lymphedema: a systematic review

PURPOSE

To summarize the evidence of the immediate and long-term effect of exercise interventions in patients with either primary or secondary lower limb lymphedema (LLL) on health-related quality of life (HR-QOL), physical function, self-reported symptoms, lower limb volume, and adverse events.

DESIGN

Systematic review following the guidelines from the Cochrane Handbook of Systematic Reviews of Interventions.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov.

ELIGIBILITY CRITERIA

Prospective exercise trials investigating exercise interventions as a single- or multicomponent programme in patients with LLL including assessment of at least one of the following outcomes: HR-QOL, self-reported LLL symptoms (heaviness, tension, and pain), physical function, or lower limb volume. Randomized controlled trials (RCTs), single-group studies, and cross-over trials were eligible. Trials with participants at risk of LLL or a diagnosis of filariasis or lipedema were excluded.

RESULTS

Twelve studies were included: three RCTs, five single-group studies, and four cross-over trials with a total of three hundred and sixty-seven participants. In patients with LLL, irrespective of severity, exercise seemed to have small but positive effects on HR-QOL, physical function, pain, and lower limb volume. Quality assessment showed high risk of bias. Large heterogeneity in participants, interventions, and outcome measures hinders performing of meta-analyses.

INTERPRETATION

Based on a small number of studies with large clinical heterogeneity, poor methodological quality, hence low level of certainty of evidence, it was not possible to provide evidence-based recommendations on exercise for patients with LLL.

Incidence of lymphedema among adults with cerebral palsy

BACKGROUND

Lymphedema is a chronic and progressive condition but is understudied among adults with cerebral palsy (CP).

OBJECTIVE

To compare the 2-year incidence of lymphedema between adults with versus without CP before and after accounting for multimorbidity, cancer diagnosis/treatment, and lymph node/channel surgery.

DESIGN

Retrospective cohort study.

SETTING

Nationwide commercial claims data from January 1, 2011 to December 31, 2017.

PARTICIPANTS

Adults ≥18 years old with and without CP with at least 12 months of continuous health plan enrollment, defined as the baseline period, were included for analysis. The 12-month baseline period was used to establish information on preexisting lymphedema (for exclusion), presence of cancer, including radiation treatment and lymph node surgery, and the Whitney Comorbidity Index (WCI).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

The 2-year incidence rate (IR) and IR ratio (IRR) of lymphedema were evaluated. Cox regression estimated the hazard ratio (HR) of 2-year lymphedema after adjusting for age, gender, WCI, cancer diagnosis/treatment, and lymph node/channel surgery.

RESULTS

The 2-year IR of lymphedema was 5.73 (95% confidence interval [CI] = 4.59-6.88) for adults with CP (n = 9922) and 1.81 (95% CI = 1.79-1.83) for adults without CP (n = 12,932,288); the IRR was 3.17 (95% CI = 2.59-3.87) and the adjusted HR was 2.43 (95% CI = 1.98-2.98). There was evidence of effect modification by gender, age, and WCI score. All HRs were elevated, but men with versus without CP had higher HRs than women with versus without CP; HRs for adults with versus without CP were higher for younger participants and those with lower WCI scores.

CONCLUSIONS

Adults with CP had a higher 2-year rate of lymphedema compared with those without CP. Men with CP had a disproportionately higher rate than women with CP when compared with their gender-based reference cohorts without CP.

Objective Assessment of the Cardiorespiratory Fitness Among Individuals With Lymphedema and Lipedema: A Systematic Review and Meta-Analysis

Background: One of the main challenges in managing lymphedema and lipedema is the lack of valid and reliable objective measures for diagnosis and follow-up. This study was aimed at gathering evidence regarding the objective measures of cardiorespiratory fitness (CRF) among these populations. Methods: Scopus, PubMed, and Embase were searched for observational studies investigating the objective measures of CRF among individuals with lipedema and lymphedema. Both primary and secondary lymphedema were included. Different CRF measures reported by the included articles were determined, and the main outcomes regarding these measurements were extracted. The meta-analysis was performed to compare the pooled mean 6-min walk test (6MWT) between individuals with lower limb lymphedema and lipedema using STATA software (Version 17.0). Results: Eight articles were included, and the majority of participants were female. Four distinct objective measures of CRF were reported among the included articles, including hemodynamic indices, spirometry indices, VO2 peak, and 6MWT. The mean VO2 peak was significantly lower among women with breast cancer-related lymphedema; however, there was no correlation between affected limb volumes and the VO2 peak. The meta-analysis revealed a lower mean 6MWT among individuals with lipedema compared to lymphedema (pooled difference: 37.71 [confidence interval (CI): 5.19-70.22], p value: 0.02, I 2: 0%). Also, there was a significant relationship between 6MWT and subjective measures of CRF, such as the Short Form 36 (SF-36) physical function score, in one included article. Conclusion: While limited evidence exists on the objective measures of CRF among individuals with lymphedema and lipedema, there might be a significant difference in 6MWT between these two groups.

Evaluation of Respiratory Function, Respiratory Muscle Strength, Physical Activity, and Functionality in Patients with Lower Extremity Lymphedema

Background: Lymphedema is a chronic, progressive condition that has major physical and psychological consequences. It was aimed to examine the respiratory functions, respiratory muscle strength, physical activity level, and functionality of patients with lower extremity lymphedema and to compare them with healthy controls. Methods and Results: A total of 82 individuals (29.3% male, 70.7% female, with a mean age of 49.89 ± 15.07 years) with lower extremity lymphedema (Group 1) and healthy individuals (Group 2) were included. Respiratory functions of the participants were evaluated by spirometry, respiratory muscle strength by maximum oral pressure measurements, physical activity levels using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), functionality by Lower Extremity Functional Scale (LEFS) and Timed Up and Go test (TUG test). All respiratory function test measurements were lower in mean Group 1 than in Group 2 (p < 0.05). While inspiratory muscle strength did not differ between the groups (p > 0.05), expiratory muscle strength was lower in Group 1 than Group 2 (p < 0.05). Although spent time and energy for sitting were higher in Group 1 (p < 0.05), IPAQ vigorous-, moderate-, and light-intensity physical activity (MET-min/week) and IPAQ-total score did not differ between groups (p > 0.05). In Group 1, mean of LEFS score was lower and TUG test (seconds) in Group 1 was longer compared to Group 2 (p < 0.05). Conclusions: Respiratory functions, expiratory muscle strength, and functionality in patients with lower extremity lymphedema were adversely affected; however, inspiratory muscle strength and physical activity levels were similar to those of healthy controls.

The relationship of kinesiophobia in patients with lymphedema: a case-control investigation

Introduction

Kinesiophobia and lymphedema appear to be related conditions, and it is important to understand this relationship, as many of the symptoms and comorbidities presented by individuals with lower limb lymphedema are prevented and treated through movement, thus constituting kinesiophobia as a barrier to intervention. The objective of this study is, therefore, to evaluate and analyze the kinesiophobic beliefs reported by individuals with and without lower limb lymphedema, regarding the agreement, severity and differences found, and to establish levels of kinesiophobia.

Methods

A case-control study with a total sample of 80 participants (40 with lower limb lymphedema and 40 without) was performed. Both groups (with and without lymphedema) were characterized anthropologically, sociodemographically, and clinically. In the case group, lymphedema was evaluated. Participants in both groups completed the Tampa Scale for Kinesiophobia - 13 items (TSK-13).

Results

Individuals with lower limb lymphedema had higher TSK-13 scores than their matched group without lymphedema. The items belonging to the activity avoidance subscale had the highest agreement and score in both groups. Differences between groups were mainly established for items belonging to the somatic focus subscale, showing that individuals with lower limb lymphedema have kinesiophobic beliefs related to the perceived severity of their lymphedema. The prevalence of kinesiophobia was increased in both groups, but the severity was mild.

Conclusions

Considering the apparent tendency of people with lower limb lymphedema to present kinesiophobia and movement-limiting beliefs regarding the condition, greater attention should be paid to its assessment, prevention and treatment from a multidisciplinary and multimodal perspective, which takes into account the multiplicity of factors inherent to kinesiophobia and lymphedema and thus reduce their impact on the management of lymphedema.