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Monteiro AJ, de Labra C, Losa-Iglesias ME, Dias A, Becerro-de-Bengoa-Vallejo R, Silva-Migueis H, Macedo F, López-López D, Gómez-Salgado J. The relationship of kinesiophobia in patients with lymphedema: a case-control investigation. Front Psychiatry 2024; 15:1293614. [PMID: 38445089 PMCID: PMC10912151 DOI: 10.3389/fpsyt.2024.1293614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
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.
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Affiliation(s)
- Ana Júlia Monteiro
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
- Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa - Lisboa, Lisbon, Portugal
| | - Carmen de Labra
- Research, Health, and Podiatry Group, Department of Physiotherapy, Medicine and Biomedical Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | | | - Adriano Dias
- Epidemiology – Department of Public Health and Grade Program of Public/Collective Health, Botucatu Medical School/Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | | | - Helena Silva-Migueis
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
- Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa - Lisboa, Lisbon, Portugal
| | - Filipe Macedo
- Integrated Continuing Care Unit, Casa de Santa Maria, Camarate, Portugal
| | - Daniel López-López
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
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Monteiro AJ, de Labra C, Losa-Iglesias ME, Dias A, Becerro-de-Bengoa-Vallejo R, Silva-Migueis H, Cardoso P, López-López D, Gómez-Salgado J. Depressive symptoms and their severity in a sample with lymphedema: a case-control investigation. Front Psychiatry 2023; 14:1202940. [PMID: 37476539 PMCID: PMC10354281 DOI: 10.3389/fpsyt.2023.1202940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/13/2023] [Indexed: 07/22/2023] Open
Abstract
Objectives Depression is a condition that can be associated with other illnesses, especially chronic illnesses. Lower limb lymphedema is a chronic, disabling condition that can affect the quality of life and be related to psychological and psychosocial factors that interfere with people's lives. This study aims to characterize and analyze the depressive symptoms and their severity reported by people with lower limb lymphedema and compare them with a matched group without lymphedema. Methods A case-control study was carried out (n = 80) with participants divided into a case group (40 people with lower limb lymphedema) and a control group (40 people without lower limb lymphedema). Both groups were anthropometrically, sociodemographically, and clinically characterized. In the case group, a characterization of lymphedema was performed. Participants completed the Beck Depression Inventory-II. Results Individuals with lower limb lymphedema have higher BDI-II scores than the matched group without lymphedema. Somatic depressive symptoms were, in general, the most reported and the ones with the highest scores. The depressive symptoms most reported by the case group were tiredness or fatigue, loss of energy, and changes in sleeping. Tiredness or fatigue, loss of energy, and loss of interest in sex were the most severe depressive symptoms reported by individuals with lower limb lymphedema. Conclusion Considering the apparent tendency to depression, greater attention should be given to the mental health of people with lower limb lymphedema.
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Affiliation(s)
- Ana Júlia Monteiro
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain
- Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa - Lisboa, Lisbon, Portugal
| | - Carmen de Labra
- NEUROcom, Centro Interdisciplinar de Química e Bioloxía (CICA), Instituto de Investigación Biomédica de A Coruña (INIBIC), School of Nursery and Podiatry, University of A Coruña, A Coruña, Spain
| | | | - Adriano Dias
- Epidemiology – Department of Public Health and Grade Program of Public/Collective Health, Botucatu Medical School/UNESP, Botucatu, Brazil
| | | | - Helena Silva-Migueis
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain
- Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa - Lisboa, Lisbon, Portugal
| | - Paula Cardoso
- Physiotherapy Department, Escola Superior de Saúde da Cruz Vermelha Portuguesa - Lisboa, Lisbon, Portugal
- Instituto Português de Oncologia de Lisboa Francisco Gentil – E.P.E. – Lisboa, Lisboa, Portugal
| | - Daniel López-López
- Research, Health, and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
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Beldame J, Sacco R, Munoz MA, Masse M, Lalevée M. Assessment of the Efficiency of Measuring Foot and Ankle Edema with a 3D Portable Scanner. Bioengineering (Basel) 2023; 10:bioengineering10050549. [PMID: 37237619 DOI: 10.3390/bioengineering10050549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023] Open
Abstract
Background: To prospectively evaluate the reliability of a portable optical scanner compared to the water displacement technique for volumetric measurements of the foot and ankle and to compare the acquisition time associated with these two methods. Methods: Foot volume was measured in 29 healthy volunteers (58 feet, 24 females and 5 males) by a 3D scanner (UPOD-S 3D Laser Full-Foot Scanner®) and by water displacement volumetry. Measurements were performed on both feet, up to a height of 10 cm above the ground. The acquisition time for each method was evaluated. The Kolmogorov-Smirnov test, Lin's Concordance Correlation Coefficient, and a Student's t-test were performed. Results: Mean foot volume was 869.7 +/- 165.1 cm3 (3D scanner) versus 867.9 +/- 155.4 cm3 (water-displacement volumetry) (p < 10-5). The concordance of measurements was 0.93, indicative of a high correlation between the two techniques. Volumes were 47.8 cm3 lower when using the 3D scanner versus water volumetry. After statistically correcting this underestimation, the concordance was improved (0.98, residual bias = -0.03 +/- 35.1 cm3). The mean examination time was 4.2 +/- 1.7 min (3D optical scanner) versus 11.1 +/- 2.9 min (water volumeter) (p < 10-4). Conclusions: Ankle/foot volumetric measurements performed using this portable 3D scanner are reliable and fast and can be used in clinical practice and research.
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Affiliation(s)
- Julien Beldame
- ICP-Clinique Blomet, 136 bis Rue Blomet, 75015 Paris, France
- Clinique Megival, 1328 Avenue de la Maison Blanche, 76550 Saint Aubin sur Scie, France
| | - Riccardo Sacco
- Department of Orthopedic Surgery, Rouen University Hospital, 37 Bd Gambetta, 76000 Rouen, France
| | - Marie-Aude Munoz
- Centre Médical Achille, 200 Avenue des Prés d'Arènes, 34070 Montpellier, France
| | - Marion Masse
- CKS, Centre kiné sport Dieppe, 32 Rue Louis Blériot, Neuville les Dieppe, 76370 Dieppe, France
| | - Matthieu Lalevée
- Department of Orthopedic Surgery, Rouen University Hospital, 37 Bd Gambetta, 76000 Rouen, France
- CETAPS EA3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, 76821 Mont-Saint-Aignan, France
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Wang L, Chen H, Li Y, Wang H, Liu N, Yu M, Shang S. Body mass index increases the risk of breast cancer-related lymphedema at 6-18 months after surgery: a retrospective study. Support Care Cancer 2023; 31:278. [PMID: 37074508 DOI: 10.1007/s00520-023-07721-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/31/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Breast cancer-related lymphedema (BCRL) is an incurable complication occurring after breast cancer treatment. The influence of obesity/overweight on the development of BCRL at different points after surgery was seldom verified. We aimed to determine the cut-off BMI/weight value associated with an increased risk of BCRL at different postoperative time in Chinese breast cancer survivors. METHODS Patients who underwent breast surgery plus axillary lymph node dissection (ALND) were retrospectively evaluated. Disease and treatment characteristics of participants were collected. BCRL was diagnosed by circumference measurements. Univariate and multivariable logistic regression was used to assess the relationship of lymphedema risk with BMI/weight and other disease- and treatment-related factors. RESULTS 518 patients were included. Lymphedema occurred more frequently among breast cancer patients with preoperative BMI ≥ 25 kg/m2 (37.88%) than among those with preoperative BMI < 25 kg/m2(23.32%), with significant differences at 6-12 and 12-18 months after surgery (χ2 = 23.183, P = 0.000; χ2 = 5.279, P = 0.022). By multivariable logistics analysis, preoperative BMI ≥ 30 kg/m2 presented a significantly greater risk of lymphedema than a preoperative BMI < 25 kg/m2 (OR [95% CI] = 2.928 [1.565, 5.480]). Other factors, including radiation (breast/chest wall + axilla vs. none: OR [95% CI] = 3.723[2.271-6.104]), was an independent risk factor for lymphedema. CONCLUSIONS Preoperative obesity was an independent risk factor for BCRL in Chinese breast cancer survivors, and a preoperative BMI ≥ 25 kg/m2 indicated greater likelihood of lymphedema development within 6-18 months postoperatively.
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Affiliation(s)
- Ling Wang
- School of Nursing, Wannan Medical College, Wuhu, 241002, China
- School of Nursing, Peking University, Haidian District, 38 Xueyuan Road, Beijing, 100191, China
| | - Hongbo Chen
- School of Nursing, Peking University, Haidian District, 38 Xueyuan Road, Beijing, 100191, China
| | - Yuanzhen Li
- School of Nursing, Wannan Medical College, Wuhu, 241002, China
| | - Huixue Wang
- School of Nursing, Wannan Medical College, Wuhu, 241002, China
| | - Ning Liu
- School of Nursing, Wannan Medical College, Wuhu, 241002, China
| | - Miao Yu
- School of Nursing, Wannan Medical College, Wuhu, 241002, China
| | - Shaomei Shang
- School of Nursing, Peking University, Haidian District, 38 Xueyuan Road, Beijing, 100191, China.
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Loibnegger-Traußnig K, Schwerdtfeger AR, Flaggl F. Effects of a Stress Management Training in Patients With Lymphedema and Obesity During Rehabilitation. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2023. [DOI: 10.1027/2512-8442/a000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Abstract: Background: Evidence for behavioral weight loss interventions demonstrates promising effects, but stress management training for weight loss and stress reduction in patients with lymphedema and obesity during rehabilitation has not been investigated yet. Aim: This study aims to examine innovative psychological treatment options for weight loss and stress management through a multifaceted approach in patients with lymphedema and obesity. Method: Seventy-one patients with lymphedema and obesity participating in an existing rehabilitation took part in this clinical trial. Half of them ( n = 36) were allocated to an additional stress management intervention. At the beginning of rehabilitation and the end (after 3 weeks; n = 66) participants’ weight, physical fitness, heart rate variability (HRV), and perceived stress were assessed. After around 8 months ( n = 28) chronic and perceived stress were evaluated again. Results: Irrespective of group allocation, rehabilitation had a positive, but short-term effect on perceived stress ( d = 0.60). Although patients receiving the additional stress management training did neither show a decrease in perceived stress nor an increase of HRV from pre- to post-assessment, they lost more weight and improved physical fitness at post-assessment as compared to the control group. Limitations: A stress-reducing effect of the training was not found, thus questioning the underlying mechanism of the applied intervention. Conclusions: Findings suggest a clinically relevant impact of psychological interventions in patients with lymphedema and a promising pathway for further research.
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Determinants of Quality of Life related to Lower Limb Lymphedema in Women with Gynecological Cancer Surgery. Asia Pac J Oncol Nurs 2022; 10:100153. [DOI: 10.1016/j.apjon.2022.100153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022] Open
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Şahinoğlu E, Ergin G, Karadibak D. The efficacy of change in limb volume on functional mobility, health-related quality of life, social appearance anxiety, and depression in patients with lower extremity lymphedema. Phlebology 2022; 37:200-205. [DOI: 10.1177/02683555211061011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives This study aims to investigate the impact of change in limb volume on the levels of functional mobility, health-related quality of life, social appearance anxiety, and depression before and after complex decongestive physiotherapy in patients with lower extremity lymphedema. Method Twenty-seven patients with unilateral lower extremity lymphedema were included. The treatment period was 20 sessions. The outcome measures were the limb volume, the Timed Up and Go test, the Short Form-36, the Social Appearance Anxiety Scale, and the Beck Depression Inventory. Results A statistically significant decrease in the limb volume ( p < 0.001) and statistically significant improvements in the Timed Up and Go test performance ( p < 0.001), the Short Form-36 Physical Component Summary score ( p < 0.01), the Social Appearance Anxiety Scale score ( p < 0.001), and the Beck Depression Inventory score ( p < 0.001) were found. No statistically significant difference was found on the Short Form-36 Mental Component Summary score ( p > 0.05). Conclusion The decrease in the limb volume improves the functional mobility, physical health-related quality of life, social appearance anxiety, and depression in patients with lower extremity lymphedema, but not the mental health-related quality of life.
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Affiliation(s)
- Ertan Şahinoğlu
- Dr İsmail Atabek Physical Therapy and Rehabilitation Center, İzmir, Turkey
| | - Gülbin Ergin
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, İzmir Bakircay University, İzmir, Turkey
| | - Didem Karadibak
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
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8
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Brown S, Dayan JH, Coriddi M, Campbell A, Kuonqui K, Shin J, Park HJ, Mehrara BJ, Kataru RP. Pharmacological Treatment of Secondary Lymphedema. Front Pharmacol 2022; 13:828513. [PMID: 35145417 PMCID: PMC8822213 DOI: 10.3389/fphar.2022.828513] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/07/2022] [Indexed: 12/12/2022] Open
Abstract
Lymphedema is a chronic disease that results in swelling and decreased function due to abnormal lymphatic fluid clearance and chronic inflammation. In Western countries, lymphedema most commonly develops following an iatrogenic injury to the lymphatic system during cancer treatment. It is estimated that as many as 10 million patients suffer from lymphedema in the United States alone. Current treatments for lymphedema are palliative in nature, relying on compression garments and physical therapy to decrease interstitial fluid accumulation in the affected extremity. However, recent discoveries have increased the hopes of therapeutic interventions that may promote lymphatic regeneration and function. The purpose of this review is to summarize current experimental pharmacological strategies in the treatment of lymphedema.
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Body image and sexuality concerns in women with breast cancer-related lymphedema: a cross-sectional study. Support Care Cancer 2022; 30:3917-3924. [PMID: 35039968 DOI: 10.1007/s00520-021-06751-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE (1) To determine, in women with breast cancer-related lymphedema (BCRL), the frequency, intensity and distress of body image and sexuality concerns. (2) To examine relationships between body image and sexuality concerns, and lymphedema, personal and cancer treatment factors. METHOD Women with BCRL (n = 64) completed the Lymphedema Symptom Intensity and Distress Scale - Arm (LSIDS-A), which focuses on the intensity and distress of a range of lymphedema symptoms. They also underwent a lymphedema assessment. Responses to eight questions from the LSIDS-A regarding sexuality, body image and intimate relationships were considered. Frequency of responses was tabulated. Multiple linear regressions were used to determine if specific factors were related to higher intensity and distress scores associated with body image and sexuality issues. RESULTS Body image and sexuality concerns were common (48%, 23% respectively). Participants reported a range (0-10) of intensity and distress related to body image and sexuality symptoms. Univariate linear regression revealed greater intensity of sexuality concerns was associated with younger age, whilst distress related to sexuality concerns was associated with higher inter-arm bioimpedance ratio and shorter duration of lymphedema. Body image concerns were not related to any considered factors. CONCLUSION Body image and sexuality concerns are common, intense and distressing for patients with breast cancer lymphedema. Assessment of both the intensity and distressed caused by these symptoms is necessary to understand the impact of lymphedema.
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Cox A, Bousfield C. Velcro compression wraps as an alternative form of compression therapy for venous leg ulcers: a review. Br J Community Nurs 2021; 26:S10-S20. [PMID: 34106008 DOI: 10.12968/bjcn.2021.26.sup6.s10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The first-line treatment for venous leg ulcers (VLUs) is compression therapy, most commonly, with compression bandages. A similar treatment measure is used for lymphoedema in the form of Velcro compression wraps (VCWs). However, the use of VCWs for VLUs is less evident, and a direct comparison to compression bandaging is not evident. This review explores the evidence to support the use of VCWs for the treatment of VLUs in order to raise awareness of alternative forms of compression therapy. Nine primary research studies were analysed, from which four key themes emerged: quality of life, cost of treatment, ulcer healing time and pressure maintenance. The findings suggest that VCWs decrease material costs by at least 50%, and further savings may be realised by reducing the costs associated with nursing time. The benefits of promoting self-care, maintaining compression, and eliciting greater healing rates are clearly evident, and the impact on quality of life is substantiated.
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Affiliation(s)
- Amy Cox
- Respiratory Registered Nurse, Royal Derby Hospital-University Hospitals of Derby and Burton
| | - Chrissie Bousfield
- Associate Professor, School of Health Sciences, University of Nottingham
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Lentz R, Shin C, Bloom Z, Yamada K, Hong YK, Wong AK, Patel K. From Bench to Bedside: The Role of a Multidisciplinary Approach to Treating Patients with Lymphedema. Lymphat Res Biol 2021; 19:11-16. [PMID: 33544026 DOI: 10.1089/lrb.2020.0118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Lymphedema is a condition characterized by dysfunction of the lymphatic system resulting in chronic, progressive soft tissue edema that can negatively impact individuals' function, self-image, and quality of life. Understanding of the disease process has evolved significantly in the past two decades with advances in diagnostic modalities and surgical techniques revolutionizing prior treatment algorithms. Methods and Results: We reviewed our current approach at the University of Southern California to improving outcomes in lymphedema treatment. Given the complexity of this medical condition, patients are best served by a multidisciplinary approach. At our institution, this involves a collaborative effort between bench researchers, lymphatic therapists, medical physicians, and lymphedema surgeons. Basic science and translational research provide further understanding into the underlying mechanisms of lymphangiogenesis and the possibility for potential therapeutic interventions. Our surgical algorithms require patients to undergo a thorough diagnostic evaluation and consultation with certified lymphatic therapists prior to undergoing either physiologic or debulking operations. Patients are followed clinically following any interventions. Further community outreach and education is carried out in order to improve upon early diagnosis and symptom recognition. Conclusions: Optimizing lymphedema care requires a collaborative interplay between researchers, physicians, and therapists. Additionally, patient and provider education on early disease recognition and treatment options is an equally critical aspect of improving patient outcomes.
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Affiliation(s)
- Rachel Lentz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, California, USA
| | - Christina Shin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, California, USA
| | - Zoe Bloom
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, California, USA
| | - Kimiko Yamada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, California, USA
| | - Young-Kwon Hong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, California, USA
| | - Alex K Wong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, California, USA
| | - Ketan Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, California, USA
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12
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Cea García J, Márquez Maraver F, Rodríguez Jiménez I, Ríos-Pena L, Rubio Rodríguez MDC. Treatment and Impact of Cervical-Cancer-Related Lymphatic Disorders on Quality of Life and Sexuality Compared with Controls. Lymphat Res Biol 2020; 19:274-285. [PMID: 33226889 DOI: 10.1089/lrb.2020.0078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Lymphatic disorders are frequent complications related to treatment for cervical cancer (CC). The aims of the study are to evaluate the impact of lymphatic disorders on quality of life (QOL) and sexuality in CC survivors after the completion of oncological treatment and to compare them with controls. Methods and Results: An ambispective cohort study was performed by using the Functional Assessment Cancer Therapy (FACT)-Cervix (Cx) fourth version, the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF), and the Female Sexual Function Index (FSFI). Twelve patients affected by lymphatic disorders comprised the study group, 251 comprised the CC control group, and 185 comprised the non-CC control group. Regarding QOL, there were no statistically significant differences between the lymphatic disorder-unaffected and non-CC control groups, except in the WHOQOL-BREF environment domain. A weak positive correlation between lymphatic disorder and FACT-Cx additional concerns (σ = 0.135) was observed. Regarding sexuality, a weak negative correlation was detected between lymphatic disorders and FSFI sexual satisfaction (σ = -0.200) and a weak positive correlation was observed between lymphatic disorders and FSFI dyspareunia (σ = 0.148). We did not observe statistically significant differences in QOL satisfaction between the lymphatic disorder-affected and non-CC control groups. Symptomatic controls reported significantly higher physical health scores than the lymphatic disorder-affected group (p < 0.05). Regarding the psychological domain, the asymptomatic controls obtained significantly higher scores than the lymphatic disorder-affected group (p = 0.003). Conclusions: Lymphatic disorders notably influenced the QOL of CC survivors compared with the non-CC control groups. Lymphatic disorders had a significant negative impact on physical and psychological health. Sexuality was scarcely affected by lymphatic disorders.
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Affiliation(s)
- Jorge Cea García
- Clinical Management Unit for Obstetrics and Gynecology, University Hospital Virgen Macarena, Seville, Spain
| | - Francisco Márquez Maraver
- Advanced Gynecological Surgery Unit for Women in Ginemed-INSEGO, Vithas-Nisa Aljarafe Hospital, Castilleja de la Cuesta, Spain
| | | | - Laura Ríos-Pena
- Institute of Science and Technology of the Loyola University, Dos Hermanas, Spain
| | - María Del Carmen Rubio Rodríguez
- Department of Radiation Oncology, HM University Sanchinarro Hospital, Madrid, Spain.,HM University Puerta del Sur Hospital, Móstoles, Madrid, Spain
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13
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Pervane Vural S, Ayhan FF, Soran A. The Role of Patient Awareness and Knowledge in Developing Secondary Lymphedema after Breast and Gynecologic Cancer Surgery. Lymphat Res Biol 2020; 18:526-533. [PMID: 33026963 DOI: 10.1089/lrb.2020.0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to compare the effects of awareness and knowledge on demographic and clinical factors in patients with breast cancer-related lymphedema (BCRL) and gynecologic cancer-related lymphedema (GCRL) in the oncologic rehabilitation setting. Methods and Results: A total of 506 female patients with upper or lower extremity lymphedema, were evaluated for lymphedema education in their postoperative period. Only 74 survivors (25%) with BCRL and 34 survivors (16.83%) with GCRL reported that they had received information about lymphedema by physicians/primary health care providers. In breast cancer survivors, the time of diagnostic delay for lymphedema was shorter in the informed group (p < 0.001), and there was a higher rate of cellulite attacks in uninformed patients (p = 0.021). Duration between surgery and lymphedema was longer and duration of diagnostic delay for lymphedema was shorter in the informed group than uninformed group in gynecologic cancer survivors (p = 0.019, p < 0.001). There was a higher rate of cellulite history in the uninformed patients than informed patients in gynecologic cancer survivors (p < 0.001). In gynecologic cancer survivors who were educated about lymphedema were at an earlier stage than noneducated patients (p = 0.024). Conclusion: The rate of awareness about lymphedema among patients with a history of surgery for gynecologic malignancies is lower compared with those for breast cancer. In female cancer survivors, awareness and knowledge about lymphedema may lead to a later onset of lymphedema, lower lymphedema grades, and fewer infection.
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Affiliation(s)
- Secil Pervane Vural
- Department of Physical Medicine and Rehabilitation, S.B.U. Ankara Training and Research Hospital, Ankara, Turkey
| | - Fikriye Figen Ayhan
- Department of Physical Medicine and Rehabilitation, School of Medicine, Atılım University, Ankara, Turkey.,Department of Physical Medicine and Rehabilitation, Medicana International Ankara Hospital, Ankara, Turkey
| | - Atilla Soran
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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14
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The Quality of Life and Psychosocial Implications of Cancer-Related Lower-Extremity Lymphedema: A Systematic Review of the Literature. J Clin Med 2020; 9:jcm9103200. [PMID: 33023211 PMCID: PMC7601061 DOI: 10.3390/jcm9103200] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/20/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022] Open
Abstract
Lower-extremity lymphedema (LEL) is a progressive, lifelong complication of cancer that places a substantial burden upon cancer survivors' quality of life (QOL) and psychosocial well-being. Despite its prevalence, cancer-related LEL is inconsistently diagnosed, treated, and poorly recognized by health care professionals. The purpose of this systematic review was to summarize and appraise the quantitative literature evaluating the impact of cancer-related LEL on patients' psychosocial well-being and QOL. Three databases (PubMed, PROQuest, and Scopus) were searched for observational research articles published before May 1st, 2020. Twenty-one articles were eligible (cross-sectional (n = 16), prospective cohort designs (n = 3), and retrospective cohort designs (n = 2)). The majority of studies reported a negative relationship between cancer-related LEL and global QOL and/or one or more psychosocial domains including (1) physical and functional; (2) psycho-emotional; (3) social, relational and financial. A greater number of LEL symptoms and higher LEL severity were associated with poorer QOL. Although the evidence to date suggests a negative relationship between cancer-related LEL and patients' QOL and psychosocial well-being, there is a substantial need for longitudinal analyses to examine the directionality and temporality of this effect in order to inform cancer survivorship care modelling and improve patient outcomes after cancer.
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15
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Angst F, Lehmann S, Aeschlimann A, Sandòr PS, Wagner S. Cross-sectional validity and specificity of comprehensive measurement in lymphedema and lipedema of the lower extremity: a comparison of five outcome instruments. Health Qual Life Outcomes 2020; 18:245. [PMID: 32698883 PMCID: PMC7374881 DOI: 10.1186/s12955-020-01488-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/10/2020] [Indexed: 12/18/2022] Open
Abstract
Background Literature on the validity of outcome measurement in lymphedema and lipedema is very sparse. This study aimed to examine the convergent, divergent and discriminant validity of a set of 5 instruments in both conditions. Methods Cross-sectional outcome was measured by the generic Short Form 36 (SF-36), the lymphedema-specific Freiburg Quality of Life Assessment for lymphatic disorders, Short Version (FLQA-lk), the knee-specific Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), the Symptom Checklist-90-revised (SCL-90R), and the Six-Minute Walk Test (6 MWT). Construct convergent/divergent validity was quantified by bivariate correlations and multivariate factor analysis, and discriminant validity by standardized mean differences (SMDs). Results Health was consistently better in lymphedema (n = 107) than in lipedema (n = 96). The highest construct convergence was found for physical health between the SF-36 and KOS-ADL (bivariate correlations up to 0.78, factor loads up to 0.85, explained variance up to 56.8%). The second most important factor was mental health (bivariate correlations up to 0.79, factor loads up to 0.86, explained variance up to 13.3%). Discriminant validity was greatest for the FLQA-lk Physical complaints (adjusted SMD = 0.93) followed by the SF-36 Bodily pain (adjusted SMD = 0.83), KOS-ADL Function (adjusted SMD = 0.47) and SF-36 Vitality (adjusted SMD = 0.39). Conclusions All five instruments have specific strengths and can be implemented according to the scope and aim of the outcome examination. A minimum measurement set should comprise: the SF-36 Bodily pain, SF-36 Vitality, FLQA-lk Physical complaints, FLQA-lk Social life, FLQA-lk Emotional well-being, FLQA-lk Health state, KOS-ADL Symptoms, KOS-ADL Function, and the SCL-90R Interpersonal sensitivity.
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Affiliation(s)
- Felix Angst
- Research department, Rehabilitation clinic ("RehaClinic"), Quellenstrasse 34, 5330, Bad Zurzach, Switzerland.
| | - Susanne Lehmann
- Research department, Rehabilitation clinic ("RehaClinic"), Quellenstrasse 34, 5330, Bad Zurzach, Switzerland
| | - André Aeschlimann
- Research department, Rehabilitation clinic ("RehaClinic"), Quellenstrasse 34, 5330, Bad Zurzach, Switzerland
| | - Peter S Sandòr
- Research department, Rehabilitation clinic ("RehaClinic"), Quellenstrasse 34, 5330, Bad Zurzach, Switzerland
| | - Stephan Wagner
- Department of angiology, Rehabilitation clinic ("RehaClinic"), Bad Zurzach, Switzerland
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16
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Kendrová L, Mikuľáková W, Urbanová K, Andraščíková Š, Žultáková S, Takáč P, Peresta Y. Comprehensive Decongestive Therapy as a Treatment for Secondary Lymphedema of the Lower Extremity and Quality of Life of Women After Gynecological Cancer Surgery. Med Sci Monit 2020; 26:e924071. [PMID: 32555125 PMCID: PMC7320633 DOI: 10.12659/msm.924071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Lymphedema is a clinical manifestation of lymphatic system failure, caused by an imbalance between the transport capacity of the lymphatic system and the volume of the produced lymph. Lymphedema is complication and significantly worsens quality of life (QoL). Material/Methods There were 50 patients diagnosed with secondary lymphedema of the lower extremities after gynecological cancer followed by radiotherapy included in this study. The average age was 57.76 years (standard deviation±10.08). Patients were treated at the Department of Physiotherapy, Balneology and Medical Rehabilitation, in hospital NsP in Bardejov. During therapy, we applied manual lymphatic drainage, instrumental lymphatic drainage, multilayer bandage, vascular gymnastics (with loaded external compression), hydrotherapy, and patient education on the adjustment necessary for a life-long regimen. The circumference of the limb was measured using the Kuhnkes disk method, QoL was assessed using the LYMQOL LEG questionnaire, and for assessment of pain the Visual Analogue Scale (VAS) was used. Results After treatment, we found a reduction in lymphedema (P<0.001), an increase in QoL (P<0.001), and a reduction in pain (P<0.001). We found a significant relationship between QoL change and pain in the domains of symptoms, function, and overall QoL (P<0.005). The results showed that reduction of lymphedema was not a significant predictor of QoL (P>0.001). Conclusions We found a positive effect in the treatment of secondary lymphedema of the lower extremity on the QoL of women after uterine cancer surgery, and also found that reduction of lymphedema and age were not predictors of improvement in QoL.
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Affiliation(s)
- Lucia Kendrová
- Department of Physiotherapy, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - Wioletta Mikuľáková
- Department of Physiotherapy, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - Katarína Urbanová
- Department of Physiotherapy, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - Štefánia Andraščíková
- Department of Midwifery, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - Silvia Žultáková
- Department of Midwifery, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - Peter Takáč
- Department of Physiatry, Balneology and Medical Rehabilitation, Medical Faculty of P. J. Šafárik University and L. Pasteur University Hospital in Košice, Košice, Slovakia
| | - Yuriy Peresta
- Department of Physiotherapy, Faculty of Health Care, University of Prešov, Prešov, Slovakia
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17
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Ozturk S, Akbaba KT, Kilic S, Cicek T, Peskircioglu L, Tandogan I, Gurlek A, Aydemir O, Ileri M, Yetkin E. Ecchymosis and Coldness in Peripheral Varicose Vein Patients: Observations From VEIN-TURKEY Study. INT J LOW EXTR WOUND 2020; 19:262-268. [DOI: 10.1177/1534734620917911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The purpose of this subgroup analysis is to investigate and analyze the venous leg symptoms including sense of coldness and sign of ecchymosis in patients with or without peripheral varicose veins (PVVs) from VEIN-TURKEY study population. A total of 600 patients, who were enrolled to VEIN-TURKEY study recently, were included in this subgroup analysis. Patients were examined clinically for the presence and severity of PVV and varicocele. Patients were asked to answer the VEINES-Sym questionnaire consisting of 10 parts and questions about ecchymosis and coldness in their legs. Frequency of symptoms present in the VEINES-Sym instrument, coldness (16.6%, 6.5%, P = .002, respectively), and ecchymosis (16.6%, 2.7%, P < .001, respectively) were significantly higher in patients with PVV compared to patients without PVV. Mean score of each symptom was significantly lower in PVV (+) patients including scores of ecchymosis and coldness. Total VEINES-Sym score was also correlated with the scores of ecchymosis ( r = 0.18, P < .001) and coldness ( r = 0.35, P < .001). Logistic regression analysis revealed that heavy legs, aching legs, night cramps, and ecchymosis are significantly and independently associated with PVV. In conclusion, sign of ecchymosis and coldness are significantly higher in patients with PVV compared to patients without PVV in a population recruited from the urology clinics. In clinical evaluation, presence or sign of ecchymosis and coldness in legs should be considered to be compatible with PVV in the absence of trauma, hematologic pathologies including antiplatelet treatment, and arterial stenosis or obstruction.
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Affiliation(s)
- Selcuk Ozturk
- Ankara Education and Research Hospital, Ankara, Turkey
| | | | | | - Tufan Cicek
- Baskent University Konya Education and Research Hospital, Konya, Turkey
| | | | | | | | | | - Mehmet Ileri
- University of Health Sciences Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ertan Yetkin
- Istinye University Liv Hospital, Istanbul, Turkey
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18
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Doruk Analan P, Kaya E. Postural Stability in Patients with Lower Limb Lymphedema. Lymphat Res Biol 2019; 17:647-650. [DOI: 10.1089/lrb.2019.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pınar Doruk Analan
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Emine Kaya
- Department of Physical Medicine and Rehabilitation, Adana City Training and Research Hospital, Adana, Turkey
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19
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Devoogdt N, Cavaggion C, Van der Gucht E, Dams L, De Groef A, Meeus M, Van Hemelrijck R, Heynen A, Thomis S, Orhan C. Reliability, Validity, and Feasibility of Water Displacement Method, Figure-of-Eight Method, and Circumference Measurements in Determination of Ankle and Foot Edema. Lymphat Res Biol 2019; 17:531-536. [DOI: 10.1089/lrb.2018.0045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
- Department of Vascular Surgery, Centre for Lymphedema, University Hospitals of Leuven, Pellenberg, Belgium
- Department of Physical Medicine and Rehabilitation, Centre for Lymphedema, University Hospitals of Leuven, Pellenberg, Belgium
| | - Claudia Cavaggion
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Elien Van der Gucht
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Lore Dams
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, Centre for Lymphedema, University Hospitals of Leuven, Pellenberg, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Roxane Van Hemelrijck
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
| | - Anneleen Heynen
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
| | - Sarah Thomis
- Department of Vascular Surgery, Centre for Lymphedema, University Hospitals of Leuven, Pellenberg, Belgium
- Department of Physical Medicine and Rehabilitation, Centre for Lymphedema, University Hospitals of Leuven, Pellenberg, Belgium
| | - Ceren Orhan
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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20
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Doersam JK, Dietrich MS, Adair MA, Rhoten B, Deng J, Ridner SH. A Comparison of Symptoms Among Patients with Head and Neck or Truncal Lymphedema and Normal Controls. Lymphat Res Biol 2019; 17:661-670. [PMID: 31381475 DOI: 10.1089/lrb.2019.0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Symptoms associated with midline lymphedema are not fully understood and it is unclear if symptoms associated with swelling in the head and neck are similar to those associated with swelling in the truncal region of the body. Objectives: Describe symptoms experienced by those with head and neck and truncal lymphedema. Compare symptom presence, intensity, and distress among those two groups and participants with no lymphedema. Methods: Cross-sectional descriptive study administered by online survey. Results: Nonlymphedema participants were younger than the lymphedema groups. Those with truncal lymphedema took more diuretic medications than the other groups. Participants with truncal lymphedema experienced a greater number of symptoms than the other groups (p < 0.001). These symptoms were also more severe and intense (p < 0.001). Fourteen symptoms distinguished the truncal group from the other two groups (p < 0.001). Nine symptoms differentiated the head and neck group from the other groups (p < 0.001). Conclusion: These preliminary findings support that symptom profiles differ among those with lymphedema and those without lymphedema. The number, type, severity, and intensity of symptoms vary based upon the location of lymphedema. The need to use two lymphedema anatomical classifications (head and neck and truncal) instead of one classification (midline) when assessing lymphedema-related symptoms is also supported.
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Affiliation(s)
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, Nashville, Tennessee.,Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Melissa A Adair
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Bethany Rhoten
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Jie Deng
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Sheila H Ridner
- Vanderbilt University School of Nursing, Nashville, Tennessee
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21
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Role of a Structured Physical Activity Pathway in Improving Functional Disability, Pain and Quality of Life in a Case of Breast and Gynecological Cancer Survivorship. J Clin Med 2019; 8:jcm8040531. [PMID: 31003402 PMCID: PMC6518154 DOI: 10.3390/jcm8040531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/08/2019] [Accepted: 04/16/2019] [Indexed: 12/25/2022] Open
Abstract
Physical activity (PA) interventions can improve physical functioning, treatment-related symptoms and quality of life (QoL) in cancer survivors. Most investigations have been conducted in breast cancer survivors, while studies on PA interventions in gynecological cancer survivors are scant. Here, we report for the first time the possible benefits of a structured PA pathway (i.e., eight weeks of adapted PA followed by twelve weeks of adapted fitness) on physical side effects, pain and QoL in an uncommon case of survivorship of both primary breast and gynecological cancers. For this purpose, a 69-year-old woman was assessed by functional test battery (shoulder-arm mobility, range of motion, back flexibility) at baseline and after the structured PA pathway. QoL and surgical shoulder, back and lower limb pain intensity were evaluated by Short Form-12 (SF-12) and numerical rating scale questionnaires, respectively. Lower limb circumference was also assessed. Improvement in upper limb function, reduction of lower limb edema and pain perception, as well as an increase in overall QoL were achieved after the completion of structured PA intervention. Our findings suggest that a PA intervention tailored to individual characteristics may represent an effective countermeasure to reduce post-treatment functional disability and pain, and thus to improve QoL in breast and gynecologic cancer survivors.
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22
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Ridner SH, Doersam JK, Stolldorf DP, Dietrich MS. Development and Validation of the Lymphedema Symptom Intensity and Distress Survey-Lower Limb. Lymphat Res Biol 2018; 16:538-546. [PMID: 30359205 DOI: 10.1089/lrb.2017.0069] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lymphedema is a chronic, incurable condition that occurs most commonly in lower limbs (legs and feet). Increased morbidity is seen with this form of lymphedema, but there are few studies and even fewer tools intended to assess symptom burden in patients impacted by this condition. A questionnaire, the Lymphedema Symptom Intensity and Distress Survey-Lower Limb (LSIDS-L), was developed to fill this gap. The measure is composed of several clusters of symptoms thought to characterize lower limb lymphedema. The initial work was conducted to propose and assess the face validity of the clusters. Subsequently, work was undertaken to empirically evaluate the presence of the symptom clusters, assess the reliability of the cluster scores, and evaluate the validity of the scores by studying associations with other valid measures. METHODS AND RESULTS During the initial work, the LSIDS-L was tested with lower limb lymphedema patients only, and in the subsequent work the LSIDS-L and valid measures were administered to patients with no lymphedema and with lower limb lymphedema. A total of 388 volunteers participated, 111 of whom indicated no diagnosis of lymphedema, and 277 indicated a diagnosis of lower limb lymphedema. Cluster analysis resulted in the exclusion of 5 items, yielding 8 clusters with a total of 31 items. Cluster scores demonstrated acceptable internal consistency, distinguished nonlymphedema patients from lower lymphedema patients, and demonstrated expected convergent and divergent validity with other valid measures. CONCLUSION The LSIDS-L is a valid tool for detecting and quantifying symptom burden in patients with lower limb lymphedema.
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Affiliation(s)
- Sheila H Ridner
- 1 Vanderbilt University School of Nursing , Vanderbilt University, Nashville, Tennessee
| | - Jennifer K Doersam
- 1 Vanderbilt University School of Nursing , Vanderbilt University, Nashville, Tennessee
| | - Deonni P Stolldorf
- 1 Vanderbilt University School of Nursing , Vanderbilt University, Nashville, Tennessee
| | - Mary S Dietrich
- 1 Vanderbilt University School of Nursing , Vanderbilt University, Nashville, Tennessee.,2 School of Medicine, Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
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23
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Wang MC, Lee SY, Hsu KF, Lin CF, Ma MC, Hsu YY. Psychometric evaluation of a Chinese version of Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema in women with gynaecological cancer surgery. Eur J Cancer Care (Engl) 2018; 27:e12940. [DOI: 10.1111/ecc.12940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/28/2018] [Accepted: 09/01/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Mei-Chin Wang
- Department of Nursing, College of Medicine; National Cheng Kung University; Tainan Taiwan
| | - Shih-Yu Lee
- College of Nursing and Health Sciences; University of Texas at Tyler; Tyler Texas
| | - Keng-Fu Hsu
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital; College of Medicine, National Cheng Kung University; Tainan Taiwan
| | - Cheng-Feng Lin
- Department of Physical Therapy, College of Medicine; National Cheng Kung University; Tainan Taiwan
| | - Mi-Chia Ma
- Department of Statistics, College of Management; National Cheng Kung University; Tainan Taiwan
| | - Yu-Yun Hsu
- Department of Nursing, College of Medicine; National Cheng Kung University; Tainan Taiwan
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24
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Gjorup CA, Zerahn B, Juul S, Hendel HW, Christensen KB, Hölmich LR. Repeatability of Volume and Regional Body Composition Measurements of the Lower Limb Using Dual-energy X-ray Absorptiometry. J Clin Densitom 2017; 20:82-96. [PMID: 27634336 DOI: 10.1016/j.jocd.2016.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/16/2016] [Indexed: 11/25/2022]
Abstract
Lower limb lymphedema is a dynamic condition in which tissue composition and volume measurements are affected. Various definitions of lower limb lymphedema exist but volume differences between the limbs are widely used. It is therefore necessary to have a readily available noninvasive measurement technique allowing multiple measurements of the lower limbs. This study investigated the repeatability of duplicate volume and regional body composition measurements of the lower limb using the GE Lunar Prodigy dual-energy X-ray absorptiometry (DXA) scanner Prodigy (GE Medical Systems, Madison, WI). Twenty-seven participants (54 limbs), 14 women and 13 men aged 33-71 years with body mass index ranging from 14 to 32 kg/m2 were recruited. Duplicate whole-body DXA scans were performed with repositioning between examinations. Regions of interest were manually drawn for the thigh, lower leg, and foot, and total volume was calculated using the density of bone mineral content, fat, and lean mass. The repeatability of the volume of the lower limb and regional thigh and lower leg tissue composition (bone mineral content, fat, and lean mass) was good with intraclass correlation coefficient values of 0.97 to 0.99, and narrow limits of agreement on the Bland-Altman plots. These results confirm DXA to be a highly repeatable method for volume and tissue composition measurements of the lower limb. In a population at risk of lymphedema, DXA offers a clinically readily available noninvasive method allowing multiple measurements of volume and tissue composition on a routine basis, important for diagnosing, monitoring, managing, and researching lymphedema.
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Affiliation(s)
- Caroline A Gjorup
- Department of Plastic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Denmark.
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Sarah Juul
- Department of Plastic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Helle W Hendel
- Department of Clinical Physiology and Nuclear Medicine, PET-center, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | | | - Lisbet R Hölmich
- Department of Plastic Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
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