RESUMO
OBJECTIVE: This study aimed to investigate the effects of complex decongestive therapy (CDT) applied to the lower extremities of patients with lymphedema of different causes on the extremity volume, quality of life (QoL), and functionality. MATERIALS AND METHOD: The study included 90 patients, of whom 28 had primary lymphedema, 30 had secondary lymphedema, 18 had phlebolymphedema, and 14 had lipolymphedema. A total of 137 extremities were treated with CDT. The patients who received CDT for 5 days a week for 3 weeks (15 sessions in total) were included in the sample. Extremity volume was measured using a tape measure. The lymphedema QoL-Leg Questionnaire was used to evaluate QoL, and the lower extremity functional scale (LEFS) was administered to assess lower extremity functionality. RESULTS: The changes in QoL before and after treatment significantly differed in the primary lymphedema, phlebolymphedema, and lipolymphedema groups (p < 0.05). The post-treatment LEFS scores indicated a significant decrease in the phlebolymphedema and lipolymphedema groups compared to the pre-treatment scores (p < 0.05). CONCLUSIONS: The difference in appearance, which is one of the sub-parameters of QoL, significantly decreased in the comparisons performed between the groups, whereas the changes in the remaining parameters were not significant.
OBJETIVO: Investigar los efectos de la terapia descongestiva compleja (TDC) aplicada a las extremidades inferiores de pacientes con linfedema de diferentes causas sobre el volumen de la extremidad, la calidad de vida y la funcionalidad. MATERIALES Y MÉTODO: Se incluyeron en el estudio 90 pacientes, de los cuales 28 tenían linfedema primario, 30 linfedema secundario, 18 flebolinfedema y 14 lipolinfedema. Un total de 137 extremidades fueron tratadas con TDC. Se incluyeron en la muestra pacientes que recibieron TDC durante 5 días a la semana durante 3 semanas (15 sesiones en total). El volumen de las extremidades se midió con una cinta métrica. Se utilizó el Cuestionario de calidad de vida (QoL) de las piernas para el linfedema para evaluar la calidad de vida, y se administró la Escala funcional de las extremidades inferiores (LEFS) para evaluar la funcionalidad de estas. RESULTADOS: Los cambios en la calidad de vida antes y después del tratamiento difirieron significativamente en los grupos de linfedema primario, flebolinfedema y lipolinfedema (p < 0.05). Las puntuaciones LEFS posteriores al tratamiento indicaron una disminución significativa en los grupos de flebolinfedema y lipolinfedema en comparación con las puntuaciones previas al tratamiento (p < 0.05). CONCLUSIONES: La diferencia de apariencia, que es uno de los subparámetros de la calidad de vida, disminuyó significativamente en las comparaciones realizadas entre los grupos, mientras que los cambios en los demás parámetros no fueron significativos.
Assuntos
Linfedema , Qualidade de Vida , Humanos , Linfedema/terapia , Linfedema/etiologia , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Extremidade Inferior , Idoso , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Lymphedema is a common complication following breast cancer treatment. The aim of this study is to evaluate the effectiveness of a self-adjusting compression garment (ReadyWrap®) in reducing (phase 1) and maintaining (phase 2) upper limb volume in women presenting breast cancer-related lymphedema. METHODS: This study will comprise a randomized, controlled, single-blind clinical trial concerning women with breast cancer-related lymphedema undergoing treatment at a public cancer treatment reference hospital in the city of Rio de Janeiro, Brazil. The intervention will be carried out by adapting self-dressing versus the standard treatment of compressive bandaging (phase 1) and compressive mesh (phase 2). Both groups will be assessed at the beginning and end of intensive treatment and followed up for up to 12 months to evaluate immediate and late outcomes. Assessments will be carried out by physical upper limb examination (inspection, palpation, volume, dynamometry, and thermography) and questionnaires application to assess patient's quality of life pertaining to the health, functionality, and symptoms of the affected upper limb, as well adverse effects and adherence to treatment. Data will be analyzed descriptively and analytically through univariate and multiple linear regressions. P values < 0.05 will be considered statistically significant. DISCUSSION: This study will evaluate the effectiveness of a self-adjustable garment (ReadyWrap®) in the treatment of lymphedema secondary to breast cancer in Brazilian women compared to the gold standard treatment for limb volume reduction (phase 1) and maintenance (phase 2) phases comprising, respectively, a compressive bandaging and a compressive mesh. The outcome results will provide data based on both quantitative responses and self-reported participant outcomes. The study will also assess the cost-effectiveness of the ReadyWrap® treatment versus standard care. Finally, we expect to reaffirm one more product/therapy as a treatment for this extremely complex and impactful condition following the data analysis. TRIAL REGISTRATION: NCT04934098 [Clinical trials phase 1]. Registered on June 22, 2021. NCT04881604 [Clinical trials phase 2]. Registered on May 11, 2021.
Assuntos
Linfedema Relacionado a Câncer de Mama , Neoplasias da Mama , Linfedema , Humanos , Feminino , Brasil , Neoplasias da Mama/complicações , Qualidade de Vida , Método Simples-Cego , Modalidades de Fisioterapia , Linfedema Relacionado a Câncer de Mama/diagnóstico , Linfedema Relacionado a Câncer de Mama/etiologia , Linfedema Relacionado a Câncer de Mama/terapia , Linfedema/diagnóstico , Linfedema/etiologia , Linfedema/terapia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Background: Lymphedema is a chronic, progressive clinical condition that evolves with intense fibrosis, the most advanced stage of which is stage III (lymphostatic fibrosclerosis). Aim: The aim of the present study was to show the possibility to reconstruct the dermal layers with the intensive treatment of fibrosis using the Godoy method. Case description: A 55-year-old patient with an eight-year history of edema of the lower limb of the leg had constant episodes of erysipelas, despite regular treatments. The edema progressed continually, associated with a change in the color of the skin and the formation of a crust. Intensive treatment (eight hours per day for three weeks) was proposed with the Godoy method. The ultrasound was performed and results revealed substantial improvement in the skin, with the onset of the reconstruction of the dermal layers. Conclusion: It is possible to reconstruct the layers of the skin in fibrotic conditions caused by lymphedema.
Assuntos
Derme , Fibrose , Linfedema , Dermatopatias , Humanos , Pessoa de Meia-Idade , Doença Crônica , Fibrose/diagnóstico por imagem , Fibrose/etiologia , Fibrose/patologia , Fibrose/terapia , Linfedema/complicações , Linfedema/diagnóstico por imagem , Linfedema/patologia , Linfedema/terapia , Pele/diagnóstico por imagem , Pele/patologia , Dermatopatias/complicações , Dermatopatias/diagnóstico por imagem , Dermatopatias/patologia , Dermatopatias/terapia , Derme/diagnóstico por imagem , Derme/patologia , Ultrassonografia/métodosRESUMO
INTRODUCTION: Lymphoedema associated with breast cancer is caused by an interruption of the lymphatic system, together with factors such as total mastectomy, axillary dissection, positive lymph nodes, radiotherapy, use of taxanes and obesity. Physiotherapy treatment consists of complex decongestive therapy, manual lymphatic drainage and exercises, among other interventions. Currently, there are several systematic review and randomised controlled trials that evaluate the efficacy of these interventions. However, at present, there are no studies that compare the effectiveness of all these physical therapy interventions. The purpose of this study is to determine which physical therapy treatment is most effective in reducing breast cancer-related lymphoedema, improving quality of life and reducing pain. METHODS AND ANALYSIS: MEDLINE, PEDro, CINAHL, EMBASE, LILACS and Cochrane Central Register of Controlled Trials will be searched for reports of randomised controlled trials published from database inception to June 2022. We will only include studies that are written in English, Spanish and Portuguese. We will also search grey literature, preprint servers and clinical trial registries. The primary outcomes are reduction of secondary lymphoedema associated with breast cancer, improvements in quality of life and pain reduction. The risk of bias of individual studies will be evaluated using the Cochrane Risk of Bias 2.0 Tool. A network meta-analysis will be performed using a random-effects model. First, pairs will be directly meta-analysed and indirect comparisons will be made between the different physical therapy treatments. The GRADE system will be used to assess the overall quality of the body of evidence associated with the main results. ETHICS AND DISSEMINATION: This protocol does not require approval from an ethics committee. The results will be disseminated via peer-reviewed publications. PROSPERO REGISTRATION NUMBER: CDR42022323541.
Assuntos
Neoplasias da Mama , Linfedema , Neoplasias da Mama/cirurgia , Neoplasias da Mama/terapia , Doença Crônica , Feminino , Humanos , Linfedema/cirurgia , Linfedema/terapia , Mastectomia/efeitos adversos , Metanálise como Assunto , Metanálise em Rede , Dor/complicações , Modalidades de Fisioterapia , Qualidade de Vida , Revisões Sistemáticas como Assunto , TaxoidesRESUMO
Functional compressive bandaging (FCB) is a therapeutic resource used to control lymphedema resulting from the treatment of breast cancer. However, the reliability of the technique is unknown. We evaluated intra- and inter-rater reliability of the spiral technique in the four-layer FCB of the arm and forearm in breast cancer survivors with lymphedema. Forty-five breast cancer survivors with a mean age of 64.88±10.01 years participated in the study. Evaluations were performed by two examiners at different times analyzing the pressure exerted (mmHg) by the spiral FCB in the arm and forearm of the upper limb affected by lymphedema. The intraclass correlation coefficient (ICC2,1) was used to determine intraand inter-examiner reliability, with a 95% confidence interval, minimum detectable change, and standard error of the measurement. Intrarater reliability was considered low to high in the arm and forearm region. Inter-rater reliability in the arm region was considered low and in the forearm region low to moderate. Our results indicate that spiral FCB has low to moderate intra-examiner and inter-examiner reliability.
Assuntos
Neoplasias da Mama , Linfedema , Idoso , Braço , Mama , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Feminino , Humanos , Linfedema/diagnóstico , Linfedema/etiologia , Linfedema/terapia , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: Lymphedema affects >1 in 1000 Americans, most often resulting from breast cancer surgery. Conservative treatment, such as compression garments, combined decongestive therapy (CDT), and pneumatic compression pumps, is the current standard of care. Despite the wide availability of these therapies, lymphedema has remained undertreated worldwide. We investigated whether third-party insurance coverage might be a barrier to obtaining conservative treatment in the United States. METHODS: We conducted a cross-sectional analysis of publicly accessible insurance policies. A total of 58 insurers were included in accordance with their state enrollment data and market share. The analysis was conducted using a web-based search and individual telephone interviews. For those policies that extended coverage, the medical necessity criteria were abstracted. RESULTS: A total of 50 insurance companies (86%) had a policy in place addressing conservative management. Included in 37 policies (64%), compression garments were covered the least often (n = 33; 89%). Although CDT was included in only 22 policies (38%), it was universally covered. Noncalibrated pneumatic compression pumps were the most frequently addressed intervention (n = 46; 79%), significantly more often than CDT (P < .01) and were universally covered, significantly more often than were compression garments (P < .04). Criteria for reimbursement were present for more than one half of the policies that provided coverage. CONCLUSIONS: A large proportion of U.S. insurers provided coverage for conservative treatment of lymphedema. However, only 38% of the policies included a statement of coverage for CDT. Most of the policies that did provide coverage for these four therapies also had multiple criteria that were required to be met before considering reimbursement. These requirements could create barriers to the receipt of treatment.
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Tratamento Conservador , Linfedema , Tratamento Conservador/efeitos adversos , Estudos Transversais , Humanos , Cobertura do Seguro , Linfedema/diagnóstico , Linfedema/terapia , Mastectomia , Estados UnidosRESUMO
The Godoy Method of cervical lymphatic therapy is the first treatment option as monotherapy for children which facilitates achieving normalization or near normalization of the affected limb as well as the maintenance of the results, which could assist millions of children throughout the world.
Assuntos
Linfedema , Criança , Humanos , Linfedema/terapiaRESUMO
Background: The aim of this study was to evaluate psychometric properties of the Lymphedema Functioning, Disability and Health Questionnaire for lower limb lymphedema (Lymph-ICF-LL) in Brazilian patients with secondary lower limb lymphedema after cancer treatment. Methods and Results: A diagnostic test study was performed in 30 patients with lower limb lymphedema. To assess the reliability, the intraclass correlation coefficient (ICC) was analyzed through test-retest, Cronbach alpha coefficient, magnitude of intrasubject variability by standard error of measurement (SEM), and smallest real difference (SRD). To assess the face and content validity, a specific questionnaire was applied to assess the clarity of the scoring system and comprehensiveness of questions. To assess construct validity, correlations between the final Brazilian version of the Lymph ICF-LL and the quality of life questionnaire SF-36 (36-Item Short Form Health Survey Questionnaire) were analyzed. The ICCs and general internal consistency scores of Lymph-ICF-LL were high (ICCs >0.90 and the Cronbach alpha coefficient >0.90, respectively). Measurement variability between the tests was acceptable (SEM 5.9) with SRD of 16.4. Face and content validity were considered excellent by the patients as the scoring system was clear and questions were understandable for 97% and 90% of the patients, respectively. Construct validity was classified as good and all hypotheses for assessing convergent validity were accepted (medium to strong correlation, from -0.69 to -0.84). Conclusion: The Brazilian version of the Lymph-ICF-LL is a reliable and valuable instrument for assessing Brazilian patients with secondary lower limb lymphedema associated with cancer treatment.
Assuntos
Linfedema , Neoplasias , Brasil/epidemiologia , Humanos , Extremidade Inferior , Linfedema/diagnóstico , Linfedema/etiologia , Linfedema/terapia , Neoplasias/complicações , Neoplasias/terapia , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
Diarrhea following bariatric surgery may be secondary to multiple causes. The aim of the present study is to report a significant reduction in episodes of diarrhea with the stimulation of the lymphatic system in a patient with post-bariatric diarrhea usingthe Godoy method for the treatment for lymphedema. Case Report: A 40-year-old female patient with obesity was submitted to bariatric surgery, type Gastric bypass (roo-en-wy), 13 years ago. Beginning immediately after surgery, the patient began to have around 12 episodes of diarrhea per day for approximately 11 years. The patient also had lower limb lymphedema and was sent to the Clínica Godoy-Brazil for treatment. The patient underwent the Godoy Method® of intensive treatment for lymphedema. However, the most important finding was the immediate reduction in the number of episodes of diarrhea per day, which went from 12-13 to 2-3 after only one day of treatment. This result regarding diarrhea has been maintained for two years, with the maximum number of seven episodes on some days, which subsequently returned to two to three episodes. The Godoy intensive lymphedema treatment method was effective at reducing the number of episodes of post-bariatric diarrhea, offering a novel treatment option for these patients