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Objective: To evaluate efficacy, safety, and adherence to using adjustable compression wraps (ACWs) for upper limb volume control in women with breast cancer-related lymphedema. Design and Setting: Randomized controlled trial at a reference hospital for breast cancer treatment in Brazil. Participants: Women in control phase of the breast cancer-related lymphedema. Interventions: Compared use of ACWs versus compressive mesh. Main Measures: Evaluated before treatment, at 30 days, and 6 months after initiating therapy. The primary outcome was the change in excess limb volume. Secondary outcomes included adherence, incidence of adverse events, functionality, quality of life, and hand grip. Statistical analysis involved calculating the effect size (ES) with a 95% confidence interval. Results: Were included 71 women with mean excess limb volume of 321.79 mL (±194.98). In the 30-day analysis (Time 1), a reduction of 37.6 mL in volume was observed only in the ACW group (p =.041, ES 0.20), with improved functionality (p =.013, ES 0.22). In the six months analysis (Time 2), the compressive mesh group increased by 2.48% in volume (p =.023, ES 0.26) and demonstrated improvement functionality (p =.036, ES 0.27). Mild adverse events and satisfactory adherence were observed. However, in the intergroup comparison, no statistically significant difference was observed for any evaluated outcome—excess volume, incidence of adverse events, adherence, hand grip, quality of life, and functionality between the groups (p >.05) at both times. Conclusions: Both compression therapies achieved satisfactory adherence, were safe, effective and equivalent for controlling limb volume in breast cancer-related lymphedema. [ABSTRACT FROM AUTHOR]

Some patients develop breast/chest lymphoedema following breast cancer treatment. Historically this group of patients has been managed in the same way as those with limb lymphoedema, through the application of compression in the form of vests or bras. Some patients reported pain and the feeling of being in a 'strait jacket' and, therefore, abandoned these items for lighter and more comfortable garments without any adverse effects. Reflecting on this insight, the author adapted breast/chest lymphoedema management by suggesting a change to lighter garments to patients who reported improved comfort, with no obvious negative impact on their lymphoedema. Within this article, the author gives a brief explanation of lymphatic mechanisms and factors relating to lymphoedema including signs and symptoms of breast oedema. There will be an exploration of the available treatments for lymphoedema along with treatment plans found to be effective by the author. [ABSTRACT FROM AUTHOR]

Heart failure (HF) and lymphoedema often co-exist, significantly affecting the quality of life and requiring complex management. Heart Failure, characterised by reduced cardiac function, affects around 1 million people in the UK. Lymphoedema, involving lymphatic failure, affects 4 to 29 per 1000 individuals, particularly older adults. Traditionally heart failure management focuses on medication, while lymphoedema relies on compression therapy (CT). The article examines the integration of CT to treat lymphoedema with coexisting HF. Evidence suggests that with careful management and multidisciplinary collaboration, CT can be safely used in stable HF patients to manage lymphoedema, improving overall treatment outcomes and patient wellbeing. This approach requires adherence to guidelines and a holistic, patient-centred care model. Debates about CT for lymphoedema in the presence of HF highlight the need for patient-focused and all-encompassing care. Practitioners must consider the broader context of both conditions and collaborate with colleagues and patients to make informed treatment decisions. [ABSTRACT FROM AUTHOR]

Objectives: The LYMQOL is the most frequently translated, validated, objective tool for assessing Health-Related Quality of Life (HRQoL) in individuals with upper limb lymphedema (ULL). There have been adaptations and validations in a number of different countries. While a German version of LYMQOL Leg for lower limb lymphedema is available, a validated translation of LYMQOL Arm to German is lacking. We aimed to perform a cross-cultural adaption and translation according to ISPOR principles. Methods: Patients suffering from ULL from Germany, Austria, and Switzerland (n = 52) were questioned twice using the translated LYMQOL Arm, SF-36, and an evaluation questionnaire. The assessment of the content validity and face validity proved this version of LYMQOL Arm to be acceptable for interviewing German-speaking patients with ULL in Germany. Results: Comparison of LYMQOL Arm and SF-36 demonstrated good construct validity. Test–retest reliability was moderate to good (intraclass correlation coefficients 0.66–0.73). Cronbach's alpha values varied between 0.79 and 0.89 in both interviews, indicating good internal consistency. Factor analysis revealed a cumulative variance of 59.5% for the four domains of the questionnaire. Conclusion: There was no significant association between lymphedema stage and LYMQOL Arm score. This trial tested the appropriateness of the German version of the LYMQOL Arm for measuring HRQoL in German-speaking individuals with ULL. [ABSTRACT FROM AUTHOR]

Objective: It has been frequently observed that patients with lymphedema experience problems that impair quality of life (QoL), such as pain, edema and sleep disturbances. The positive effects of complex decongestive therapy (CDT) on pain, extremity volume and QoL have been reported in the literature. The aim of this study was to investigate the effects on sleep quality, pain, extremity volume, and QoL of the first phase of CDT applied to patients who developed lymphedema after cancer surgery. Materials and Methods: The study included a total of 48 female patients with unilateral lymphedema (23 breast cancer and 25 urogynaecological cancer) who developed upper or lower extremity lymphedema after cancer surgery. The patients were questioned about QoL, pain, extremity volume, medical history, and demographic data before starting treatment. Then CDT was applied five days a week for three weeks, as a total of 15 sessions, after which the patients were re-evaluated. Pain severity was evaluated using a visual analog scale, sleep quality with the Pittsburgh sleep quality index, QoL with the lymphedema QoL questionnaire, and extremity volume was measured and calculated using the Frustum formula. Results: A significant improvement was detected in pain (p<0.001), extremity volume (p=0.015), sleep quality (p<0.001) and overall QoL score (p=0.012) in the group that developed lymphedema in the upper extremity after treatment. A significant improvement was achieved in pain (p<0.001), extremity volume (p<0.001), sleep quality (p<0.001) and overall QoL score (p<0.001) in the group that developed lymphedema in the lower extremity. Conclusion: This study is the first to demonstrate the effects of CDT on sleep quality while confirming its therapeutic effects on pain, extremity volume and QoL in patients who developed lymphedema after cancer surgery. When treating sleep disturbances in lymphedema patients, it is important to consider the therapeutic benefits of CDT on sleep quality. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Poor access to lymphoedema specialists and communication between them and patients prevents appropriate lymphoedema management. Therefore, development and dissemination of remote systems is necessary to improve care in rural areas with limited medical personnel or access to medical coordination. Aims: The authors evaluated the elements required for providing patient education on conservative therapy for lymphoedema, to determine the feasibility of remote management. Methods: The study involved connecting a health professional in a local clinic (point A) treating a patient with lymphoedema, who was present alongside the clinician, with a specialist certified lymphoedema therapist (CLT) located remotely in a university (point B). Findings: The CLT was able to greet, interview and provide guidance to the patient on conservative therapy. Direct contact with the patient was not possible, which limited visualisation, palpation, leg circumference measurement, and lymphatic drainage management. Conclusion: The findings suggest that remote a lymphoedema management approach involving conservative therapy benefits both patients and health professionals, particularly in rural regions. Future studies are needed to confirm the effectiveness of this approach to confirm adequate treatment. [ABSTRACT FROM AUTHOR]

Purpose: The skin and mucous membrane of cancer patients can be directly or indirectly impaired during the treatment of cancers, bringing about not physical but also psychological damages to cancer patients. A practical guideline is of great significance to improve the quality of life for patients suffered from cutaneous adverse events. Methods: This guideline was generated based on up-to-date evidence and the consensus of experts specialized in dermatology. Results: The current guideline include the baseline screening of skin and mucosal membranes, the manifestations of injuries on skin, mucosa and appendages, along with the treatment of them. The causal anti-tumor management include chemotherapy, radiotherapy, immune therapy and surgery. Conclusion: This guideline can be helpful to reduce the risk of cutaneous adverse events during anti-cancer treatment and improve the quality of life of patients suffered from these adverse events. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluate the quality of clinical practice guidelines (CPGs) for breast cancer related lymphoedema (BCRL) and compare the similarities and differences in recommendations. Background: Many CPGs of BCRL have been developed; however, their recommendations and quality are controversial. Methods: Relevant papers were retrieved from electronic databases, professional associations and guideline development organizations, from 1 January 2015 to 30 September 2021. The Appraisal of Guidelines Research and Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. Intraclass correlation coefficient (ICC) analysis was used to evaluate the overall consistency among evaluators. Results: Eight CPGs were included. The ICC values evaluation for CPGs ranged from 0.76 to 0.95, with good consensus among evaluators. The highest median score was 68.75% (61.46, 72.22%) for clarity, and the lowest was 37.50% (25.78, 51.30%) for applicability. The NICE, ACS/ACSO and APTA CPGs were rated well in most areas. Professional health education, individualized exercise programme and regular surveillance are the main methods to prevent lymphoedema. Conclusion: In the past 6 years, the quality of BCRL guidelines has varied greatly, especially in the domains of rigour and applicability. Interrater agreement was excellent, but recommendation showed some inconsistencies in the details. Summary statement: What is already known about this topic? Providing recommendations based on evidence‐based guidelines for care of cancer treatment‐related lymphoedema will help to improve outcomes for patients with this chronic condition. What this paper adds? The rigour of the guidelines needs to be improved.Guideline‐making organizations have the responsibility to promote the application of guidelines into practice using a variety of methods.Multifactorial reasons were responsible for the differences inguidelines' recommendations The implications of this paper Nurses need to be more aware of guideline recommendations.There are inconsistencies in the details, despite many similarities.The formulation of individual nursing care programmes should be tailored to the local clinical situation and working environment. [ABSTRACT FROM AUTHOR]

Objectives: To determine the demographics, outcomes, and healthcare utilization of patients with chronic venous insufficiency-associated lymphedema (CVI-LED) and the prevalence of lymphedema-specific therapy use after venous intervention. Methods: The IBM MarketScan Commercial and Medicare Claims Databases were examined for patients with CVI-LED. Patient demographics and the use of lymphedema-specific therapy before and after venous intervention were collected. Results: Of 85,601 LED patients identified, 8,406 also had a diagnosis of CVI. In the CVI-LED group, 1051 underwent endovenous ablation or venous stent placement. The use of lymphedema-specific therapy before and after venous intervention was 52% and 39%, respectively (p <.05). The mean time of initiation of LED-specific therapy following venous intervention was 265 days after ablation and 347 days after stent placement. Conclusion: Treating venous hypertension improves certain venous-related signs and symptoms of CVI. However, a significant proportion of patients have persistent edema which may reflect underlying, sub-optimally treated LED. [ABSTRACT FROM AUTHOR]

The aim of this review is to assess the efficacy and safety of using heat and cold therapy for adults with lymphoedema. A multi-database search was undertaken. Only studies which included adults with lymphoedema who were treated with heat or cold therapy reporting any outcome were included. Screening, data extraction, and assessment of bias were undertaken by a single reviewer and verified by a second. Due to the substantial heterogeneity, a descriptive synthesis was undertaken. Eighteen studies were included. All nine studies which assessed the effects of heat-therapy on changes in limb circumference reported a point estimate indicating some reduction from baseline to end of study. Similarly, the five studies evaluating the use of heat-therapy on limb volume demonstrated a reduction in limb volume from baseline to end-of-study. Only four studies reported adverse events of which all were deemed to be minor. Only two studies explored the effects of cold therapy on lymphoedema. Tentative evidence suggests heat-therapy may have some benefit in treating lymphoedema with minimal side effects. However, further high-quality randomised controlled trials are required, with a particular focus on moderating factors and assessment of adverse events. This review highlights the potential benefit that heat therapy may have on reducing limb circumference and volume for adults with lymphoedema. There was no evidence that controlled localised heat therapy was unsafe. The current evidence-base is at a point where no specific clinical recommendations can be made. The use of heat therapy should only be applied as part of a methodologically robust study to treat lymphoedema. [ABSTRACT FROM AUTHOR]

Increasing pressures on healthcare resources require constant evaluation of the efficiency and effectiveness of provision, particularly for the rising number of vulnerable, elderly and obese patients. Practices regarding compression are arguably often ingrained due to its historical usage, with evidence from managing chronic venous insufficiency (CVI) underpinning its effectiveness. This evaluation explores the clinical benefit, impact, outcomes and cost-efficiencies of using an adjustable compression wrap system instead of previous care. 'Before-after design' observation of 50 patients captured baseline resource use, costs and outcomes (clinical and patient) at the time of assessment and again at a maximum of six-month follow-up. Data after using the adjustable compression wrap showed significantly improved clinician-reported outcomes: presence of wounds/leg ulceration (from 56% to 21%), incidence of cellulitis (halved), and reduced complexity/severity of lymphoedema. Additionally, patientreported outcomes, visual analogue scale (VAS) health score and LYMPROM© scores for pain, heaviness, shopping for shoes and clothes, and body image significantly improved. The mean number of community nurse visits per patient reduced from 11.6. to 9.1, but was not statistically significant (p-value 0.09). However, this evaluation found that over six months there was a mean cost reduction of over £383.70 per patient, which included the purchase price of the adjustable compression wrap system. [ABSTRACT FROM AUTHOR]

Optimal management of breast cancer-related lymphoedema (BCRL), a common and debilitating complication of surgery and radiotherapy, depends on early detection, personalised risk assessment and proactive intervention. For instance, a recent review advises healthcare professionals to reframe the narrative about the daily-living skin trauma risks away from 'what to avoid' to 'what to do'. Another review recommends daily, or nearly daily, exercise at home to reduce lymphoedema severity. However, several questions await full answers. There is, for instance, no consensus regarding the most appropriate surgical technique for preventing BCRL. This feature summarises some recent papers updating healthcare professionals about BCRL. [ABSTRACT FROM AUTHOR]

Primary lymphedema is the most common form of lymphedema presenting in the pediatric age group. Childhood lymphedema is caused by hereditary or congenital malformations in the lymphatic system that can manifest at birth or during childhood or adolescence. Complex decongestive therapy (CDT) is the cornerstone of conservative management of lymphedema in both adult and pediatric lymphedema patients, although pediatric treatment guidelines are still lacking. In this study we aimed to assess the effects of CDT on pediatric patients. Childhood lymphedema patients who presented to the lymphedema rehabilitation unit of our university hospital before the age of 18 and who were treated for lymphedema with CDT were included in the study. Data on patient demographics, disease characteristics, and treatment duration were recorded. Limb volumes were calculated from patient measurements using a spreadsheet software (Limb Volume Calculator) that utilized the geometric formula for volume of a truncated cone. Measurements were taken before treatment and also weekly after initiation of treatment. Percent excess volume (PEV) was used instead of absolute volume difference to define the severity of lymphedema. A total of 34 limbs from 24 patients were included in the study. The mean age of the patients was 10.1 ± 4.9 years and 14 (58.3 %) were female. Most patients had one affected limb but 16 had bilateral lower-extremity lymphedema. The mean duration of treatment with CDT was 153.6 ± 155.8 days. Excess volume percentage change between pre-treatment PEV (602.8 ± 713.8) and post-treatment PEV (514.6 ± 699.1) was found to be statistically significant (p < 0.05). Pediatric lymphedema management is a difficult and less well studied area in lymphedema rehabilitation. Our data support the use of CDT, which is a safe and effective treatment method, for pediatric lymphedema patients. [ABSTRACT FROM AUTHOR]

Chronic lymphedema is a progressive and inflammatory disease caused by impaired lymphatic transport. This study evaluates the effects of complex decongestive therapy (CDT) and aquatic physiotherapy on markers of the inflammatory process and lower limb volumes in individuals with lymphedema. A randomized controlled clinical trial was carried out with three groups: patients with lymphedema submitted to CDT, patients with lymphedema submitted to aquatic physiotherapy, and control group of individuals without lymphedema. The evaluation was performed through blood count, CRP measurements, C3, C4 complement, measurement of serum levels of cytokines interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), interleukins 4 (IL-4), 6 (IL-6), and 10 (IL-10), and the volume of a lower limb using the volume formula of a truncated cone. The study was registered with the Brazilian Clinical Trials Registry (RBR-4tpkszn). Our work showed a reduction in the TNF-α levels of patients in the CDT group (p =.028). Significant differences were found between the control group and the CDT group for IL-10 (p =.049) and Monocytes (p =.039). No significant reduction in limb volume was found. Our results show that CDT was able to significantly reduce the inflammatory marker TNF-α in patients with lymphedema, suggesting an anti-inflammatory effect of the therapy. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Breast cancer is among the most prevalent malignancies in women worldwide, with substantial morbidity and mortality. Upper limb lymphedema (ULL) is a common complication after breast cancer surgery that affects patients' daily activities and quality of life. Decongestive lymphatic therapy (DLT) and intermittent pneumatic compression (IPC) therapy are 2 primary treatment methods for ULL. Objectives: This study aimed to compare the efficacy of DLT with IPC versus DLT alone in the management of ULL following breast cancer surgery. Method: PubMed Central, SCOPUS, EMBASE, MEDLINE, Cochrane Trial Registry, Google Scholar, and Clinicaltrials.gov databases were comprehensively searched for randomized controlled trials (RCTs) comparing DLT with IPC and DLT alone in patients with breast cancer-related ULL. The risk of bias was evaluated using the RoB 2 tool. Pooled effect sizes were calculated using random-effects models. Results: A total of 1,894 citations were identified by the systematic search. Of them, 9 RCTs were included in the analysis. The pooled standardized mean difference (SMD) for percentage volume reduction was 0.63 (95% confidence interval [CI]: −0.24 to 1.50; I2 = 90.9%), showing no significant difference between the DLT alone and DLT combined with IPC (p = 0.15). Pain and heaviness scores were also comparable between the groups. However, there was a significant difference in external rotation joint mobility (SMD = 0.62; 95% CI: 0.08–1.16; I2 = 23.8%), favoring DLT with IPC. Conclusions: Our findings suggest that DLT with IPC and DLT alone showed similar findings in managing ULL after breast cancer surgery, with DLT with IPC showing a greater impact on external rotation joint mobility. Healthcare providers should consider patient preferences and individual factors when selecting the most appropriate treatment modality for ULL management. [ABSTRACT FROM AUTHOR]

Background: Lymphoedema is a progressive condition causing significant alterations to life, exerting pressures on unscheduled care from complications including cellulitis and wounds. An on the ground education programme (OGEP) was implemented to raise knowledge, competence and confidence in lymphoedema management in community clinical services. The aim of this study was to explore the impact and outcomes of the OGEP intervention. Methods: Data were captured before and after OGEP on 561 lymphoedema patients in the community setting. Data recorded included resource use, costs and outcomes (EQ-5D-5L and LYMPROM). Results: Data demonstrated statistically significant reductions in resource allocations including staff visits (P<0.001), cellulitis admissions (P<0.001), compression consumables and wound dressing costs (P<0.001). Overall, the total mean per patient cost decreased from £1457.10 to £964.40 (including intervention) with outcomes significantly improved in EQ-5D-5L/LYMPROM scores. Conclusion: The analysis suggests the OGEP intervention may offer reductions in resource costs and improvements in patient outcomes. OGEP may therefore provide an innovative solution in future care delivery. [ABSTRACT FROM AUTHOR]

Simple Summary: Some cancer survivors, especially breast cancer survivors, may face the issue of lymphedema. Although it tends to be incurable, there are some methods to manage lymphedema. Exercise was thought to aggravate lymphedema severity in cancer survivors until a completely opposite view was proposed in 1998. Since then, an increasing number of studies have been carried out to investigate the effects of exercise on cancer survivors with lymphedema. Currently, exercise is widely considered safe and beneficial. However, the formulation of exercise prescriptions for patients with lymphedema has been under exploration. The aim of this literature review is to extract information from existing studies to provide some advice for the design of exercise prescriptions in terms of reducing lymphedema severity. The findings of this literature may help patients reduce the severity of lymphedema and improve their quality of life. It may also help reduce healthcare costs and improve affordability. Exercise has been repeatedly shown to be safe and beneficial for cancer survivors. However, there is no normative guideline for exercise prescription, and it is still under exploration. Therefore, this literature review aims to provide some advice for the formulation of exercise prescriptions for patients with breast cancer-related lymphedema (BCRL) from the perspective of reducing lymphedema severity. A review of relevant studies published before November 2023 was conducted using three scientific databases: PubMed, Embase, and Scopus. A total of 2696 articles were found. Eventually, 13 studies fulfilled the inclusion criteria and were included in this literature review. We concluded that daily, or nearly daily, exercise at home can be recommended. Moreover, reduced lymphedema severity may not be maintained after ceasing the exercise program, so exercise should be a lifelong practice. [ABSTRACT FROM AUTHOR]

Breast cancer--related lymphedema is a lifelong disease associated with decreased quality of life and increased healthcare costs. Evidence supports early detection and prompt treatment through prospective surveillance models as standard of care. Additional research on risk stratification and predictive modeling may lead to patient-centered treatments. Advanced practice providers are uniquely positioned to develop and implement comprehensive lymphedema programs focused on treatment and prevention pathways. AT A GLANCE * Lymphedema is the result of progressive, inflammation-induced fibrosis and responds more favorably to early intervention as compared to late-stage disease. * Best practice and national clinical guidelines recommend prospective lymphedema surveillance models as standard of care. * Investigating mechanisms behind individual susceptibility can aid in the development of riskdriven and personalized treatment pathways. [ABSTRACT FROM AUTHOR]

The 11th annual National Lymphoedema Conference, organised by the British Journal of Community Nursing in association with the British Lymphology Society and Lipoedema UK, was hosted at the America Square Conference Centre, London, on 22 February 2024. The conference, which aims to provide new insights into the latests developments in lymphoedema care and management through talks by leading experts in the field, was attended by an impressive number of delegates and exhibitors. The sessions were Chaired by BLS Trustee Rebecca Elwell, and are summarised below. [ABSTRACT FROM AUTHOR]

Toe and foot swelling can manifest as lymphoedema or chronic oedema but can also be a complication of the treatment of these conditions. In this article, the authors discuss the assessment and treatment options for toe and foot swelling, highlighting the importance of prevention in the first instance. [ABSTRACT FROM AUTHOR]

The Health and Safety Execultive lymphoedema model of care was published in 2018 highlighting the lack of dedicated lymphoedema services in Ireland. This led to the introduction of a proof-of-concept primary care specialist lymphoedema clinic. The clinic was responsible for all patients from their county. A comprehensive dataset was gathered which included the patient's history for 1 year prior to their presentation at clinic and then 6 monthly. A quality of life tool (LymQoL) and a patient satisfaction survey were completed. Completed 1-year data showed a significant reduction in GP and public health nurse visits as well as a reduction in the occurrence of cellulitis and associated hospital admissions. All areas of quality of life were improved and patient satisfaction was either excellent (89%) or very good (11%). The 1-year findings strongly support the roll-out of specialist clinics to all regional health areas. [ABSTRACT FROM AUTHOR]

This article will focus on the integration of tissue viability and lymphoedema services to improve outcomes for patients with leg ulceration. It will highlight why there is a need for lymphoedema specialist knowledge within the care of patients with leg ulceration and how the services are closely aligned. Lymphoedema can adversely affect wound healing and the article will provide case studies that highlight how developing a hybrid tissue viability and lymphoedema clinician or integration of the specialists can provide effective patient-centred care at reduced cost. The article offers potential strategies and suggestions on how to address inequalities in care and how to improve service provision. [ABSTRACT FROM AUTHOR]

Lymphoedema is a long-term condition which is incurable at the present time. Due to the nature of the condition, being both long-term and manifesting in physical changes (swelling), its impact on the person and their lives can be hard to quantify. Management options need to be considered within a person-centred approach, with the four cornerstones of treatment being skin care, exercise, compression therapy and manual lymphatic drainage (MLD). Evidence for each is varied and practitioners need to determine their therapeutic benefit. Beyond the cornerstones of treatment, future developments are ongoing within the areas of surgery, such as venous anastomosis and pharmacological interventions, which may reduce the effects of continual inflammation. In the future, these developments may become part of the care delivered to those affected by lymphoedema. However currently, skin care, exercise, and compression therapy remain fundamental, with MLD included if therapeutically indicated, as well as educating and empowering those involved in self-management with the support of practitioners. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical performance, quality of life (QoL) and patient satisfaction with an innovative flat-knit compression garment for the daytime treatment of lymphoedema patients in daily routine. Method: In a prospective multicentre observational study, patients with leg or arm lymphoedema (stage I-II, International Society of Lymphology (ISL) standards, 2016) received a made-to-measure flat-knit compression class 2 JOBST Confidence (BSN-JOBST GmbH, Germany) thigh-high stocking or arm sleeve. Primary endpoint was the oedema status as determined by the mean sum of the circumferences at the beginning and the end of the wearing period. Secondary endpoints included QoL-related parameters and patient satisfaction with product features assessed through questionnaires. The observation period lasted three weeks. Results: A total of 97 patients (87 females, 10 males), of which 65 had leg lymphoedema and 32 had arm lymphoedema, received the study device. The oedema status was effectively maintained (slight reduction in mean sum of circumferences by –3.1±7.3cm; p=0.0001). For QoL-related parameters, the patients reported fewer limitations in work, leisure and psychological wellbeing after wearing the stocking or arm sleeve (all p-values <0.0001). They also experienced less limitations in function and movement, feeling of tension and heaviness, and fewer difficulties wearing clothes, shoes, jewellery or watches at study end (all p-values <0.0001). In terms of pleasant feeling on the skin, moisture management, softness of material, range of motion, overall wearing comfort and heat build-up under the garment, patients were more satisfied with the tested compression garment than with previously worn compression garments (all p-values <0.001). Conclusion: In this study, the tested innovative compression product increased patient satisfaction with the improved product features while the lymphoedema status was successfully maintained. [ABSTRACT FROM AUTHOR]

Lymphedema is a chronic condition, which can impact a person's quality of life and function. Identifying lymphedema at an early stage is key to preventing a person from developing chronic lymphedema. Physiatry can play an important role in education, identification of risk factors, performing prospective lymphedema surveillance programs, and prevention/treatment of lymphedema. Incorporating lymphedema surveillance programs into routine cancer care provides physiatry with the opportunity to assess additional rehabilitation and functional needs of a cancer patient. [ABSTRACT FROM AUTHOR]

This case study describes the successful management of a patient with primary lymphoedema, who was experiencing lymphorrhoea and epidermolysis, using a multidisciplinary approach. The patient had Klippel–Trenaunay syndrome. The multidisciplinary team, in an outpatient clinic in Japan, included a certified lymphoedema therapist, plastic surgeons, and a wound, ostomy and continence nurse. The team performed complex physical therapy and lymphaticovenular anastomosis, which promoted the resolution of the lymphorrhoea. This resulted in improvements in skin condition, the prevention of recurrent cellulitis, and no increase in limb circumferences during the 1-year follow-up period. This report highlights the importance of a multidisciplinary approach to lymphoedema management, including lymphorrhoea control that fitted in with the patient's daily life. It is hoped that this article will contribute to the improvement of the quality of life of patients with lymphoedema. [ABSTRACT FROM AUTHOR]

Lymphoedema is the gradual, abnormal build-up of lymph fluid in the tissues resulting from a failure of the lymphatic system. The swelling impedes movement and is painful. Compression garments are contraindicated and not tolerated by patients with extensive peripheral arterial disease. In this case study, simple lymphatic drainage was therefore considered a safer treatment option to reduce oedema and to encourage proactive self-management for a patient with bilateral amputations, diabetes and peripheral arterial disease. [ABSTRACT FROM AUTHOR]

The vast majority of wound care is undertaken by community nurses (Dhoonmoon, 2023), with £941 million attributed to venous leg ulcer care and a further £836 million spent on unspecified leg ulcer management (Guest et al, 2017). If signs and symptoms can be recognised and a diagnosis made, a plan of care can be drawn up and treatment implemented quickly and efficiently to reduce costs escalating further. More important though, the patient's condition will improve quickly and deterioration in quality of life can be avoided. Nursing staff are currently encouraging patients to take a more active role in their own care, guiding them in how to look after their own long-term conditions, which can promote long lasting healing and independence [ABSTRACT FROM AUTHOR]

The article provides information on lymphatic insufficiency and stiff compression in venous leg ulceration.

Background: There is no clear guidance or comprehensive comparative evidence to help clinicians select between adjustable wraps for compression therapy. However, adjustable wraps could be compared with three metrics used for compression bandages: variation in pressure, stiffness and elasticity. Aims: To determine whether easywrap (Haddenham Healthcare) had lower standard deviation (SD) in lying pressure, greater static stiffness index (SSI) and/or a greater mean elongation ratio than six other adjustable wraps. Methods: In this preliminary exploratory study, seven adjustable wraps were tested in vivo 20 times each (140 tests in total), on 20 people (with a variable number of readings per participant), to give the SD in lying pressure and mean SSI. The same wraps were tested in vitro five times each to give the mean elongation ratio. Findings: Of all seven adjustable wraps, easywrap had the second lowest SD in lying pressure at 5.9 mmHg, compared with 8.9 mmHg overall; the highest mean SSI at 13.2 mmHg, compared with 9.5 mmHg overall; and the highest mean elongation ratio at 137.0%, compared with 107.1% overall. Conclusions: These metrics suggest that easywrap has clinical advantages over other adjustable wraps. A lower variation in lying pressure suggests more consistent application of pressures within intended therapeutic levels. Higher SSI indicates greater resistance to stretching, which is linked to improved venous function and oedema reduction. Higher elongation ratio demonstrates greater tensile strength, which should maintain therapeutic pressure for longer without readjustment. [ABSTRACT FROM AUTHOR]

Background: Complete decongestive therapy is the standard treatment for lymphedema. Manual lymphatic drainage and short-stretch multilayer compression bandaging are two daily stages of complete decongestive therapy during which physiotherapists work with patients. Objective: The aim of this study was to assess the risks of musculoskeletal disorders to which physiotherapists are exposed during these two phases. Method: Five physiotherapists performed five 20 min manual lymphatic drainages, followed by the compression bandaging phase. From the video recordings, 8477 postures defined by 13 joint angles were grouped into clusters using hierarchical cluster analysis. The risk of musculoskeletal disorders in physiotherapists' postures was assessed using ergonomic tools. Results: Seven clusters, called generic postures (GP), were identified and defined throughout the mean joint angle values and standard deviation. Four seated GPs were found for the drainage phase, and three standing GPs were identified for the bandaging phase. This phase corresponded to a quarter of the total duration. The GP's ergonomic scores ranged from 4.51 to 5.63 and from 5.08 to 7.12, respectively, for the Rapid Upper Limb Assessment (RULA) and Rapid Entire Body Assessment (REBA). GP1, GP3, and GP4 presented the highest ergonomic scores (RULA scores: 5.27 to 5.63; REBA scores: 6.25 to 7.12). The most affected areas were the neck (flexion > 20° for all GPs), trunk (flexion between 25 and 30° for GP2, and GP7 during the bandaging phase and GP4 during the drainage phase), and shoulder (flexion and abduction >20° for all GPs except GP5). Conclusions: These results highlighted that the two complete decongestive therapy phases could be described as a combination of GP. Ergonomic assessment showed that compression bandaging as well as drainage phases expose physiotherapists to moderate musculoskeletal disorder risks that require "further investigation and change soon". [ABSTRACT FROM AUTHOR]

Lymphoedema secondary to breast cancer is one of the most unfortunate outcomes, and lymphoedema secondary to breast cancer in the ipsilateral upper extremity and its management, has been described in the literature. We are reporting a case of lymphoedema and lymphorrhoea in the breast itself, managed by compression bandaging with limited resources and the use of active pharmacological agents in the palliative care unit of a tertiary care hospital. Lymphoedema and lymphorrhoea in the breast are not very common to see in clinics, but management of this case even though no protocol available, was done by modification of bandaging techniques available for limb lymphoedema management. [ABSTRACT FROM AUTHOR]

Background Klippel-Trénaunay syndrome (KTS) is a rare congenital vascular malformation syndrome defined as capillary and venous malformations, and hypertrophy of the limb with or without lymphatic malformation. Currently there is no cure for KTS but the majority of patients are advised to wear compression garments on the affected limb to control swelling and discomfort. Aim To describe used compression therapy methods and their results in a paediatric patient with KTS. Methods The patient records were assessed for the used treatment methods for KTS. Our patient was treated with multimodal treatments to alleviate symptoms, and compression therapy was used specially to control lymphoedema and venous insufficiency. Results A 13-year-old boy with KTS had lymphoedema and venous insufficiency of the right lower extremity since birth. Compression therapy was started at the age of 2 months with a custom-made, single-leg compression pantyhose with gradual compression from distal to proximal regions. Furthermore, a manual lymphatic drainage and intermittent pneumatic compression were added on the regimen respectively. Other treatment methods included sclerotherapy, surgery and medication. None of treatment methods was sufficient alone to reduce limb oedema but the patient reported improved performance when using compression garments and a positive impact after enhanced compression therapy. Conclusion This report shows the importance of continuous and individualised compression therapy in the treatment of lymphoedema associated to KTS. [ABSTRACT FROM AUTHOR]

Lymphedema treatment has traditionally been based on conservative therapies. In recent years, the introduction of two microsurgical techniques—venolymphatic anastomoses and lymph-node transplantation—have revolutionized the therapeutic approach to this disease. However, these surgical techniques only provide a partial volume reduction, and thus, they require further improvement. A new device called BioBridgeTM, an implantable biocompatible and biodegradable mesh, made up of aligned nanofibrillar collagen scaffolds that mimic the collagen matrix, could significantly improve the benefits of these surgical strategies, favoring lymphatic regeneration. In this article, we describe our experience with three patients affected by primary lymphedema, two treated with a lymph-node transplant, and one with venolymphatic anastomosis. All interventions involved the placement of nanocollagen scaffolds. With each patient, non-contrast magnetic resonance lymphography was performed for surgical planning and there was an imaging and a clinical follow-up at 1 year. All patients showed a significant reduction in the affected areas with the demonstration of new lymphatic vessels at MR imaging follow-up. This was a preliminary experience, and it showed the potential benefit of positioning nonfibrillar scaffolds in combination with other microsurgical therapies for lymphedema. [ABSTRACT FROM AUTHOR]

Lymphoedema is thought to affect around 200 000 people in the UK (NHS England, 2023). Secondary lymphoedema is a relatively common complication of cancer and cancer treatment, and in advanced disease it may present a challenging issue for community nursing staff caring for patients approaching the end of their lives. In this article, a case study considers the assessment and treatment of upper limb lymphoedema in a patient with advanced metastatic breast cancer. Management of this complex and distressing condition requires holistic assessment and collaborative care planning with the patient and their wider care team, including onward referral to specialist lymphoedema and palliative care services. The case study considers the typical presentation of lymphoedema in an upper limb, exclusion of reversible causes for oedema, awareness of palliative care emergencies such as superior vena cava obstruction, and the provision of supportive therapeutic interventions in context of the patient's expressed wishes for her ongoing care. [ABSTRACT FROM AUTHOR]

The aim was to investigate the effectiveness of Kinesio taping for lymphedema following head and neck cancer therapy and its effect on patient compliance and quality of life. A total of 66 patients with lymphedema following head and neck cancer therapy were randomly allocated to the therapeutic Kinesio taping group (n = 33) and the sham Kinesio taping group (n = 33). All participants received manual lymphatic drainage, Kinesio taping, and home exercises for the first four weeks, and only home exercises for the second four weeks. The tape measurements, a scale of external lymphedema, a scale of the internal lymphedema, and quality of life were evaluated in both groups. The perceived discomfort consisting of limitation of daily living activities, pain, tightness, stiffness, and heaviness were also recorded. When the group x time effect was evaluated, it was observed that external lymphedema was significantly reduced in both groups according to neck and face composite measurements (p <.001). However, in these measurements, a significant difference was found between the groups in favor of the KT group (p =.001, p =.032, respectively). At the end of the study, there was no significant difference in terms of internal lymphedema in both groups (p =.860). The quality of life parameters such as global health status and swallowing were significantly better in the Kinesio taping group (p <.001). There was no significant difference in the parameters of perceived discomfort between the two groups (p =.282, p =.225, p =.090, p =.155, p =.183, respectively). Kinesio taping is effective in tape measurements and positively affects the quality of life in lymphedema following head and neck cancer therapy. [ABSTRACT FROM AUTHOR]

The article offers updates on the activities and events of the British Lymphology Society in 2024 and 2025. These include the 2024 National Lymphoedema Conference, the launch of the Lower Limb Inflammatory Pathway at the 2024 European Wound Management Association Conference, a fundraising event held at Claridge's Hotel in London, England, participation in the Legs Matter Week, the Lymphaletics 2025 event in London, and a conference at the Chester Race Course in England in October 2024.

In the article, the author discusses how community nurses in the United Kingdom (UK) can empower people with lymphoedema based on the concept of patient accountability and empowerment. Also cited are the features of lymphoedema like chronic swelling, pain and heaviness in the tissues, and the focus of treatment like lymphatic drainage, exercise, and skincare.

Aim: The present aimed study was to report the mobilization of body fluids after five days of intensive treatment for secondary lower limb lymphedema. Materials and methods: A crossover clinical trial was conducted involving the analysis of changes in intracellular and extracellular fluids in all extremities and the trunk in women with lower limb lymphedema secondary to treatment for gynecological cancer. Evaluations were performed with multi-segment bio impedance analysis before and after intensive treatment using Godoy Method® eight hours per day for five days. Comparisons were made using Wilcoxon signed-ranks test. Results: Significant changes in intracellular and extracellular fluids were found in all extremities and the trunk (p<0.0001 for all comparisons). Conclusion: Intensive Godoy Method® leads to important changes in the distribution of body fluids in the treatment of lower limb lymphedema following treatment for gynecological cancer, with a significant increase in fluids in the upper limbs and trunk as well as significant reductions in the lower limb and in intracellular and extracellular water. [ABSTRACT FROM AUTHOR]

In both developing toddlers and adults, the staggering number of proteins contained in the extracellular matrix interact dynamically with the whole nervous system circuitry. Edema develops when lymphatic drainage is restricted, leading to the accumulation of toxic wastes and the possibility for systemic dysregulation of the neuronal synapses. It is imperative that extra proteins and wastes are removed from the interstitial space. Therefore, to promote complete health, including hormonal health in women, the lymphatic system must be addressed. Our observations demonstrate the numerous advantages of decongestive physical therapy for female lymphedema patients. The objective of this research is to see how effective decongestive physiotherapy approaches are in lymphedema patients. The diseased limb’s area was greatly lowered, which improved the sleep quality and quality of life (QOL) score that had been confirmed using the Cronbach’s alpha value for the total color energy-physiological medi taping (CEPMT). The main goals of CEPMT are to enhance lymphatic circulation and avoid lymphatic stasis, which enhances QOL and sleep. The patient’s recovery was significantly aided by patient education, counseling, and a home bandaging routine, which was verified using the questionnaire approach. In gynecological cancer patients, CEPMT is crucial for lowering lymphoedema, enhancing sleep quality, and improving CEPMT. [ABSTRACT FROM AUTHOR]

Background: The treatment of lymphoedema requires a multi-professional and interdisciplinary approach. Despite being prescribed in the management of lymphatic disorders, the effectiveness of the phlebological insoles is still under investigation. Aim: This scoping review aims to identify and analyse evidence regarding the efficacy of phlebological insoles as a conservative intervention for lower limb lymphoedema. Method: The following databases were searched up to November 2022: PubMed, Cochrane Library, CINAHL Complete, PEDro and Scopus. Preventive and conservative interventions were considered. Studies considering people with lower limb oedema, of any age and type of oedema, were eligible for inclusion. No restrictions in terms of language, year of publication, study design and type of publication were applied. Additional studies were sought through grey literature. Results: From 117 initial records, 3 studies met the inclusion criteria. Two quasi-experimental studies and one randomised cross-over study were included. The results of the examined studies confirmed the positive effects of insoles usage and foot and ankle mobility on the venous return. Conclusion: This scoping review provided an overview of the topic. The studies analysed in this scoping review have shown that insoles seem to be beneficial in reducing the lower limb oedema in healthy individuals. However, there are still no comprehensive trials confirming this evidence on people with lymphoedema. The small number of identified articles, the selection of participants not affected by lymphoedema, the use of heterogeneous devices in terms of modifications and materials highlight the need of further investigations. Future trails should include people affected by lymphoedema, address the choice of materials in manufacturing the insoles and take in consideration the patients' adherence to the device and concordance to the treatment. [ABSTRACT FROM AUTHOR]

While electronic health (eHealth) has been gaining in popularity in recent years, its adoption was accelerated by the COVID-19 pandemic, when restrictions on in-person consultations compelled healthcare practitioners to turn to modalities such as telehealth for patient management. There are numerous potential benefits of using eHealth in lymphoedema management, including improved access to care, better tracking of symptoms and enhanced options for patient engagement and empowerment. As healthcare practitioners continue to prioritise patient-centred care, with an emphasis on putting the patient's needs first and making treatment as accessible as possible, eHealth offers a promising opportunity to improve lymphoedema care. This article provides an overview of eHealth, explores a classification system for the various forms of eHealth, discusses the rationale for using eHealth, and proposes future research directions in lymphoedema care. [ABSTRACT FROM AUTHOR]

Secondary lymphoedema is a troubling and complex symptom in people with advanced metastatic cancer. Currently there is no standardised approach to managing secondary lymphoedema in the palliative care population. This case study of lower limb lymphoedema utilises subcutaneous drainage with specific cannula placement. The hope is that this insight may allow for future standardisation of this procedure.. [ABSTRACT FROM AUTHOR]

Manual lymphatic drainage (MLD) massage is widely accepted as a conservative treatment for lymphoedema. This case study examines the effectiveness ofMLD in combination with bio-electric massage therapy (BMT)/transcutaneous electrical nerve stimulation (TENS) for those living with lymphoedema and lipoedema. The use of non-invasive multi-modal treatment methods such as these in the treatment/management oflymphoedema and lipoedema can be useful reducing limb volume and improving quality oflife for people living with this condition. Results obtained in this case study showed reduction in volume oflimbs, as well as texture changes and positive effects in symptom-related outcomes. During the case study, the client became more optimistic about her condition and motivated to try more physical activities. This case study highlights the need for further experimental studies on the effectiveness ofMLD with BMT in lymphoedema and lipoedema. [ABSTRACT FROM AUTHOR]