Authors (including presenting author) :
Chak YT(1), Chan LYC(1), Lam YC(1), Wong SL(1), Mok YC(1), Chan LC(1)
Affiliation :
(1)Department of Physiotherapy, Pok Oi Hospital
Introduction :
Lymphedema is a lifelong swelling condition. It is caused by an accumulation of protein-rich fluid in the subcutaneous tissues which is mostly related to the removal of lymph nodes in cancer treatment or malfunction of the lymphatic system. Complete decongestive therapy is the proven effective conservative management of lymphedema. It consists of skin care, manual lymphatic drainage, compression therapy and remedial exercise. Most of the components require skills of health care workers and labour intensive. Since there is a rising trend of breast cancer in Hong Kong and its related upper limb lymphedema over a 10-year postoperative period reached to 49%, the demand for lymphedema treatment has increased dramatically. A pilot structured lymphedema management program focusing on patient empowerment was designed and formed in the physiotherapy department, Pok Oi Hospital in April 2019 to tackle the increased caseload.
Objectives :
This study is to evaluate the effectiveness and efficacy of the structured program.
Methodology :
This is a retrospective study. The assessment results of patients with stage I and II unilateral upper extremity lymphedema were retrieved and analysed in this study. The subjects are divided into two groups according to the treatment program they underwent in the Physiotherapy Department, Pok Oi Hospital – (1) underwent structured lymphedema program during October 2019 to March 2021, and (2) underwent non-structured lymphedema treatment during October 2017 to March 2019. Exclusion criteria are active malignancy, active cellulitis, received lymphedema surgical intervention, stage 0 and III lymphedema. Condition staging, total circumference of the limb and total treatment sessions were collected as the outcome measurements. SPSS was used to analyse the data.
Result & Outcome :
A total of twenty-three female subjects, fourteen from structured and nine from non-structured program, fulfilled the selection criteria and were included in this retrospective analysis. The mean age was 59.8 +/- 9.3 years old. Though patients of both groups had a positive effect on the condition such as improvement of the disease staging or reduction of the total circumference, there was no statistically significant improvement in the non-structured group. In contrast, there was a significant decrease in total circumference and condition staging with the p-value 0.005 and 0.046 respectively in the structure group. Apart from the clinical outcome measurement, the mean of total treatment sessions was significantly reduced from 20 sessions in non-structured program to 6 sessions in the structured group with the p-value 0.013. This pilot structured lymphedema management program provides an effective and efficient treatment to the patients. It not only lessens the limb total circumference as well as its staging. It also diminishes the total number of treatment sessions by empowering patient’s self-management.
