Body Positional Effects on Bioimpedance Spectroscopy Measurements for Lymphedema Assessment of the Arm

Abstract

Background: Bioimpedance spectroscopy (BIS) measurements have conventionally been performed using a device that uses gel-backed electrodes with the patient in a supine position. More recently, impedance devices that use stainless steel electrodes with the patient in a standing position have become available. The aim of this study was to assess and compare BIS measurements made in three different body positions using two different impedance devices (lead device and stand-on device) in women with and without arm lymphedema. Methods: A cross-sectional study design was used to recruit two cohorts of women, healthy controls (n = 47) and those who had been diagnosed with breast cancer (n = 53) and were either at risk of (n = 14) or with unilateral arm lymphedema (n = 39). BIS measurements were taken three times in each position for each device. Results: Impedance measurements were reliably made using either a lead or stand-on device with a coefficient of variation being 0.6% or lower. Absolute impedance measurements for the stand-on device were larger than the comparable lead device values due to the difference in electrode position, but were highly correlated (r = 0.92, p < 0.0001). Interarm impedance ratios and L-Dex scores were slightly (3.1% equivalence), but significantly different. Conclusion: The findings support impedance measurements being made reliably using either the lead or standon device, representing supine and upright measurement positions, respectively. Data between devices were, however, not directly interchangeable.

The Risk of Subclinical Breast Cancer-Related Lymphedema by the Extent of Axillary Surgery and Regional Node Irradiation: A Randomized Controlled Trial

“…12,13 BIS, particularly when performed using newer upright scale-like devices, provides immediate reproducible and objective feedback and can be done by any trained staff members in a few minutes. 14 Studies have found that BIS is a reliable objective measure for patients with early lymphedema with a score of >7.1, consistent with clinical BCRL. 12 BIS, particularly when performed using newer upright scale-like devices, provides immediate feedback and can be done by any trained staff in a few minutes.…”

“…12 BIS, particularly when performed using newer upright scale-like devices, provides immediate feedback and can be done by any trained staff in a few minutes. 14 Ridner (2019) compared early detection using TM or BIS over 3 years in a multicenter international randomized control trial. Trigger points defining sBCRL requiring intervention were a BIS change of !6.5 L-Dex units and, for the TM group, a volume change in the at-risk arm that was between !5 and <10% above presurgical baselines (without a similar change in the noneat-risk arm).…”

Prospective surveillance model in the home for breast cancer-related lymphoedema: a feasibility study

“…BIS monitoring involved the use of a BIS stand-on device. The stand-on device used was a commercially available impedance device (SOZO ® , ImpediMed Limited, Brisbane, Australia) with demonstrated validity and reliability [28]. BIS measures the resistance at 0 kHz (R0) of the unaffected limb and compares this to the resistance at 0 kHz of the affected/at-risk limb expressed as the following ratio (unaffected:affected/at-risk).…”

“…They were excluded if they had implantable devices such as pacemaker or other inbuilt stimulator, were pregnant, reported having a previous history of breast cancer or arm lymphoedema, if they had a health condition that may affect body fluid status or if they reported having a psychiatric illness that would limit their compliance with study requirements The intervention consisted of a package including BIS monitoring, education, and support to promote self-management and physical activity over a 6-month period Item 3: What (Materials): any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers BIS monitoring involved the use of a BIS stand-on device. The stand-on device used was a commercially available impedance device (SOZO®, ImpediMed Limited, Brisbane, Australia) with demonstrated validity and reliability [ 28 ]. This device is portable and can be operated easily by an individual completing self-measurements within a home environment with access to power and a wireless internet network Electronic scales were used so that the participant could take their weight prior to a BIS measurement The education component focussed on risk minimisation and included provision of the Australian Cancer Council Understanding Lymphoedema fact sheet [ 27 ] Self-management strategies included skin care, exercise, self-lymphatic drainage massage, compression and the use of pneumatic compression.…”

“…BIS monitoring involved the use of a BIS stand-on device. The stand-on device used was a commercially available impedance device (SOZO®, ImpediMed Limited, Brisbane, Australia) with demonstrated validity and reliability [ 28 ]. This device is portable and can be operated easily by an individual completing self-measurements within a home environment with access to power and a wireless internet network…”