Lymphedema Rehabilitation: Provision and Practice Patterns among Service Providers: National Survey

Abstract

Background: Information on the current practices and quantification of lymphedema service may be beneficial to promote and improve health care system. Therefore, this study aimed to describe characteristics of lymphedema practitioners, and lymphedema patients’ profile, and provide a comprehensive picture of lymphedema service provision in Saudi Arabia. Methods: A cross-sectional study involved use of an online survey. The survey questionnaires included information about demographic and professional characteristics of lymphedema practitioners, lymphedema profile, questions on the services provided, and perceived barriers in providing a service. Results: Eighteen lymphedema practitioners (37.50%) responded to the survey. They worked in the major cities: Riyadh (78%), Jeddah (17%), and Dammam (5%), and most of them working in public hospitals (67%). Respondents typically had a background in physical or occupational therapy and had completed a basic training course on lymphedema treatment and management. About 75% of patients seen by practitioners had secondary lymphedema, 47% with breast cancer-related lymphedema. On average 72%, practitioners provide a “comprehensive” lymphedema services. The average number of lymphedema practitioners per service is 2.67. The perceived barriers reported included an inadequate number of certified therapists (100%), difficulties with transportation and lack of financial support (each =72%), and limited space for lymphedema practice/management (89%). Conclusion: The results suggest that lymphedema practitioners provide a reasonable, but not the optimal, services for lymphedema patients. The service provision is still limited and inequities. Therefore, more staffing is required to promote awareness of the condition and related services, improve referral and care coordination, and enhancing geographical and multidisciplinary coordination of the service.

Healthcare Practitioners’ Knowledge of Lymphedema

“…After screening, 16 articles met the inclusion criteria [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Figure 1 shows the PRISMA flow chart of included and excluded articles.…”

“…Lymphedema and Study Design. Although in five articles, the type of lymphedema was not determined, and it was generally addressed to any type of lymphedema [21,22,25,34,36]; different types were studied, including BCRL [27,29,30], cancer-related lymphedema [28,31,33], filariasis [23,35], and podoconiosis [23,24,26,32]. Interestingly, one article was focused only on genital lymphedema [21].…”

“…The design of studies was cross-sectional and qualitative in 12 [21,22,[24][25][26][27][28][29][30][31][32]36] and two [34,35] articles, respectively, while two studies were interventional [23,33]. These characteristics are provided in Table 1.…”

“…Questionnaire and Key Concepts. The knowledge assessment in seven articles was not based on measurable results of a questionnaire and was self-reported or interviewed [21,22,25,28,[33][34][35]. Despite that, the key concept of the questionnaire in two articles was not provided [22,29]; each key concept of prevention (B) and management (D) was addressed in 13 articles.…”

“…The knowledge assessment in seven articles was not based on measurable results of a questionnaire and was self-reported or interviewed [21,22,25,28,[33][34][35]. Despite that, the key concept of the questionnaire in two articles was not provided [22,29]; each key concept of prevention (B) and management (D) was addressed in 13 articles. The lymphatic system (A), diagnosis (C), and complications (E) were present in the questionnaire of 11, 12, and six articles, respectively.…”