Modern Treatment of Lymphoedema I. Complex Physical Therapy: The First 200 Australian Limbs

Abstract

Complex Physical Therapy (CPT) is discussed and its principles outlined. CPT involves: 1. skin care, 2. a special lymphatic massage, 3. compression bandaging and (later) garments, 4. special exercises which supplement the massage. CPT was used on 78 patients with postmastectomy lymphoedema (17 with Grade 1 and 61 with Grade 2). There were significant differences between the Grades. In the first four-week course the mean Grade 1 was reduced from 121% of normal to 107% (the mean change in the oedema was 103% of its initial value), and Grade 2 from 153% to 123% (with a mean change in oedema of 60%). All these were very highly significant. Over the next year there was a small, but very significant, decrease in the percentage of oedema. A further four-week course resulted in significant, and similar, reductions in the residual oedema. CPT was used to treat 128 lymphoedematous legs; 22 were Grade 1 lymphoedema, 84 were Grade 2 and 19 were elephantitic (Grade 3). After the first course of CPT the mean losses were: 1.1, 1.3 and 3.7 litres, respectively (all very significant). Over the next 11 months there were significant further reductions for all legs and in the amount of oedema of the unilateral legs. Some patients had a second course of CPT with similar reductions in the remaining oedema to that after the first course.

The Long -Term Effects of Complex Decongestive Physical Therapy on Lower Extremity Secondary Lymphedema and Quality of Life

“…The present study showed the greatest improvements in rolephysical (p=0.002) and general health (p=0.003). The trend toward increases in physical functioning and role-physical scores of functional status and mental and general health scores of well-being supports the theory that CDPT is beneficial for the physical, and psychological health of women with secondary lymphedema after gynecological cancer treatment 5,25,26) . Subjects expressed feeling more confident using their affected lower limb for activities of daily living, and some mentioned that they had returned to walking long distances, playing sports, performing housework and shopping after the decongestive phase.…”

“…Lymphedema volume was calculated for each segment by utilizing the formula for a truncated cone: Volume =H (C 2 + Cc+ c 2 )/12, H =height, C =circumference of the top of the cone, c =circumference of the base of the cone. This method demonstrated excellent inter-and intra-observer reproducibility in comparison with water displacement, which is considered the gold standard 25,26) . Volumes for each segment were averaged and the reduction in lower limb circumference was calculated by the following formula with the unaffected limb used as a normal control for the affected limb (percentage excess volume; PCEV): PCEV =(affected volume -unaffected volume)/unaffected volume × 100.…”

Overview of treatment options and review of the current role and use of compression garments, intermittent pumps, and exercise in the management of lymphedema

“…Garment use for 20 hours per day and longer has been suggested. 1,5,11,12,24,25 Bertelli et al 23 have reported statistically significant reduction of edema in patients who wore garments for 6 consecutive hours per day. A multivariate analysis noted superior reduction in those women who had not had significant weight gain following treatment for breast carcinoma.…”

“…12 Manual lymphatic drainage has been reported to be effective when used in combination with other antiedema efforts, such as complex decongestive therapies, as well as in combination with an intermittent compression pump and complex decongestive therapies. Manual lymphatic drainage is a specialized, distinct form of massage, incorporating regional massage as well as treatment of the affected limb.…”

“…1 It has been suggested that this increased pressure is exerted against the skin and other subcutaneous tissues that aid in maintaining interstitial fluid homeostasis. 1,2,8,12,24 These tissues ultimately will stretch as a result of this relentless force. Use of a garment or other type of wrap, such as a bandage, likely relieves the skin and subcutaneous tissues from bearing this increased pressure.…”