Background and Purpose. Upper-extremity (UE) swelling following breast cancer treatment is a frequent manifestation of lymphedema. In order to document outcomes from lymphedema treatments, reliable, valid, and practical measurements of UE swelling are necessary. The purpose of this study was to compare geometric methods of determining UE volumes with water displacement methods. Subjects. The edematous hand, forearm, and upper arm of 50 women with UE swelling secondary to lymphedema were measured. Methods. Upper-extremity volumes were determined by water displacement using arm and hand volumeters. Displaced water was weighed to determine volume. Circumferential girth measurements were taken. Width and depth measurements of the hand were taken with a tension-controlled caliper. Geometric volume formulas for a cylinder, frustum, rectangular solid, and trapezoidal solid were used to calculate volumes of the arm and hand at different measurement intervals. Results. Intraclass correlation coefficients [2,1] for interrater and intrarater reliability of all water and geometric measurements of the arm and hand were .91 to .99 and .92 to .99, respectively. Water displacement correlated with geometric measurements in the arm (r=.97–.98) and in the hand (r=.81–.91). The limits of agreement (LOA) indicated that water and geometric measurements of arm volume differed by 479 to 655 mL. Scatterplots of the LOA data indicated in that geometric volumes were either larger or smaller than water volumes. The smallest standard error of measurement for the arm measurements was for the 6-cm frustum method at 115 mL; for the hand measurements, the smallest standard error of measurement was for the frustum method at 16 mL. Discussion and Conclusion. Volume of an edematous UE calculated by geometric formulas correlated strongly with volume determined by water displacement. Although strongly correlated, the measurements obtained by the 2 methods did not agree.

Survivors who were active were not afraid to exercise. However, concern about lymphedema and knowledge about safe and effective exercise programs influenced choices regarding physical activity and exercise.

Background Pain is one of the most commonly reported impairments after breast cancer treatment affecting anywhere from 16-73% of breast cancer survivors Despite the high reported incidence of pain from cancer and its treatments, the ability to evaluate cancer pain continues to be difficult due to the complexity of the disease and the subjective experience of pain. The Oncology Section Breast Cancer EDGE Task Force was created to evaluate the evidence behind clinical outcome measures of pain in women diagnosed with breast cancer. Methods The authors systematically reviewed the literature for pain outcome measures published in the research involving women diagnosed with breast cancer. The goal was to examine the reported psychometric properties that are reported in the literature in order to determine clinical utility. Results Visual Analog Scale, Numeric Rating Scale, Pressure Pain Threshold, McGill Pain Questionnaire, McGill Pain Questionnaire – Short Form, Brief Pain Inventory and Brief Pain Inventory – Short Form were highly recommended by the Task Force. The Task Force was unable to recommend two measures for use in the breast cancer population at the present time. Conclusions A variety of outcome measures were used to measure pain in women diagnosed with breast cancer. When assessing pain in women with breast cancer, researchers and clinicians need to determine whether a unidimensional or multidimensional tool is most appropriate as well as whether the tool has strong psychometric properties.

Background Breast cancer–related lymphedema (BCRL) is a well-known side effect of cancer and its treatment with wide-ranging prevalence estimates. Objective This study describes associations between breast cancer–related lymphedema (BCRL) signs, symptoms, and diagnosis for women who were African American, white, or had a low income and survived breast cancer. Design This is a cross-sectional, observational study that used a computer-assisted telephone interview. Methods Women who had survived breast cancer were queried on the presence of 5 lymphedema signs and symptoms (edema in the breast, axilla, arm, and/or hand; tissue fibrosis; pitting; hemosiderin staining; heaviness) and whether they had a diagnosis of BCRL. Relationships between signs/symptoms and diagnosis for each group were evaluated with kappa and chi-square statistics. Results The study sample included 528 women who had survived breast cancer (266 white and 262 African American), with 514 reporting complete data on household income; 45% of the latter reported an annual household income of ≤$20,000. Women who were African American or had a low income were nearly twice as likely as women who were white to have any of 8 signs/symptoms of BCRL. Regardless of race and income, >50% of women with all BCRL signs and symptoms reported that they were not diagnosed with BCRL. Limitations The main limitations of our study are the lack of medical chart data and longitudinal design. Conclusions Women who were African American or had a low income and had survived breast cancer had a greater burden of BCRL signs and symptoms than women who were white. The lack of a strong association between BCRL signs, symptoms, and diagnosis suggests that BCRL may be underdiagnosed. These findings suggest that more rigorous screening and detection of BCRL—especially for women who are African American or have a low income—may be warranted. Cancer rehabilitation programs may be able to fill this gap.

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Background and Purpose: The Commission on Accreditation in Physical Therapy Education includes criteria for the management of edema. The purpose of this case report is to outline content and instructional guidelines for edema and lymphedema management in 2 entry-level Doctor of Physical Therapy curricula. Case Description: Teaching edema management includes both general and specific knowledge of the anatomy and physiology of the lymphatic system, an understanding of the pathophysiology of edema, and competency in traditional and innovative skills of edema management in the context of a patient management model and evidence-based practice. Northwestern University Department of Physical Therapy and Human Movement Science has a required dedicated course that combines clinical management of patients with lymphatic and integumentary dysfunction. The University of Southern California integrates edema management throughout the 3-year curriculum. Both of these programs are presented in detail. Outcomes: The Northwestern program has been presented continuously since 2003; the University of Southern California began integrative edema management in 2002 and evolved into the current model in 2005. Mean scores on the Federation of State Boards of Physical Therapy examination consistently indicate that graduates from both schools rank higher than other first-time test takers from US accredited programs in the area of cardiovascular/pulmonary and lymphatic systems. Discussion and Conclusion: This report provides objectives, methods, and references to guide an instructional course in edema management in an entry-level Doctor of Physical Therapy curriculum. Two cases of integrating edema content within a current curriculum are presented. An essential element for a successful program is the availability of academic or clinical faculty trained in lymphedema management.

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The contextual factors (environment, healthcare service organization, need for rehabilitation and status and history of the physiotherapy profession) were essential for project and instructional choices. Facilitating factors included the established professional degree and association, continuing professional development requirements, a core group of active professionals and an existing foundation from other projects. The processes and contextual considerations may be useful in countries with established professional-level education but without established postentry-level training. Implications for Rehabilitation Organizations planning continuing professional development programs may benefit from considering the context surrounding training when planning, designing and developing instruction. The surrounding context including the environment, the organization of healthcare services, the population defined need for rehabilitation, and the domestic status and history of the physiotherapy profession, is important for physiotherapy projects in countries with lower resources. Facilitating factors in low resource countries such as an established professional degree and association, continuing professional development requirements, a core group of active professionals and an existing foundation from other projects impact the success of projects. Methods that may be useful for relevance, dissemination and consistency include involvement of in-country leaders and instructors and attendance in multiple courses with consistent themes. Rehabilitation professionals in low resource countries may benefit from continuing professional development courses that emphasize practical skills, and clinical reasoning, accompanied by clinical mentoring and directed coaching that encourages knowledge transfer to the clinical setting. Active learning approaches and multiple progressive courses provide opportunities to develop peer support through professional communities of practice.