Background: Survivors of breast cancer (SBC) with breast cancer–related lymphedema (BCRL) have demonstrated neuromusculoskeletal restrictions, sensorimotor impairments, postural instability, and balance deficits. To date, there have been no studies that investigate outcome measures (OMs) used by certified lymphedema therapists (CLTs) with SBC with BCRL. Objective: The purposes of this study were to (1) determine types of OMs used and their frequency of use by CLTs with SBC with BCRL and their differences between therapy professions, and (2) identify unique characteristic predictors for use of OMs. Methods: Cross-sectional online survey research design. Electronic surveys were distributed to CLTs from various institutions. Data from 70 physical therapists (PTs) and 41 occupational therapists were analyzed from 130 completed surveys. Results: Sixteen OMs used most often assessed joint function, flexibility, strength, pain, volume, sensation, tissue consistency, body composition, health-related quality of life, and upper quadrant function. There were differences between PTs and occupational therapists in use of OMs. Lymphology Association of North America certification, practice setting, and profession (physical therapy and occupational therapy) predicted the use of some OMs. Conclusions: This study identified individual OMs used on SBC with BCRL in clinical practice among interdisciplinary CLTs. The number of OMs used to assess body functions and structures exceed those OMs for activities and participation, which may be influenced by CLT profession, Lymphology Association of North America certification, and level of highest degree.

Background and Purpose: The lymphatic system is vital for fluid homeostasis, waste removal, immunity, and tissue healing. It can be impacted by multiple diseases and traumatic processes seen by physical therapists across practice settings; hence, lymphology education in professional (entry-level) doctor of physical therapy (DPT) programs is needed. Studies to obtain information about professional DPT lymphology education have not been conducted for 20 years. The purposes of this study were to (1) describe current, typical lymphology content within professional DPT programs; and (2) identify whether lymphology content is perceived as entry-level material amongst professional DPT faculty who were responsible for teaching lymphology content (TL) and professional DPT faculty who did not teach lymphology content (NTL). Subjects: Professional DPT faculty (N = 43) in the United States who taught or did not teach lymphology curriculum. Methods: Crosssectional online survey research design. Descriptive data were gathered on lymphology content, hours, and curriculum standings. The χ 2 test assessed relationships between faculty status and entry-level lymphology curriculum status. The Spearman rank correlation coefficient assessed relationships between teaching hours and entry-level status. Results: Variability exists across curricula in range of hours devoted to didactic (0.4-14.1 hours) and laboratory (0-10 hours) instruction pertaining to lymphology. Individual curriculum contents were predominantly considered entry-level material. Limitations: Response rate was limited. Conclusion:Consistent lymphology curriculum content and format are lacking within the professional DPT programs that participated in the survey, indicating opportunities for advancements in entry-level lymphology education and investigation into best educational practices for teaching this content.

Background: Various outcome measures (OMs) have been used with individuals with breast cancer–related lymphedema (BCRL). There have not been studies investigating the facilitators and barriers to the use of OMs by certified lymphedema therapists (CLTs) on BCRL. The purposes of this study was to (1) identify facilitators and barriers for use of OMs reported by CLTs and (2) investigate the association of personal and professional characteristics of CLTs and their knowledge or beliefs about OMs. Methods: Cross-sectional online survey research design. Electronic surveys were distributed to CLTs from various institutions. Data from 70 physical therapists and 41 occupational therapists were analyzed. Point-biserial correlations examined associations and logistic regression examined predictors to OMs facilitators and barriers. Results: Certified lymphedema therapists agreed that OMs help direct a plan of care (90.1%), improve quality of care (76.6%), and determine the efficacy of their intervention on BCRL (72.7%). Certified lymphedema therapists reported difficulty knowing the best OM to choose due to numerous options (67.3%). Barriers for OMs included lack of knowledge and time, availability in workplace, and personal preferences. Characteristics associated with barriers and facilitators were few and poorly correlated. Conclusion: Certified lymphedema therapists agree on the benefits of and to the use of OMs, however, physical therapist CLTs may value the use of OMs less than occupational therapists. Certified lymphedema therapists experience barriers to use of OMs related to lack of knowledge and implementation skills. Further guidance is needed in selecting OMs for breast cancer survivors with BCRL to reduce barriers to their use.

Purpose of Review Breast cancer–related lymphedema (BCRL) is a debilitating progressive disease resulting in various impairments and dysfunctions. Complete decongestive therapy embodies conservative rehabilitation treatments for BCRL. Surgical procedures performed by plastic and reconstructive microsurgeons are available when conservative treatment fails. The purpose of this systematic review was to investigate which rehabilitation interventions contribute to the highest level of pre- and post-microsurgical outcomes. Recent Findings Studies published between 2002 and 2022 were grouped for analysis. This review was registered with PROSPERO (CRD42022341650) and followed the PRISMA guidelines. Levels of evidence were based upon study design and quality. The initial literature search yielded 296 results, of which, 13 studies met all inclusion criteria. Lymphovenous bypass anastomoses (LVB/A) and vascularized lymph node transplant (VLNT) emerged as dominant surgical procedures. Peri-operative outcome measures varied greatly and were used inconsistently. There is a dearth of high quality literature leading to a gap in knowledge as to how BCRL microsurgical and conservative interventions complement each other. Summary Peri-operative guidelines are needed to bridge the knowledge and care gap between lymphedema surgeons and therapists. A core set of outcome measures for BCRL is vital to unify terminological differences in the multidisciplinary care of BCRL. Condensed Abstract Complete decongestive therapy embodies conservative rehabilitation treatments for breast cancer-related lymphedema (BCRL). Surgical procedures performed by microsurgeons are available when conservative treatment fails. This systematic review investigated which rehabilitation interventions contribute to the highest level of pre- and post-microsurgical outcomes. Thirteen studies met all inclusion criteria and revealed that there is a dearth of high quality literature leading to a gap in knowledge as to how BCRL microsurgical and conservative interventions complement each other. Furthermore, peri-operative outcome measures were inconsistent. Peri-operative guidelines are needed to bridge the knowledge and care gap between lymphedema surgeons and therapists.

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