Evaluation of inter-rater reliability of subjective and objective criteria for diagnosis of lymphedema in upper and lower limbs

Abstract

BACKGROUND: The diagnosis of lymphedema can be obtained objectively by measurement methods, and also by subjective methods, based on the patient's complaint. OBJECTIVE: To evaluate inter-rater reliability of objective and subjective criteria used for diagnosis of lymphedema and to propose a lymphedema cut-off for differences in volume between affected and control limbs. METHODS: We studied 84 patients who had undergone lymphadenectomy for treatment of cutaneous melanoma. Physical measures were obtained by manual perimetry (MP). The subjective criteria analyzed were clinical diagnosis of lymphedema in patients' medical records and self-report of feelings of heaviness and/or increase in volume in the affected limb. RESULTS: For upper limbs, the subjective criteria clinical observation (k 0.754, P<0.001) and heaviness and swelling (k 0.689, P<0.001) both exhibited strong agreement with MP results and there was moderate agreement between MP results and swelling (k 0.483 P<0.001), heaviness (k 0.576, P<0.001) and heaviness or swelling (k 0.412, P=0.001). For lower limbs there was moderate agreement between MP results and clinical observation (k 0.423, P=0.003) and regular agreement between MP and self-report of swelling (k 0.383, P=0.003). Cut-off values for diagnosing lymphedema were defined as a 9.7% difference between an affected upper limb and control upper limb and a 5.7% difference between lower limbs. CONCLUSION: Manual perimetry, medical criteria, and self-report of heaviness and/or swelling exhibited better agreement for upper limbs than for lower limbs for diagnosis of lymphedema.

Use of compression garment in the treatment of malignant lymphedema in a patient with recurrent breast cancer: case report

“…In this case reported, the feeling of heaviness was quite expressive, which improved with the use of the compression garment. Based on manual perimetry, it is known that there is a strong correlation between the feeling of heaviness and limb volume increase 12 . The feeling of heaviness is improved when the volume of the limb is reduced.…”

The validity of an adjustable compression velcro wrap for the treatment of patients with upper limb lymphedema secondary to breast cancer: a pilot study

“…However, after its use, only 11.1% of these patients mentioned the discomfort. Campanholi et al 17 observed good agreement between manual perimetry and subjective evaluation through self-report of heaviness and/or upper limb swelling. When limb perimetry decreases, sensation of heaviness is reduced.…”