A Lymphedema Self-Management Programme: Report on 30 Cases

Abstract

Purpose: Compression therapy is the most important element in the treatment and long-term management of moderate and severe lymphedema, but it is not universally accessible in Canada. For those unable to access private lymphedema treatment, physiotherapists at the McGill University Health Centre (MUHC) Lymphedema Clinic began teaching patients and caregivers how to use compression bandages safely and effectively. Methods: A retrospective chart review was combined with structured telephone or in-person interviews with 30 people who had attended a self-bandaging clinic in the MUHC Lymphedema Clinic between 2011 and 2012. Patients were monitored weekly until limb volume plateaued, and a compression garment was then fitted for ongoing maintenance. Monthly or quarterly surveillance continued for 1 year. Follow-up interviews were conducted 3 to 18 months after patients had received their garments. Results: The majority of participants had moderate to severe lymphedema; all achieved reduction of edema in the range of 48% to 92%. More than three-quarters of participants reported a global rate of change (GRC) of b80%. Themes derived from the interviews included the importance of bandaging, the feeling of being in control, and difficulties with compression garments. Participants spontaneously expressed satisfaction about having tools to manage their condition themselves. Conclusion: For selected patients with lymphedema, a self-bandaging programme can be a route to lymphedema reduction, independence, and self-efficacy.

A review of the evidence for adjustable compression wrap devices

“…5,6 Selfapplication of compression is reported as providing greater independence, self-efficacy, and a sense of control for people with lymphoedema. 7 Intensive treatment using compression therapy can be demanding for patients and professionals, particularly if regular bandage application is necessary due to severe ulceration, leakage of exudate, or problematic skin conditions. Miller et al 8 described more than 50% of patients treated with multi-layer bandaging as non-concordant, for various possible reasons such as poor tolerance of treatments or limited motivation.…”

Results of home-based modified combined decongestive therapy in patients with lower extremity lymphedema

“…In a previous study, a case series about self-bandaging, 30 upper and lower extremity lymphedema patients received a self-bandaging training program during 3-12 weeks of treatment [27]. Among all participants with LEL, edema reduction after intensive self-bandaging showed statistically significant differences at all stages.…”

Lay Caregivers Education in Multicomponent Compression Bandaging in Obese Patients with Lower Limb Edema: A Case–Control Pilot Study

“…3 Self-performance of complex decongestive therapy, based on compression, manual lymphatic drainage, and remedial exercises, can be a valuable method to decrease limb volume and chronic pain in breast cancer-related lymphedema. 4,5 Self-bandaging programs for lymphedema patients have been promoted in many countries, for example, in Canada, 6 Ireland, or the Netherlands. 7 Although many lifestyle changes and self-care indications for patients with lower limb edema are proposed, 8 the utility of self-applied short-stretch leg compression has not been evaluated, except for adjustable wrap compression systems.…”