A Systematic Review of the Outcomes Used to Assess Upper Body Lymphedema

Sierla, Robyn; Dylke, Elizabeth; Kilbreath, Sharon L.

doi:10.1080/07357907.2018.1517362

Cited by 15 publications

(9 citation statements)

References 62 publications

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“…In another more recent meta-analysis that included the results of five studies, circumference measurement was also found to be the most frequently used method (33 studies), followed by water displacement (20) and perimetry (7). Other methods were also noted, but they were even less frequently used [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Determination of the Minimum Detectable Change in the Total and Segmental Volumes of the Upper Limb, Evaluated by Perimeter Measurements

et al. 2020

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Among female breast cancer survivors, there is a high prevalence of lymphedema subsequent to axillary lymph node dissection and axillary radiation therapy. There are many methodologies available for the screening, diagnosis and follow-up of breast cancer survivors with or without lymphedema, the most common of which is the measurement of patients’ arm circumference. The purpose of this study was to determine the intra-rater minimal detectable change (MDC) in the volume of the upper limb, both segmentally and globally, using circumference measurements for the evaluation of upper limb volume. In this study, 25 women who had received a unilateral mastectomy for breast cancer stage II or III participated. On two occasions separated by 15 min, the same researcher determined 11 perimeters for each arm at 4 cm intervals from the distal crease of the wrist in the direction of the armpit. The MDC at the segmental level ranged from 3.37% to 7.57% (2.7 to 14.6 mL, respectively) and was 2.39% (42.9 mL) at the global level of the arm; thus, minor changes in this value result in a high level of uncertainty in the interpretation of the results associated with the diagnosis of lymphedema and follow-up for presenting patients.

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Section: Introductionmentioning

confidence: 99%

Determination of the Minimum Detectable Change in the Total and Segmental Volumes of the Upper Limb, Evaluated by Perimeter Measurements

et al. 2020

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“…Interview questions were guided by assessments used by the therapist during the observational period. Questions, and therefore codes, were initially led by the categories of assessment observed and reported in the literature 3 : size or volume measurement; BIS; visual signs of lymphedema; palpated signs of lymphedema; and patient self-report. If required, additional questions were asked to elicit the rationale for the inclusion or exclusion of each assessment or measurement tool.…”

Section: Participantsmentioning

confidence: 99%

“…A range of objective and subjective clinical assessments have evolved to detect change in a limb with lymphedema. 3 The measurement of limb size through water displacement and flexible tape circumference measurements has long been used to identify and track changes in the presentation of lymphedema. 4,5 Additional tools used in the research, including TonometryÔ, BIS, callipers, ultrasound, and MoistureMeterÔ, provide an objective measurement of soft tissue changes.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 Additional tools used in the research, including TonometryÔ, BIS, callipers, ultrasound, and MoistureMeterÔ, provide an objective measurement of soft tissue changes. 3 These objective assessments may be supplemented with subjective assessments, including (1) palpation, (2) observed changes to the size and shape of the region affected or to the dermis, (3) and patient-reported symptoms. 6 In the clinical setting, it is unknown what clinical reasoning informs the choice of assessment.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Upper Limb Lymphedema: A Qualitative Study Exploring Clinicians' Clinical Reasoning

Sierla

Dylke

Shaw

et al. 2021

Lymphatic Research and Biology

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Background: A variety of objective and subjective assessments are available for clinical assessment of lymphedema. The aim of this study was to explore the clinical reasoning underpinning the assessment of upper limb lymphedema by experienced lymphedema clinicians. Methods and Results: Semistructured, individual, interviews were conducted with lymphedema therapists (n = 14) from a variety of treatment settings. These interviews were conducted after observations of these therapists assessing patients with lymphedema and focused on: (1) the therapists' rationale for the assessments selected, (2) how the data were analyzed, and (3) how the information was then used. Assessment selection was guided by the purpose of the visit, patient preference, resources, and time available. Subjective measures of visible and palpated tissue changes were used to target treatment, and objective measures of circumference and bioimpedance spectroscopy and patient report of symptoms informed treatment evaluation and disease progression. Objective data collected were primarily analyzed for interlimb difference and change between appointments. Conclusions: A range of clinical assessments were used in the evaluation of lymphedema to detect the presence of lymphedema, estimate the extent of soft tissue change, understand the patient experience of lymphedema, and evaluate treatment response. A primary determinant for the collection of objective measures was the appointment duration. Current methods of data analysis and reporting do not facilitate the review of change over time.

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“…Rodent tails and hindlimb models fail to accurately recapitulate latent onset in the human body, which ranges from 3 mo to 3 years[ 27 , 28 ]. However, a positive feedback loop is widely accepted during lymphedema development, involving local inflammation, the fibrosis of lymphatic vessels, and the deposition of adipose fat[ 29 , 30 ]. Lymphedema is therefore chronic, potentially progressive, and irreversible.…”

Section: Pathological Changes During Lymphedemamentioning

confidence: 99%

Adipose-derived stem cell therapy shows promising results for secondary lymphedema

Pan

2020

WJSC

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Lymphedema is mainly identified by progressive soft tissue swelling in impaired lymphatic system. Secondary lymphedema attributed to cancer therapy, parasite infection, and trauma remains a serious global disease. Patients with lymphedema suffer swelling, pain, and fatigue, with the dysfunction of the deformed extremities reducing the quality of life and increasing the risk of infection and lymphangiosarcoma. Adipose-derived stem cells (ADSCs) possess prominent regenerative potential to differentiate into multilineage cells, and produce various lymphangiogenic factors, making ADSC therapy a promising approach for lymphedema. The development of lymphedema consists of local inflammation, the fibrosis of lymphatic vessels, and the deposition of adipose fat. Existing animal models do not mimic the chronic inflammation environment, therefore suitable models are required in further studies. Some signal pathways and molecular mechanisms in physiological and pathological lymphagiogenesis remain unclear. In previous animal and human trials, ADSC therapy reduced edema in varying degrees. A larger number of trials with larger samples and longer follow-up periods are required to verify the efficiency and feasibility of ADSC therapy. ADSCs are of easy availability and immune exemption, making them a candidate for lymphedema treatment. Whether ADSCs enhance malignant characteristics or trigger the malignant change deserves further exploration and study before ADSC therapy can be made widely available.

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A Systematic Review of the Outcomes Used to Assess Upper Body Lymphedema

Cited by 15 publications

References 62 publications

Determination of the Minimum Detectable Change in the Total and Segmental Volumes of the Upper Limb, Evaluated by Perimeter Measurements

Determination of the Minimum Detectable Change in the Total and Segmental Volumes of the Upper Limb, Evaluated by Perimeter Measurements

Assessment of Upper Limb Lymphedema: A Qualitative Study Exploring Clinicians' Clinical Reasoning

Adipose-derived stem cell therapy shows promising results for secondary lymphedema

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