Guidelines for managing people with lymphoedema remotely: a post-COVID-19 response document

Abstract

During the COVID-19 pandemic it was initially not possible to see people with lymphoedema face-to-face at lymphoedema services, due to the potential risks of the virus, because they were shielding, because of redeployment of rooms or staff, and due to sporadic restrictions of movement. The pandemic therefore accelerated adjustments in lymphoedema service delivery, while ensuring effective and efficient care was paramount. This document presents a pragmatic guide for lymphoedema services. Although clinical and non-clinical staff need to comply with guidance from their own organisations/commissioners, this document aims to provide specific guidance and share good practice in relation to lymphoedema management. These guidelines are based on analysis of the national response of Lymphoedema Network Wales during the first few months of the COVID-19 pandemic and incorporate supporting contemporary advice. They have been used throughout NHS Wales, providing a standardised approach in supporting care for people with lymphoedema. In light of the enduring nature of COVID-19, it is imperative that lymphoedema services have a means to provide suitable care for patients. Although face-to-face appointments are sometimes deemed necessary, many patients can be suitably supported via telehealth consultations. These guidelines may help lymphoedema services restore and reset in a safe and acceptable manner.

A spotlight on lymphoedema Did Not Attends: Demographics and workforce costs

“…During the first year of the Covid19 pandemic 2020 to 2021, service activity reduced by 10% but proportionally, more people attended their appointments, that is, the proportion of DNA appointments greatly decreased, the DNA rate reduced from 6% to 2%. One reason for this could be that planned implementation of virtual consultations were expedited 25 with proven benefits including travel/waiting time and costs for the patient (time off work and childcare) being eliminated. The DNA percentage increased back up to 5% in 2021 to 2022 despite maintaining the availability of virtual consultations.…”

Surgical Treatment and Rehabilitation Strategies for Upper and Lower Extremity Lymphedema: A Comprehensive Review

“…This evidence suggested the potential implications of self-treatment administration to provide potential effective intervention to manage this disabling condition during COVID-19 spreading, given the critical issue in lymphedema management represented by the redeployment of specialized staff and the closure of outpatients’ conventional care services [ 45 , 46 ]. In light of these considerations, the recent paper by Noble-Jones et al [ 47 ] proposed a supporting intervention based on teleconsultation, image sharing, virtual staff team meetings, and education, which is in accordance with the telerehabilitation trend already proposed in several reports aiming at improving rehabilitation during COVID emergency [ 48 , 49 , 50 ]. Although several therapeutic interventions require in-presence rehabilitation, telemedicine might represent a promising option for strictly monitoring lymphedema and tailoring rehabilitation to patient’s needs potentially using the technology advancements proposed in recent years [ 51 , 52 ].…”

Evaluation der Versorgungsituation von Patient*innen mit chronischen Lymphödemen während der COVID-19-Pandemie

“…Alternative nicht als ersetzende, sondern additive Option gesehen werden [19]. Insbesondere bei besonders komplexen Fällen sollte die persönliche Vorstellung präferiert werden [2,9,20,21,22]. Hierzu zählen Entzündungen, rezidivierende Erysipele, stark volumenschwankende Ödeme sowie das Lymphödem Stadium III.…”

“…Nevertheless, such alternatives should not be seen as substitutes but as additional options [19]. Particularly in complex cases, the personal attendance of the patient should be favored [2,9,20,21,22]. These cases include inflammation, recurrent erysipelas, highly volatile edema and stage III lymphedema.…”