Intra-Rater Reliability and Agreement of the Indurometer When Used to Assess Mid-Calf Tissue Compressibility Among People Affected by Moderate to Severe Lymphedema in Bangladesh and Ethiopia

Douglass, Janet; Mableson, Hayley; Martindale, Sarah L.; Karim, Jahirul; Mahmood, Asm Sultan; Hailekiros, Fikre; Kelly-Hope, Louise A.

doi:10.1089/lrb.2019.0060

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…In the Myanmar cohort, a handheld tonometer, the Indurometer (Flinders and SA Biomedical Engineering, Australia), was able to detect a significant increase in mid-calf tissue compressibility among asymptomatic young people who were infected with LF, indicating that free fluid had begun to accumulate in the connective tissue spaces, even though there was no clinical sign of swelling. The Indurometer has demonstrated good intra-rater reliability in several populations including people affected by lower-limb lymphedema in this study [21,[23][24][25].…”

Section: Introductionmentioning

confidence: 60%

“…Tissue compressibility was quantified using the Indurometer (BME-1563; Flinders and SA Biomedical Engineering, Bedford Park, Australia) and the protocol was published in an intra-rater reliability analysis on the study population [23]. Briefly, the Indurometer is a handheld, battery-operated unit with a 1-centimeter (cm) diameter indenter projecting through a 7-cm diameter Perspex ® reference plate.…”

Section: Outcomes Measures and Data Collectionmentioning

confidence: 99%

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Effect of an Enhanced Self-Care Protocol on Lymphedema Status among People Affected by Moderate to Severe Lower-Limb Lymphedema in Bangladesh, a Cluster Randomized Controlled Trial

Douglass

Mableson

Martindale

et al. 2020

JCM

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Background: Lymphatic filariasis (LF) is a major cause of lymphedema, affecting over 16 million people globally. A daily, hygiene-centered self-care protocol is recommended and effective in reducing acute attacks caused by secondary infections. It may also reverse lymphedema status in early stages, but less so as lymphedema advances. Lymphatic stimulating activities such as self-massage and deep-breathing have proven beneficial for cancer-related lymphedema, but have not been tested in LF-settings. Therefore, an enhanced self-care protocol was trialed among people affected by moderate to severe LF-related lymphedema in northern Bangladesh. Methods: Cluster randomization was used to allocate participants to either standard- or enhanced-self-care groups. Lymphedema status was determined by lymphedema stage, mid-calf circumference, and mid-calf tissue compressibility. Results: There were 71 patients in each group and at 24 weeks, both groups had experienced significant improvement in lymphedema status and reduction in acute attacks. There was a significant and clinically relevant between-group difference in mid-calf tissue compressibility with the biggest change observed on legs affected by severe lymphedema in the enhanced self-care group (∆ 21.5%, −0.68 (−0.91, −0.45), p < 0.001). Conclusion: This study offers the first evidence for including lymphatic stimulating activities in recommended self-care for people affected by moderate and severe LF-related lymphedema.

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Section: Introductionmentioning

confidence: 60%

Section: Outcomes Measures and Data Collectionmentioning

confidence: 99%

Effect of an Enhanced Self-Care Protocol on Lymphedema Status among People Affected by Moderate to Severe Lower-Limb Lymphedema in Bangladesh, a Cluster Randomized Controlled Trial

Douglass

Mableson

Martindale

et al. 2020

JCM

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“…Detailed data collection methods have been published [ 21 , 28 , 34 ]. The primary outcome was change in lymphedema status as determined by a combination of; (1) lymphedema stage [ 33 ], (2) mid-calf circumference, and (3) mid-calf tissue compressibility quantified by tissue tonometry using the Indurometer [ 35 ].…”

Section: Methodsmentioning

confidence: 99%

“…The Indurometer (BME-1563; Flinders and SA Biomedical Engineering, Bedford Park, South Australia) was used to quantify tissue compressibility at the same mid-calf point. A detailed description of the Indurometer and its operation were published in an intra-rater reliability analysis on the study population [ 34 ].…”

Section: Methodsmentioning

confidence: 99%

Addition of Lymphatic Stimulating Self-Care Practices Reduces Acute Attacks among People Affected by Moderate and Severe Lower-Limb Lymphedema in Ethiopia, a Cluster Randomized Controlled Trial

Douglass

Hailekiros²,

Martindale

et al. 2020

JCM

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Lymphedema causes disability and exacerbates poverty in many countries. The management of lymphatic filariasis (LF) and podoconiosis-related lymphedema involves daily hygiene to reduce secondary infections, but self-massage and deep-breathing, which have proven beneficial in cancer-related lymphedema, are not included. A cluster randomized trial in northern Ethiopia investigated the effects of lymphatic stimulation for people affected by moderate to severe lymphedema. Participants were allocated to either standard (control n = 59) or enhanced (intervention n = 67) self-care groups. Primary outcomes were lymphedema stage, mid-calf circumference, and tissue compressibility. Secondary outcomes were the frequency and duration of acute attacks. After 24 weeks, fewer patients were assessed as severe (control −37.8%, intervention −42.4%, p = 0.15) and there were clinically relevant changes in mid-calf tissue compressibility but not circumference. There was a significant between-group difference in patients who reported any acute attacks over the study period (control n = 22 (38%), intervention n = 7 (12%), p = 0.014). Daily lymphedema self-care resulted in meaningful benefits for all participants with a greater reduction in acute episodes among people performing lymphatic stimulation. Observations of a change in lymphedema status support earlier findings in Bangladesh and extend the demonstrated benefits of enhanced self-care to people affected by podoconiosis.

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“…Tissue tonometry has been used in research on other forms of lymphoedema to quantify changes in skin stiffness and tissue compressibility. Good intra-rater reliability at all stages of filarial lymphoedema [ 15 ] including subclinical tissue change has been reported [ 9 ], but it is not widely available or accessible to local health staff. More recently, a portable three-dimensional infrared imaging tool has provided an innovative way to estimate limb volume measurements in a field setting [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Infrared Thermal Imaging as a Novel Non-Invasive Point-Of-Care Tool to Assess Filarial Lymphoedema

Kelly-Hope

Karim

Mahmood

et al. 2021

JCM

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Lymphatic filariasis causes disfiguring and disabling lymphoedema, which is commonly and frequently exacerbated by acute dermatolymphangioadenitis (ADLA). Affected people require long-term care and monitoring but health workers lack objective assessment tools. We examine the use of an infrared thermal imaging camera as a novel non-invasive point-of-care tool for filarial lower-limb lymphoedema in 153 affected adults from a highly endemic area of Bangladesh. Temperature differences by lymphoedema stage (mild, moderate, severe) and ADLA history were visualised and quantified using descriptive statistics and regression models. Temperatures were found to increase by severity and captured subclinical differences between no lymphoedema and mild lymphoedema, and differences between moderate and severe stages. Toes and ankle temperatures detected significant differences between all stages other than between mild and moderate stages. Significantly higher temperatures, best captured by heel and calf measures, were found in participants with a history of ADLA, compared to participants who never had ADLA, regardless of the lymphoedema stage. This novel tool has great potential to be used by health workers to detect subclinical cases, predict progression of disease and ADLA status, and monitor pathological tissue changes and stage severity following enhanced care packages or other interventions in people affected by lymphoedema.

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Intra-Rater Reliability and Agreement of the Indurometer When Used to Assess Mid-Calf Tissue Compressibility Among People Affected by Moderate to Severe Lymphedema in Bangladesh and Ethiopia

Cited by 4 publications

References 17 publications

Effect of an Enhanced Self-Care Protocol on Lymphedema Status among People Affected by Moderate to Severe Lower-Limb Lymphedema in Bangladesh, a Cluster Randomized Controlled Trial

Effect of an Enhanced Self-Care Protocol on Lymphedema Status among People Affected by Moderate to Severe Lower-Limb Lymphedema in Bangladesh, a Cluster Randomized Controlled Trial

Addition of Lymphatic Stimulating Self-Care Practices Reduces Acute Attacks among People Affected by Moderate and Severe Lower-Limb Lymphedema in Ethiopia, a Cluster Randomized Controlled Trial

Infrared Thermal Imaging as a Novel Non-Invasive Point-Of-Care Tool to Assess Filarial Lymphoedema

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