Review of Health-Related Quality of Life Assessments for Patients With Lymphedema

Abstract

In collaboration with Heidi Shaffer, one of the occupational therapists on staff at the MultiCare lymphedema clinic in Gig Harbor, Washington, we sought to answer the question "Which patient-reported outcome assessments are most valid and reliable in measuring health-related quality of life (HRQoL) in patients with lymphedema?" We conducted a systematic literature review to answer this question. In reviewing selected databases, 19 articles were chosen to appraise the evidence supporting psychometric properties and clinical utility of 10 HRQoL assessments used for patients with lymphedema. The Disability of the Arm, Shoulder and Hand (DASH) and Lymphedema Life Impact Scale (LLIS) assessments demonstrated stronger evidence for test-retest reliability, internal consistency, and clinical utility for use in a lymphedema practice setting in the U.S. than other assessments. The next step was to bring the findings back to Heidi and her colleagues to answer questions they had about using recommended assessments to generate G-codes for Medicare reporting and to explore strategies that could be used to implement these recommended assessments within MultiCare's electronic medical record (EMR) system. We provided an in-service on our findings for MultiCare's lymphedema therapists, at which time we distributed laminated calculation cards for converting DASH scores to G-code modifiers and obtained feedback through a satisfaction survey. In addition, we met with the Director of Physical Medicine and Rehabilitation at MultiCare, Sherri Olsen, to determine the best process for embedding the LLIS and the DASH into their EMR and identify future research needs. Additional steps will include follow up on the progress and outcomes of embedding the assessments into the EMR and further research to address changes in the literature, HRQoL assessments for other diagnostic populations, and determining the efficacy and benefits of prehab treatments. LYMPHEDEMA HRQOL ASSESSMENTS Executive SummaryThis year-long review effort began by asking the question, "Which functional outcome measures used by lymphedema therapists are best for determining G-codes?" In order to meet the needs of our collaborating clinician, Heidi Shaffer from the MultiCare lymphedema clinic in Gig Harbor, our research question was changed to, "Which patient-reported outcome assessments are most valid and reliable in measuring health-related quality of life in patients with lymphedema?" Currently, HRQoL measures specific to patients with lymphedema are lacking psychometric rigor. These instruments are particularly critical following a recent mandate by Medicare to produce G-codes, which report function-related outcomes. Our aim with this literature review was to provide local lymphedema therapists with recommended HRQoL assessments that could be used within the facility's electronic medical record (EMR) system to generate Medicare G-codes.We conducted a systematic literature review to appraise the evidence supporting the psychometric properties and clinical utility of 10 HRQ...