Use of Outcome Measures by Certified Lymphedema Therapists With Survivors of Breast Cancer With Breast Cancer–Related Lymphedema

Abstract

Background: Survivors of breast cancer (SBC) with breast cancer–related lymphedema (BCRL) have demonstrated neuromusculoskeletal restrictions, sensorimotor impairments, postural instability, and balance deficits. To date, there have been no studies that investigate outcome measures (OMs) used by certified lymphedema therapists (CLTs) with SBC with BCRL. Objective: The purposes of this study were to (1) determine types of OMs used and their frequency of use by CLTs with SBC with BCRL and their differences between therapy professions, and (2) identify unique characteristic predictors for use of OMs. Methods: Cross-sectional online survey research design. Electronic surveys were distributed to CLTs from various institutions. Data from 70 physical therapists (PTs) and 41 occupational therapists were analyzed from 130 completed surveys. Results: Sixteen OMs used most often assessed joint function, flexibility, strength, pain, volume, sensation, tissue consistency, body composition, health-related quality of life, and upper quadrant function. There were differences between PTs and occupational therapists in use of OMs. Lymphology Association of North America certification, practice setting, and profession (physical therapy and occupational therapy) predicted the use of some OMs. Conclusions: This study identified individual OMs used on SBC with BCRL in clinical practice among interdisciplinary CLTs. The number of OMs used to assess body functions and structures exceed those OMs for activities and participation, which may be influenced by CLT profession, Lymphology Association of North America certification, and level of highest degree.

Practice patterns of physical therapists and physical therapist assistants treating patients with breast cancer related lymphedema

“…However, there was high adherence to use of exercise at 87%. A recent report by Doubblestein et al reported that 100% of PTs surveyed reported using volume and circumference measures [29] compared to 49% who use circumference to calculate limb volume in this study. However, Doubblestein et al grouped all circumference and volume measures into one category and did not discern stage of BCRL within their survey and this may explain the large difference between reports.…”

“…These two sampling methods limited our ability to account for the total number of PTs or PTAs who received the survey, thereby limiting our ability to calculate a survey response rate. Other physical therapy practice pattern surveys report a 2-82% response rate [24,28,29,34]. The second is that we assessed adherence to clinical practice guidelines using a single method, survey.…”

Facilitators and Barriers to the Use of Outcome Measures by Certified Lymphedema Therapists

“…An online survey design was implemented to gather responses from CLTs from various postprofessional lymphedema continuing education programs and related professional associations in the United States. Detailed description of the survey methodology, variables, and statistical analysis is provided elsewhere 8. This study is a follow-up analytic investigation to the study by Doubblestein et al,8 which received exempt status by the Health Sciences and Behavioral Sciences Institutional Review Board of the University of Michigan, Flint and from A.T.…”

“…The survey was divided into 3 domains to gather (1) demographics and practice characteristics of respondents, (2) levels of use of standardized and clinically relevant OMs, and (3) levels of agreement on facilitators and barriers to using OMs. Outcome measures were separated into 2 domains from the International Classification of Functioning, Disability and Health (ICF): (1) OMs used by CLTs to measure ICF domain of body structures and functions with subdomains of (1.1) joint function, (1.2) flexibility, (1.3) strength, (1.4) volume, (1.5) pain, (1.6) tissue consistency, (1.7) body composition, and (1.8) sensation; and (2) OMs used by CLTs to measure ICF domains of activities and participation with subdomains of (2.1) patient-reported function and health-reported quality of life, (2.2) patient-reported upper quadrant function, (2.3) patient-reported fatigue, (2.4) mobility and balance, and (2.5) upper extremity activity and motor control 8. A total of 92 OMs (see Supplemental Digital Content 1, available at: http://links.lww.com/REHABONC/A46) were scored a level of use by the respondents.…”

“…A clinical practice guideline (CPG) for the diagnosis of BCRL was developed by the Academy of Oncologic Physical Therapy of the American Physical Therapy Association and recommends OMs for this population 7. Beyond these guidelines, there are other OMs being used by certified lymphedema therapists (CLTs) for use in the population with BCRL 8. Adding to that fact is that there is a multidisciplinary group of professionals who are CLTs including, physical therapists (PTs), occupational therapists (OTs), massage therapists (MTs), nurses (RNs), and physicians (MDs) 9.…”