Sezgin Ozcan Didem, Dalyan Meltem, Unsal Delialioglu Sibel, Duzlu Ulku, Polat Cemile Sevgi, Koseoglu Belma Fusun
Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital , Ankara, Turkey .
Lymphat Res Biol. 2018 Oct;16(5):446-452. doi: 10.1089/lrb.2017.0061. Epub 2018 Jan 22.
We aimed to evaluate the effects of complex decongestive therapy (CDT) on upper extremity functions, the severity of pain, and quality of life. We also searched the impact of the sociodemographic and clinical characteristics on the improvement in upper extremity functions.
A total of 37 women with breast cancer-related lymphedema (BCRL) [age, 53.6 ± 11.2 (28-72)] were included in this study. All patients underwent CDT-phase 1 program, including meticulous skin care, manual lymphatic drainage, remedial exercises, and compression bandages. Arm volume was calculated by a formula for truncated cone using circumferential measurements. A baseline questionnaire, including sociodemographic and clinical properties, was used for each patient. Short Form-36 (SF-36), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and Visual Analog Scale (VAS) for pain and heaviness were used as clinical assessment scales.
The mean of the posttreatment volume of the affected limb was lower compared to pretreatment volume (2741.81 ± 696.85 and 2990.67 ± 745.49, respectively), and the mean percentage change in edema volume was 38.1% ± 26.5%. We observed a statistically significant reduction in pain and heaviness VAS scores and improvement of shoulder mobility among upper extremities with lymphedema (p < 0.001) after CDT. The mean of posttreatment DASH score was lower compared to pretreatment score (37.19 ± 16.01, 49.81 ± 18.84, respectively, p < 0.001). All subgroups of the SF-36 parameters were increased after the CDT application (p < 0.01). Besides being under 65 years old, having a body mass index above 30 and short duration of lymphedema were found to be related to greater improvement in upper extremity functions.
CDT provides enhancement of upper extremity functions and quality of life in patients with BCRL. The reduction in lymphedema volume, pain, and heaviness and the improvement in shoulder mobility may be the contributed factors.
我们旨在评估综合消肿治疗（CDT）对上肢功能、疼痛严重程度和生活质量的影响。我们还研究了社会人口统计学和临床特征对上肢功能改善的影响。
本研究共纳入37例乳腺癌相关淋巴水肿（BCRL）患者[年龄53.6±11.2（28 - 72岁）]。所有患者均接受CDT第一阶段治疗方案，包括细致的皮肤护理、手动淋巴引流、康复锻炼和加压绷带。使用截断圆锥体公式通过周长测量计算手臂体积。为每位患者使用一份包括社会人口统计学和临床特征的基线问卷。采用简短健康调查问卷（SF - 36）、手臂、肩部和手部功能障碍（DASH）问卷以及疼痛和沉重感视觉模拟量表（VAS）作为临床评估量表。
与治疗前相比，患侧肢体治疗后的平均体积较低（分别为2741.81±696.85和2990.67±745.49），水肿体积的平均百分比变化为38.1%±26.5%。我们观察到，CDT后，淋巴水肿上肢的疼痛和沉重感VAS评分有统计学意义的降低，肩部活动度得到改善（p < 0.001）。治疗后的DASH评分平均值低于治疗前评分（分别为37.19±16.01、49.81±18.84，p < 0.001）。应用CDT后，SF - 36参数的所有亚组均有所增加（p < 0.01）。除了年龄在65岁以下外，还发现体重指数高于30以及淋巴水肿病程较短与上肢功能的更大改善有关。
CDT可改善BCRL患者的上肢功能和生活质量。淋巴水肿体积、疼痛和沉重感的减轻以及肩部活动度的改善可能是促成因素。
