Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100, Samanpazari, Ankara, Turkey.
Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Hacettepe University, Ankara, Turkey.
Support Care Cancer. 2021 Nov;29(11):6545-6553. doi: 10.1007/s00520-021-06235-4. Epub 2021 Apr 29.
The aims of this study were to investigate if/how the presence of lymphedema affects the sensation of the upper limb and to assess whether complex decongestive physiotherapy (CDP) has a favorable impact on sensory testing.
A total of 27 patients with unilateral stage 2 breast cancer-related lymphedema (BCRL) were included in the study. Bilateral circumferential measurements were taken with a tape measure at different levels. Based on these measurements, limb volumes were determined by summing segment volumes derived from the truncated cone formula. Circumferential measurements and ultrasonographic evaluations (epidermis, dermis, and subcutaneous fat thicknesses) were performed at 10 cm distal to the elbow crease. The Semmes-Weinstein monofilament (SWM), static and moving two-point discrimination, pressure pain threshold (PPT), and tactile localization tests were also applied at the same site. After an initial evaluation, all patients underwent CDP phase 1 program. All the evaluations were repeated at the end of the treatment period.
Before CDP, affected sides had significantly higher values than the unaffected sides in terms of SWM (p < 0.001), static (p = 0.002) and moving (p = 0.011) two-point discrimination, PPT (p = 0.001), and tactile localization (p < 0.001) values. After CDP, SWM (p = 0.002), static (p = 0.009) and moving (p = 0.024) two-point discrimination, PPT (p = 0.014), and tactile localization (p < 0.001) values decreased significantly on the affected sides.
BCRL seems to reduce light touch, static and moving two-point discrimination, PPT, and tactile localization sensations, whereas CDP seems to improve these sensory perceptions in women with BCRL. Ultrasonographic measurements also appear to be promising for prompt and convenient follow-up in the management of BCRL.
Clinical Trial Registration Number: NCT04296929 (date of registration: March 5, 2020).
本研究旨在探讨上肢淋巴水肿的存在如何影响上肢感觉，并评估复杂消肿物理治疗（CDP）对感觉测试是否有有利影响。
本研究共纳入 27 例单侧 2 期乳腺癌相关淋巴水肿（BCRL）患者。使用卷尺在不同水平处测量双侧周径。根据这些测量值，通过将截头圆锥公式得出的各节段体积相加来确定肢体体积。在肘皱褶 10cm 处远端进行周径测量和超声评估（表皮、真皮和皮下脂肪厚度）。还在同一部位进行 Semmes-Weinstein 单丝（SWM）、静态和动态两点辨别觉、压痛阈值（PPT）和触觉定位测试。在初始评估后，所有患者均接受 CDP 第 1 阶段方案。所有评估均在治疗期末重复进行。
在 CDP 之前，患侧的 SWM（p<0.001）、静态（p=0.002）和动态（p=0.011）两点辨别觉、PPT（p=0.001）和触觉定位（p<0.001）值均显著高于健侧。在 CDP 之后，患侧的 SWM（p=0.002）、静态（p=0.009）和动态（p=0.024）两点辨别觉、PPT（p=0.014）和触觉定位（p<0.001）值均显著降低。
BCRL 似乎降低了轻触觉、静态和动态两点辨别觉、PPT 和触觉定位觉，而 CDP 似乎改善了 BCRL 女性的这些感觉知觉。超声测量似乎也有望在 BCRL 的管理中实现及时、方便的随访。
临床试验注册号：NCT04296929（注册日期：2020 年 3 月 5 日）。
