Ehmann Suzie, Mayrovitz Harvey N
Physical Therapy, Nova Southeastern University, Fort Lauderdale, USA.
Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA.
Cureus. 2023 May 6;15(5):e38647. doi: 10.7759/cureus.38647. eCollection 2023 May.
Background The clinical efficacy of a compression application has been often limited to the assessment of the change in limb volume, change in clinical symptoms (i.e., wound size, pain, range of motion, incidence of cellulitis), or vascular hemodynamics of the whole limb. Assessing compression-related biophysical changes of a localized area, such as around a wound, or in an area outside of an extremity cannot be objectively assessed by these measurements. Tissue dielectric constant (TDC) values, which provide a measure of the local tissue water (LTW) content, offer an alternative method to document variation in the LTW content of the skin in a specific location. The goals of the present research were (1) to characterize TDC values, expressed as percentage tissue water, from multiple areas along the medial aspect of the lower leg of healthy volunteers and (2) to explore the potential utilization of the TDC values to assess change in tissue water content in a localized area following compression applications. Methods TDC was measured at 10, 20, 30, and 40 cm proximal to the medial malleolus on the medial aspect of the right leg of 18 young adult healthy women with an age range of 18-23 years and a body mass index of 18.7 to 30.7kg/m. TDC was measured at baseline and after 10 minutes of exercise with compression in place on three separate days during which three different compression applications were assessed: a longitudinal elastic stockinette, a two-layer cohesive compression kit, and a combination of the two. Leg circumferences and compression-related interface pressures were also measured. Results Test-Retest Reliability of circumferential measurements and TDC values evaluated using Intraclass correlation coefficient (ICC ) revealed excellent and moderate-to-good reliability, respectively. Analysis of TDC values along the length of the limb using Friedman's test, revealed a small but statistically significant overall difference among baseline TDC values attributable to a smaller value at 40 cm. The largest difference in cumulative average was 7.7% which occurred between 20 and 40 cm, with all other differences between locations less than 1%. No significant differences between the compression applications were observed. Conclusion The present findings demonstrate the utility of TDC measurements as a modality to assess compression-related changes in the legs of healthy women as a foundation for their potential use in assessing outcomes of compression treatments for persons with lower extremity edema or lymphedema. The absence of a significant change in TDC values in these healthy non-edematous conditions and the demonstrated reliability of the TDC measurements on three different days provides further support for the utility of such applications of TDC measurements. The extension to patients with lower extremity edema or lymphedema needs to be evaluated.
压迫疗法的临床疗效通常局限于评估肢体体积变化、临床症状改变(如伤口大小、疼痛、活动范围、蜂窝织炎发生率)或整个肢体的血管血流动力学。通过这些测量方法无法客观评估局部区域(如伤口周围或肢体外部区域)与压迫相关的生物物理变化。组织介电常数(TDC)值可衡量局部组织含水量,为记录特定位置皮肤局部组织含水量的变化提供了一种替代方法。本研究的目的是:(1)表征健康志愿者小腿内侧多个区域的TDC值(以组织含水量百分比表示);(2)探讨利用TDC值评估压迫应用后局部区域组织含水量变化的可能性。方法:对18名年龄在18 - 23岁、体重指数在18.7至30.7kg/m的年轻成年健康女性的右小腿内侧,在内踝近端10、20、30和40厘米处测量TDC。在基线以及在三天内的三个不同压迫应用(纵向弹性弹力袜、两层粘性压迫套件以及两者组合)下,在施加压迫的情况下运动10分钟后测量TDC。同时测量腿部周长和与压迫相关的界面压力。结果:使用组内相关系数(ICC)评估的周长测量和TDC值的重测信度分别显示出极好以及中度到良好的信度。使用弗里德曼检验对沿肢体长度的TDC值进行分析,结果显示基线TDC值之间存在微小但具有统计学意义的总体差异,这是由于40厘米处的值较小。累积平均值的最大差异为7.7%,出现在20厘米和40厘米之间,其他位置之间的差异均小于1%。未观察到不同压迫应用之间存在显著差异。结论:本研究结果表明,TDC测量作为一种评估健康女性腿部与压迫相关变化的方式具有实用性,为其在评估下肢水肿或淋巴水肿患者压迫治疗效果方面的潜在应用奠定了基础。在这些健康无水肿的情况下TDC值无显著变化,以及在三天内TDC测量显示出的可靠性,为TDC测量的此类应用的实用性提供了进一步支持。对于下肢水肿或淋巴水肿患者的应用扩展需要进一步评估。