Attaining consensus on a core dataset for upper limb lymphoedema using the Delphi method: A foundational step in creating a clinical support system.

Lymphoedema is a condition of localised swelling caused by a compromised lymphatic system. The protein-rich fluid accumulating in the interstitial tissue can create inflammation and irreversible changes to the skin and underlying tissue. An array of methods has been used to assess and report these changes.

Quantification of breast lymphoedema following conservative breast cancer treatment: a systematic review.

Purpose: Breast lymphoedema is a possible side effect of breast conserving surgery, but it is poorly understood. This is due, in part, to difficulty assessing the breast. This systematic review described outcome measures that quantify breast lymphoedema signs and symptoms and evaluated the measurement properties for these outcome measures.

Reliability and Measurement Error of Breast Volume Calculation Using Three-Dimensional Surface Imaging.

Breast lymphedema after breast cancer is challenging to quantify. Three-dimensional (3D) surface imaging is one available technique to measure breast volume, however, the measurement properties of available software programs have not been fully determined. The aim of this study was to determine equivalency of measurements with two software programs as well as reliability, standard error of measurement (SEM), and smallest detectable change (SDC).

Safety and Feasibility of a Kinesiotape Application for Secondary Hand Lymphedema: A Case Series.

The safety and feasibility of using kinesiotape as a short-term alternative treatment to compression garments or gloves for hand lymphedema have not been examined. The aim of this study was to examine if kinesiotape could maintain size and extracellular fluid (ECF) volume of the hand and forearm, as well as upper limb function and quality of life for women with secondary hand lymphedema. Six women with secondary hand lymphedema underwent pretreatment measurements, including hand and digit size using a tape measure; ECF volume using bioimpedance spectroscopy; and patient-reported outcome measurements of upper limb function and quality of life.

Prophylactic Use of Compression Sleeves Reduces the Incidence of Arm Swelling in Women at High Risk of Breast Cancer-Related Lymphedema: A Randomized Controlled Trial.

Purpose: To determine whether prophylactic use of compression sleeves prevents arm swelling in women who had undergone axillary lymph node dissection for breast cancer surgery.

Methods: Women (n = 307) were randomly assigned to either a compression or control group. In addition to usual postoperative care, the compression group received two compression sleeves to wear postoperatively until 3 months after completing adjuvant treatments.

Body image and sexuality concerns in women with breast cancer-related lymphedema: a cross-sectional study.

Purpose: (1) To determine, in women with breast cancer-related lymphedema (BCRL), the frequency, intensity and distress of body image and sexuality concerns. (2) To examine relationships between body image and sexuality concerns, and lymphedema, personal and cancer treatment factors.

Method: Women with BCRL (n = 64) completed the Lymphedema Symptom Intensity and Distress Scale - Arm (LSIDS-A), which focuses on the intensity and distress of a range of lymphedema symptoms.

Lymphoscintigraphy as an Outcome Measurement for Conservative Upper Limb Lymphedema Treatments: A Systematic Review.

The impact of conservative interventions on lymphatic function and the relationship to clinical outcomes is currently unknown. A systematic review was undertaken to evaluate studies that used lymphoscintigraphy to measure outcomes from conservative intervention for secondary arm lymphedema and to explore the relationship between changes in the lymphoscintigraphy and clinical outcomes. Five databases were systematically searched using the selection criteria: randomized controlled trials (RCTs); quasi-RCTs; pre/post and cohort studies; upper limb secondary lymphedema; use of lymphoscintigraphy as an outcome measure; and conservative intervention.

Ultrasound: Assessment of breast dermal thickness: Reliability, responsiveness to change, and relationship to patient-reported outcomes.

Background: The current study assessed the level of reliability of ultrasound to assess dermal thickness, a clinical feature of breast lymphedema. Additionally, the relationship of dermal thickness to patient-reported outcomes was investigated.

Methods: Women (n = 82) with unilateral breast edema secondary to treatment of breast cancer were randomized to an exercise or control group.

The accuracy and precision of interface pressure measuring devices: A systematic review.

Introduction: Interface pressure measuring devices are used to assess the pressures exerted by compression. Their performance, however, has not been considered as a contributing factor to reported inconsistences in the application of compression. A systematic review was undertaken to investigate the performance of commercially available devices used to measure interface pressure.

Self-reported questionnaires for lymphoedema: a systematic review of measurement properties using COSMIN framework.

Introduction: Lymphoedema may develop as a result of numerous genetic and traumatic causes; however, treatment for cancer is the most common cause of its development in more economically developed nations. This systematic review critically appraised, compared and summarised the measurement properties of lymphoedema-specific self-reported questionnaires (SRQs) measuring various patient-reported outcomes including quality of life (QOL), function, morbidity, and symptoms.

Methods: Seven databases were searched to identify studies of the measurement properties of SRQs.

Reliability and Validity of Physical Tools and Measurement Methods to Quantify Hand Swelling: A Systematic Review.

Objective: Hand swelling may result from injury or trauma. Various physical assessment tools and measurement methods can be used to quantify the volume or size of the hand or fingers; however, the reliability and validity of each tool and measurement method have not been evaluated. The purpose of this study was to evaluate the reliability and validity of physical assessment tools and methods used to quantify hand and finger volume orsize.

Clinician Assessment of Upper Limb Lymphedema: An Observational Study.

Clinical management of lymphedema requires assessment, initially for detection, and then for determining treatment response and informing the treatment plan. It is unknown how the components of a lymphedema assessment are used in a clinical environment. Experienced lymphedema therapists were observed assessing patients presenting with new or existing upper body lymphedema.

Interchangeability of Two Electrode Placement Protocols Used by Bioimpedance Spectroscopy Devices in the Detection of Breast Cancer-Related Lymphedema.

Bioimpedance spectroscopy (BIS) devices are routinely used in the assessment of breast cancer-related lymphedema (BCRL). The equipotential electrode placement is a commonly used protocol for the assessment of BCRL. However, the sternal notch electrode placement protocol is also in use.

Assessment of Upper Limb Lymphedema: A Qualitative Study Exploring Clinicians' Clinical Reasoning.

A variety of objective and subjective assessments are available for clinical assessment of lymphedema. The aim of this study was to explore the clinical reasoning underpinning the assessment of upper limb lymphedema by experienced lymphedema clinicians. Semistructured, individual, interviews were conducted with lymphedema therapists ( = 14) from a variety of treatment settings.

Bioimpedance Spectroscopy of the Breast.

Bioimpedance spectroscopy (BIS) measurements of breast lymphedema poses practical and technical challenges, in particular the determination of the resistance at zero frequency (R), the index of change in breast lymph content. Conventionally, R is calculated from data analysis by using a procedure eponymously known as Cole modeling, a method that is error-prone in the breast. The aim of this study was to evaluate polynomial curve fitting as an alternative analytic procedure.

Screening for breast cancer-related lymphoedema: self-assessment of symptoms and signs.

Introduction: In the absence of monitoring programs, those at risk of developing breast cancer-related lymphoedema (BCRL) must detect its development. However, the efficacy of self-assessment for BCRL has not been widely investigated. This study will determine if symptoms and signs of BCRL are associated with lymphoedema detected by bioimpedance spectroscopy (BIS) and whether those with and without BCRL can accurately assess the signs of its presence.

Physical Activity for Symptom Management in Women With Metastatic Breast Cancer: A Randomized Feasibility Trial on Physical Activity and Breast Metastases.

Context: Physical activity for women with early-stage breast cancer is well recognized for managing cancer-related symptoms and improving quality of life. While typically excluded from interventions, women with metastatic breast cancer may also benefit from physical activity.

Objective: To 1) determine the safety and feasibility of a physical activity program for women with metastatic breast cancer and 2) explore the efficacy of the program.

Cancer-associated secondary lymphoedema.

Lymphoedema is an oedematous condition with a specific and complex tissue biology. In the clinical context of cancer, the pathogenesis of lymphoedema ensues most typically from the modalities employed to stage and treat the cancer (in particular, surgery and radiotherapy). Despite advances in cancer treatment, lifelong lymphoedema (limb swelling and the accompanying chronic inflammatory processes) affects approximately one in seven individuals treated for cancer, although estimates of lymphoedema prevalence following cancer treatment vary widely depending upon the diagnostic criteria used and the duration of follow-up.

Electrode Equivalence for Use in Bioimpedance Spectroscopy Assessment of Lymphedema.

Background: Bioimpedance spectroscopy (BIS) is commonly used in the assessment and monitoring of lymphedema. This study investigated electrodes as a source of variability that could impact the accuracy of BIS in the clinic and determined if Ag/AgCl electrocardiograph (ECG) electrodes could be used as an alternative to instrument-specific electrodes.

Methods And Results: Two types of Ag/AgCl electrodes were studied: instrument-specific bioimpedance electrodes (bioimpedance) and single tab ECG electrodes (cardiac).

A Systematic Review of the Outcomes Used to Assess Upper Body Lymphedema.

Purpose: To ascertain how change in upper body lymphedema is assessed and understand how clinically significant change is determined.

Method: A systematic search of the literature resulted in 55 eligible studies for analysis.

Results: A range of assessment methods, measurement protocols, and outcomes were used in the literature.

Biotechnologies toward Mitigating, Curing, and Ultimately Preventing Edema through Compression Therapy.

For a century-old problem, edema and its treatment have gone remarkably unnoticed by the biomedical community. Given the prevalence of lymphedema and its debilitating repercussions, there is an acute need for both efficacy-based measures and clinical standards to guide compression garment design and therapeutic application. This review outlines the current state of the art in compression treatment and suggests an integrated biomedical engineering approach going forward.

Estimation of Arm Adipose Tissue Quotient Using Segmental Bioimpedance Spectroscopy.

Background: Breast cancer-related lymphedema (BCRL) is a chronic condition characterized by accumulation of lymph fluid that may subsequently become fibrotic with infiltration of adipose tissue. Bioimpedance spectroscopy (BIS) is the preferred method for early detection of lymphedema as it can estimate extracellular lymph fluid. This study developed a modified impedance technique that concurrently estimates both lymph accumulation and increases in adipose tissue.

Segmental Bioimpedance Informs Diagnosis of Breast Cancer-Related Lymphedema.

Background: Detection of lymphedema, particularly its mild stage, is clinically challenging. The aim of this study was to determine whether segmental bioimpedance spectroscopy (BIS) provided additional information to whole arm BIS in assessing women with or at risk of lymphedema following breast cancer.

Methods And Results: Participants (n = 66), aged 61.

Reference Ranges Using Bioimpedance for Detection of Lymphedema in Chinese Women.

Background: Bioimpedance is a commonly used technique for detection of early lymphedema. The thresholds used for detection are based on impedance measurements obtained in Western populations. It is unknown whether these thresholds are applicable to a Chinese population.