Abstract
Lymphedema is a chronic skin disease that has many causes and leads to significant disfigurement and disability worldwide. Recommendations for lymphedema self-care vary by setting and the World Health Organization guidelines for people affected by lymphatic filariasis- and podoconiosis-related lymphedema are centered around a basic daily hygiene regimen. Research on cancer-related lymphedema in developed country settings suggests that deep-breathing exercises and self-massage can improve lymphedema status, but these exercises are not routinely taught to people affected by lymphedema in developing country settings. To determine if the activities proven in cancer-related lymphedema can improve outcomes for people affected by lymphatic filariasis- or podoconiosis-related lymphedema, an enhanced self-care protocol for lower limb lymphedema was developed and trialed in Nilphamari District in Bangladesh and Simada Woreda in Ethiopia. Enhanced self-care activities were chosen on the basis that they would not add financial burden to patients or their families and included recommendations to perform deep-breathing exercises and self-massage, drink clean water, and eat fresh fruits and vegetables. The enhanced-care protocol was developed in collaboration with implementing partners in both countries and may be applicable in other populations affected by lower-limb lymphedema. Trial methods and results will be submitted for peer reviewed publication. Current recommendations for lymphedema self-care may be less effective for people with more advanced disease and new or cross-cutting methods are needed to improve outcomes for these populations.
Highlights
Lymphedema is a chronic swelling of the skin and underlying tissue and a major cause of disability globally
It can occur from multiple etiologies including lymphatic filariasis (LF), a vector-borne parasite endemic to many tropical countries [1] and podoconiosis is lymphedema caused by long-term bare-foot exposure to irritant soils [2]
It is expected that both protocols will achieve reduction in the frequency and duration of acute attacks and improve quality of life among people affected by lymphedema
Summary
Lymphedema is a chronic swelling of the skin and underlying tissue and a major cause of disability globally. As in LF, the swelling appears first in the feet and ankles but due to the site exposure of the irritant, skin changes on the feet can occur much earlier in podoconiosis than in LF-related lymphedema In both diseases a major portion of the burden to patients and their communities is due to the frequency, intensity, and duration of secondary bacterial and fungal infections known as ‘acute attacks’ [12,13,14]. Simple measures such as deep breathing, self-massage, and progressive exercises were shown to benefit women with breast cancer-related lymphedema of the arm [19,20] These activities aim to stimulate lymph flow from the affected area and are emphasized to recommendations for meticulous skin care. The additional activities were designed to stimulate lymph flow, support immune function, and improve skin integrity, and included deep breathing exercises, Methods Protoc. 2019, 2, 77 leg exercises, self-lymphatic-massage, and recommendations to drink clean water and eat fresh fruits and vegetables
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