Abstract
Complete decongestive therapy (CDT), a physical therapy including manual lymphatic drainage (MLD) and compression bandaging, is aimed at mobilizing fluid and reducing limb volume in lymphedema patients. Details of fluid shifts occurring in response to CDT are currently not well studied. Therefore, we investigated fluid shifts before, during and after CDT. Thirteen patients (3 males and 10 females, aged 57 ± 8.0 years, 167.2 ± 8.3 cm height, 91.0 ± 23.4 kg weight) diagnosed with stage II leg lymphedema participated. Leg volume, limb and whole-body fluid composition (total body water (limbTBW/%TBW), extracellular (limbECF/%ECF) and intracellular (limbICF/%ICF fluid), as well as ECF/ICF and limbECF/limbICF ratios were determined using perometry and bioelectrical impedance spectroscopy. Plasma volume, proteins, osmolality, oncotic pressure and electrolytes were assessed. Leg volume (p < 0.001), limbECF (p = 0.041), limbICF (p = 0.005) and limbECF/limbICF decreased over CDT. Total leg volume and limbTBW were correlated (r = 0.635). %TBW (p = 0.001) and %ECF (p = 0.007) decreased over time. The maximum effects were seen within one week of CDT. LimbICF (p = 0.017), %TBW (p = 0.009) and %ICF (p = 0.003) increased post-MLD, whereas ECF/ICF decreased due to MLD. Plasma volume increased by 1.5% post-MLD, as well as albumin and the albumin-to-globulin ratio (p = 0.005 and p = 0.049, respectively). Our results indicate that physical therapy leads to fluid shifts in lymphedema patients, with the greatest effects occurring within one week of therapy. Fluid shifts due to physical therapy were also reflected in increased plasma volume and plasma protein concentrations. Perometry, in contrast to bioelectrical impedance analysis, does not seem to be sensitive enough to detect small fluid changes caused by manual lymphatic drainage.
Highlights
The lymphatic vasculature is a second network of vessels, adjacent to the blood vasculature
A recent study by Habnouni and colleagues (2020) reported that 30 min of manual lymphatic drainage led to a reduced limb circumference in children with lower limb lymphedema, limb volume did not decrease [32]. This is in agreement with our results. These findings suggest that perometry may not be sensitive enough to detect short-term fluid shifts induced by physical therapy in lower limb lymphedema patients
Our results indicated fluid shifts occurring due to physical therapy and manual lymphatic drainage
Summary
The lymphatic vasculature is a second network of vessels, adjacent to the blood vasculature. It plays a crucial role in normal physiology [1,2]. Initial protein concentration of the lymphatic fluid is around 3–4% Once it reaches the blood stream, protein concentration is believed to be higher. Any dysfunction within the lymphatic vasculature can lead to the accumulation of fluid within the tissue. This occurs due to an imbalance of plasma filtration and transport capacity of the vessels [2,6], resulting in different pathological conditions, such as lymphedema
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