Impact of Aggressive Decongestion on the Maintenance Phase in Combined Physical Therapy for Lower Extremity Lymphedema

Abstract

To evaluate the impact of initial aggressive decongestion (Phase 1) on the maintenance phase of complex physical therapy (CPT). We reviewed 27 patients with unilateral and 3 patients with bilateral lower extremity lymphedema who started CPT between April, 2009 and October, 2010. Twelve patients elected to undergo in-hospital Phase 1 (Group I), while the other 18 started CPT on an outpatient-basis without having Phase 1 (Group O). The extremity volume was assessed at the beginning of CPT, and then 3 and 6 months later. A significant reduction in extremity volume was achieved in each group after 6 months of CPT: from 9049 ± 1912 mL at the beginning to 7771 ± 1486 mL (p = 0.0033) in group I; and from 7370 ± 1392 mL to 7036 ± 1241 mL (p = 0.0200) in group O. However, after 6 months, extremity volume reduction (-845 ± 1283 mL in group I vs. -404 ± 370 mL in group O; p = 0.7672) and volume reduction rates (-23.6 ± 22.7% in group I vs. -46.4 ± 52.2% in group O; p = 0.2564) did not differ significantly between the groups. Phase 1 did not have a significant impact on the maintenance phase in terms of control of the extremity volume for at least 6 months after the induction of CPT.