Abstract
Understanding whether a true change has occurred during the process of care is of utmost importance in lymphedema management secondary to cancer treatments. Decisions about when to order a garment, start an exercise program, and begin or end therapy are based primarily on measurements of limb volume, based on circumferences taken by physiotherapists using a flexible tape. This study aimed to assess intra-rater and inter-rater reliability of measurements taken by physiotherapists of legs and arms with and without lymphedema and to evaluate whether there is a difference in reliability when measuring a healthy versus a lymphedematous limb. The intra-rater reliability of arm and leg measurements by trained physiotherapist were very high (scaled standard error of measurements (SEMs) for an arm and a leg volume were 0.82% and 0.64%, respectively) and a cut-point of 1% scaled SEM may be recommended as a threshold for acceptable reliability. Physiotherapists can rely on the same error when assessing lymphedematous or healthy limbs. For those who work in teams and share patients, practice is needed in synchronizing the measurements and regularly monitoring their inter-rater reliability.
Highlights
Post-cancer treatments lymphedema (LE) is a chronic disease, which has no cure [1]; it can be managed successfully by reducing symptoms and volume and maintaining that reduction [2]
Five patients with secondary lymphedema participated in the study
Since the majority (83%) of PTs measured below the 1% scaled standard error of measurement (SEM) and as no recommendation regarding minimum clinically important difference (MCID) for scaled SEM exists in the literature for legs or for arms, we recommend that a Distribution based MCID for scaled SEM will be set at 1% by clinicians when assessing both arm or leg LE
Summary
Post-cancer treatments lymphedema (LE) is a chronic disease, which has no cure [1]; it can be managed successfully by reducing symptoms and volume and maintaining that reduction [2]. LE early detection is performed by measuring volume and assessing symptoms and comparing them to baseline measurements [3]. Management strategies vary and may include, for example, daily bandaging, performing exercises twice weekly, using a pneumatic compression device, or receiving manual lymph drainage. As long as patients improve by reaching their treatment goals, the treatment will be considered a success [4]. Examples of treatment goals may be: improving a specific function, reducing symptoms such as pain or heaviness, preventing infection, improving body image, improving limb shape, etc. Assessing LE outcomes only from the patient’s perspective is not sufficient for therapists in their decision-making process; objective assessment, such as volume measurement, is needed as well
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