Lymphoedema Care Research Articles

CSP2023: 409 - The role of physiotherapy within the community based Sheffield Lymphoedema and Ambulatory Wound Care Service: a service improvement project

CSP2023: 409 - The role of physiotherapy within the community based Sheffield Lymphoedema and Ambulatory Wound Care Service: a service improvement project

National Lymphoedema Conference 2024: session summaries.

The 11th annual National Lymphoedema Conference, organised by the British Journal of Community Nursing in association with the British Lymphology Society and Lipoedema UK, was hosted at the America Square Conference Centre, London, on 22 February 2024. The conference, which aims to provide new insights into the latests developments in lymphoedema care and management through talks by leading experts in the field, was attended by an impressive number of delegates and exhibitors. The sessions were Chaired by BLS Trustee Rebecca Elwell, and are summarised below.

Assessment and management of upper limb lymphoedema in advanced disease: a case study.

Lymphoedema is thought to affect around 200 000 people in the UK (NHS England, 2023). Secondary lymphoedema is a relatively common complication of cancer and cancer treatment, and in advanced disease it may present a challenging issue for community nursing staff caring for patients approaching the end of their lives. In this article, a case study considers the assessment and treatment of upper limb lymphoedema in a patient with advanced metastatic breast cancer. Management of this complex and distressing condition requires holistic assessment and collaborative care planning with the patient and their wider care team, including onward referral to specialist lymphoedema and palliative care services. The case study considers the typical presentation of lymphoedema in an upper limb, exclusion of reversible causes for oedema, awareness of palliative care emergencies such as superior vena cava obstruction, and the provision of supportive therapeutic interventions in context of the patient's expressed wishes for her ongoing care.

Practice points for lymphoedema care in low- and middle- income countries developed by nominal group technique

BackgroundLymphoedema is a common, distressing, and debilitating condition affecting more than 200 million people globally. There is a small body of evidence to guide lymphoedema care which underpins several lymphoedema clinical practice guidelines developed for high-income countries (HIC). Some of these recommendations are unlikely to be feasible in low-resource settings.AimTo develop practice points for healthcare workers that optimise lymphoedema care in low- and middle-income countries (LMIC).MethodsA nominal group technique (NGT) was undertaken to gain consensus on which content from HIC guidelines was important and feasible to include in practice points for LMIC, and other important advice or recommendations. Participants included experts, clinicians, and volunteers involved in lymphoedema care in LMIC. The NGT followed five key stages: silent ‘ideas’ generation, round-robin rationale, clarification, refinement and verification. The first, fourth and fifth stages were completed via email, and the second and third during a video meeting in order to generate a series of consensus based prevention, assessment, diagnosis, and management of lymphoedema in LMIC practice points.ResultsOf sixteen participants invited, ten members completed stage 1 of the NGT (ideas generation), of whom six contributed to stages 2 (round-robin) and 3 (clarification). All those who completed stage 1 also completed stages 4 (refinement) and 5 (verification). Practice points unanimously agreed on included Complex Decongestive Therapy (CDT) and good skin care, with management to be determined by lymphoedema stage. For podoconiosis-endemic areas, the use of socks and shoes was identified as very important in the prevention of non-filarial lymphoedema and other lymphoedema-causing conditions. Participants indicated that diagnosing lymphoedema using the lymphoscintigraphy and Indocyanine green (ICG) fluorescent lymphography was not possible due to unavailability and cost in LMIC. Surgical procedures for lymphoedema management were unanimously eliminated due to the unavailability of technology, limited workforce, and expensive cost in LMIC.ConclusionThe consensus-based practice points generated by this project provide healthcare workers with guidance on caring for people with lymphoedema in LMIC. Further development of workforce capacity is needed.

Skin care protocol: suggesting a routine

Skin care is an essential part of lymphoedema management, and has been classed as one of the 'four cornerstones of lymphoedema care' by the British Lymphology Society. However, there is a lack of evidence-based guidelines and skin care protocols, which advice individuals with lymphoedema on how to look after their affected skin. In this article, Anita Hobday provides guidance on how to create a skin care routine for people affected with lymphoedema.

A qualitative process evaluation of a community conversation intervention to reduce stigma related to lower limb lymphoedema in Northern Ethiopia

BackgroundLower limb lymphoedema (swelling of the lower leg) due to Neglected Tropical Diseases (NTDs) such as podoconiosis, lymphatic filariasis and leprosy is common in Ethiopia, imposing huge burdens on affected individuals and communities. Stigma significantly increases the disease burden and acts as a major barrier to accessing lymphoedema care services. A multi-component stigma reduction intervention was implemented in Northern Ethiopia. Community Conversation (CC) was one of the components implemented, and aimed to reduce stigma and enhance access to and uptake of integrated lymphoedema care services with the active engagement of community members.MethodsA cross-sectional qualitative process evaluation was conducted to document lessons focusing on CC’s relevance, outcomes and implementation challenges. Data were collected from a total of 55 purposively selected participants (26 from the CC intervention site and 29 from the control site) through key informant interviews, in-depth individual interviews and focus group discussions.ResultsCommunity Conversations increased acceptability of health messages about lymphoedema and created peer learning opportunities for unaffected community members. Improvement in the awareness of CC participants about the causes, prevention and treatment of lymphoedema contributed significantly to the reduction of stigmatizing attitudes and discriminatory behaviors, thereby improving access to and utilization of lymphoedema care services provided through primary health care facilities. However, a range of challenges affecting implementation of CC and outcome quality were identified, including perceived complexity of the facilitation guide among facilitators, expectation of incentives among CC participants, inadequate implementation of facilitation principles and procedures, inadequacy of supportive supervision, and low engagement of untrained health workers in CC.ConclusionsWith these challenges addressed, the implementation of CC integrated with other lymphoedema care services shows potential to reduce stigma and promote access to lymphoedema care services.

Online Complex Decongestive Therapy (CDT) Initiation for Lymphoedema - A Case Study.

Lymphoedema is a chronic disease affecting millions. Standard treatment is Complex Decongestive Therapy (CDT) which entails physical interaction with a therapist to imitate the drainage of the edematous fluid along with training to continue self-care at home. We present a case study of initiating CDT totally online. The result showed that, though totally online lymphoedema care is possible, hurdles do exist. It can be an option to exercise even after the COVID period.

Improving care for cancer-related and other forms of lymphoedema in low- and middle-income countries: a qualitative study

BackgroundLymphoedema is a common, distressing and debilitating condition that can be related to cancer and its treatment or other conditions. Little is known about current practices in the diagnosis, assessment and management of lymphoedema in low- and middle-income countries (LMIC).AimTo describe current practices in diagnosing, assessing and managing cancer-related and other forms of lymphoedema in LMIC, and related barriers and facilitators.MethodsAn exploratory-descriptive qualitative study. Participants were lymphoedema experts or health care professionals identified via published lymphoedema papers and professional organizations respectively. Sampling was purposive to ensure a diversity of perspectives and experience. Data collection was via semi-structured telephone/video interviews, and questions canvassed participants’ experiences and perceptions of lymphoedema care in LMIC. Interviews were audio-recorded and transcribed verbatim. Analysis proceeded via inductive coding before mapping codes to the World Health Organization’s (WHO) Innovative Care for Chronic Conditions Framework.ResultsNineteen participants were interviewed, most of whom were physiotherapists (n = 11). Ten participants worked permanently in a LMIC, while the remainder were based in a high-income country (HIC) and had been involved in initiatives to improve lymphoedema care across multiple LMIC. Participants indicated that management of cancer versus non-cancer related lymphoedema was similar, but that pathways to care were more straight-forward for those receiving cancer care, leading to earlier diagnosis. Key facilitators to optimizing lymphoedema care in LMIC included: 1) joining forces to overcome lymphoedema-related stigma; 2) building workforce capabilities; and 3) partnering with patients and families to support self-management. Ideas for building workforce included developing health professional knowledge, supporting a commitment to multidisciplinary team care, and adapting HIC guidelines for lymphoedema care to LMIC. Partnering with patients and families to support self-management involved following the person-centred approach, establishing clear communication, promoting adherence to management, adapting management to available resources, and involving patient family and friends in lymphoedema care.ConclusionRaising community and health professional awareness regarding lymphoedema and its management is a key first step to improving care outcomes. Resources for clinicians and patients/families developed for lymphoedema care in HIC need to be adapted for low resource settings.

Scaling-up filariasis lymphoedema management into the primary health care system in Kerala State, Southern India: a case study in healthcare equity

BackgroundLymphatic filariasis (LF) remains one of the world’s most debilitating parasitic infections and is a major contributor to poor health in many endemic countries. The provision of continuing care for all those affected by LF and its consequences is an important component of the United Nations’ Sustainable Development Goals. The aim of this study is to integrate lymphedema care into the primary health care system of the State by developing lymphedema clinics at each district, through training of health personnel to fulfill WHO recommendation for morbidity management and disability prevention.MethodsSelected health care providers from all the districts in Kerala State of India participated in intensive training sessions endorsed by the State’s health administration. The six training sessions (from 5 June 2017 to 25 May 2018) included appropriate self-care information and development of individual plans for each participating institution to provide instruction and care for their lymphoedema patients. The learning achieved by attendees was assessed by pre- and post-training tests. The number of lymphoedema patients receiving care and instruction from the post-training activities of each participating institution was assessed from local records, 6 months after the conclusion of the training sessions.ResultsOne hundred and eighty-four medical personnel (91 doctors and 93 nurses) from 82 medical institutions were trained which quickly led to the establishment of active lymphoedema clinics providing the essential package of care (EPC) for lymphoedema patients at all the participating institutions. Six months after the training sessions the number of previously unidentified lymphoedema patients registered and receiving care at these clinics ranged from 296 to almost 400 per clinic, with a total of 3,477 new patients receiving training in EPC.ConclusionsGeneralist health personnel, when appropriately trained, can provide quality lymphoedema care in public health settings and patients when provided services close to their home, are willing to access them. This is a feasible strategy for integrating long term care for LF patients into the national health system, and is a clear example of moving towards equity in health care for the medically underserved, and thus successfully addresses a major goal of the global program to eliminate lymphatic filariasis.Graphical

The difference a year can make

British Journal of Healthcare ManagementVol. 27, No. 12 EditorialThe difference a year can makeIsobel CloughIsobel CloughCorrespondence to: Isobel Clough; E-mail Address: [email protected]MA Healthcare Ltd, Mark Allen Group, London, UKSearch for more papers by this authorIsobel CloughPublished Online:7 Dec 2021https://doi.org/10.12968/bjhc.2021.0157AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Booth C, Dyminski P, Rattray M et al. The case for mobile cancer care units: an NHS team's experience. Br J Healthcare Manage. 2021;27(5):152–155. https://doi.org/10.12968/bjhc.2021.0024 Link, Google ScholarBritish Medical Association. Pressure points in the NHS. 2021a. https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressure-points-in-the-nhs (accessed 24 November 2021) Google ScholarBritish Medical Association. Cornered: GPs under attack. 2021b. https://www.bma.org.uk/news-and-opinion/cornered-gps-under-attack (accessed 24 November 2021) Google ScholarCenters for Disease Control and Prevention. Benefits of getting a COVID-19 vaccine. 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccine-benefits.html (accessed 24 November 2021) Google ScholarFord M. Union leaders and NHS staff targeted with ‘vile abuse’ over COVID-19 vaccines. 2021. https://www.nursingtimes.net/news/coronavirus/union-leader-and-nhs-staff-targeted-with-vile-abuse-over-covid-19-vaccines-02-08-2021/ (accessed 24 November 2021) Google ScholarGabe-Walters M, Thomas M, Noble-Jones R. Lymphoedema care in the mobile unit: a service evaluation of patient experience and attendance rates. Br J Healthcare Manage. 2021;27(6):1–8. https://doi.org/10.12968/bjhc.2020.0167 Link, Google ScholarNHS Confederation. COVID-19 latest developments. 2021. https://www.nhsconfed.org/articles/covid-19-latest-developments (accessed 24 November 2021) Google ScholarNHS. NHS announces deal for life changing sickle cell treatment. 2021a. https://www.england.nhs.uk/2021/10/nhs-announces-deal-for-life-changing-sickle-cell-treatment/ (accessed 24 November 2021) Google ScholarNHS. NHS launches world first trial for new cancer test. 2021b. https://www.england.nhs.uk/2021/09/nhs-launches-world-first-trial-for-new-cancer-test/ (accessed 24 November 2021) Google ScholarO'Kane M. Looking to the future of UK clinical research on international clinical trials day. 2021. https://medregs.blog.gov.uk/2021/05/20/looking-to-the-future-of-uk-clinical-research-on-international-clinical-trials-day/ (accessed 24 March 2021) Google ScholarOffice for National Statistics. Coronavirus (COVID-19) latest insights: vaccines. 2021. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19latestinsights/vaccines#vaccinations (accessed 22 November 2021) Google ScholarShah A, Harken J, Nelson Z. Quality improvement in practice—part two: applying the joy in work framework to healthcare. Br J Healthcare Manag. 2021;27(9):234–240. https://doi.org/10.12968/bjhc.2021.0022 Link, Google ScholarTaylor D. Clinics pop up in London to help low vaccine take-up. 2021. https://www.theguardian.com/world/2021/mar/25/clinics-pop-up-in-london-to-help-low-vaccine-take-up (accessed 24 November 2021) Google ScholarThe Health Foundation. Health Foundation submission to the autumn budget and spending review 2021. 2021. https://www.health.org.uk/sites/default/files/2021-10/202109_Health%20Foundation%20submission%20to%20the%20Autumn%20Budget%20and%20Spending%20Review%202021.pdf (accessed 24 November 2021) Google ScholarWebster R. Building trust in an integrated care system: a leader's experience. Br J Healthcare Manage. 2021;27(6):1–4. https://doi.org/10.12968/bjhc.2021.0017 Link, Google Scholar FiguresReferencesRelatedDetailsCited byMaking space in the NHSIvan K Cohen14 April 2022 | British Journal of Healthcare Management, Vol. 28, No. 4Practical considerations for the commissioning and delivery of modular facilitiesIsobel Clough9 November 2021 | British Journal of Healthcare Management, Vol. 28, No. Sup3Placing modular facilities in a resource-limited healthcare systemIsobel Clough3 December 2021 | British Journal of Healthcare Management, Vol. 28, No. Sup3 2 December 2021Volume 27Issue 12ISSN (print): 1358-0574ISSN (online): 1759-7382 Metrics History Published online 7 December 2021 Published in print 2 December 2021 Information© MA Healthcare LimitedPDF download

A qualitative study on the implementation of a holistic care package for control and management of lymphoedema: experience from a pilot intervention in northern Ethiopia

BackgroundNeglected Tropical Diseases (NTDs) such as podoconiosis, lymphatic filariasis (LF) and leprosy mainly affect communities in low resource settings. These diseases are associated with physical disability due to lymphoedema as well as poor mental health and psychosocial outcomes. Integration of care across these NTDs at primary health care level, which includes mental health and psychosocial care alongside physical health care, is increasingly recommended.MethodsA holistic integrated care package was developed and piloted as part of the EnDPoINT project in Gusha district, Awi zone, Ethiopia. The intervention was conducted at the health care organization, health facility and community levels. To assess the impact of the care package in terms of acceptability, scalability, sustainability and barriers to implementation, a qualitative study was conducted in January 2020. This included four focus group discussions (29 participants) and ten key informant interviews with decision makers, health professionals, patients, and community representatives.ResultsThe integrated lymphoedema care package was found to be efficient compared to vertical programs in saving time and resources. It also resulted in improved awareness of the causes, treatment and prevention of lymphoedema, in marked improvements in the lymphoedema, and in reduced stigma and discrimination. The care package was found to be acceptable to patients, health professionals and decision makers. The barriers to integrated care were unrealistic patient expectations, inadequate dissemination across health workers, and poor transportation access. Health professionals, decision makers and patients believed the integrated lymphoedema care package to be scalable and sustainable.ConclusionThe integrated holistic care package was found to be acceptable to patients, health professionals and decision makers. We recommend its scale-up to other endemic districts.

Lymphoedema care in the mobile unit: a service evaluation of patient experience and attendance rates

Background/aims Lymphoedema can be a life-long burden to patients. Value-based lymphoedema services should aim to empower patients and meet expectations of care. This study evaluated the attendance rates and experiences of patients accessing a mobile health unit for lymphoedema care. Methods A questionnaire was shared with all adult patients with lymphoedema at 16 mobile unit clinics in south Wales over 3 months in 2019. Attendance rates and questionnaire data were explored descriptively. Results Out of 417 patients, 175 (37%) participated in the study. Of these, a considerable majority (132/148, 89%) expressed a preference for the mobile unit compared to hospital-based services. Reasons for this preference included ease of access, excellent staff and parking facilities. Non-attendance rates of 8% were observed at the mobile unit. Conclusions Patients favoured attending the mobile unit, suggesting that mobile care is a key aspect of value-based healthcare, allowing services to be planned around patient needs. However, this did not fully resolve the issue of non-attendance. The impact of such community-based services on health outcomes, costs and staff experiences should be explored before widespread adoption is implemented.

The education needs of health professionals conservatively managing genital oedema: UK survey findings.

Adults and children report genital oedema but prevalence is unknown. Pre-registration nurse training rarely includes genital oedema and postgraduate training opportunities are rare. To identify the education needs of health professionals regarding management of genital oedema. An electronic survey was cascaded to health professionals through relevant professional groups and social media. Of 149 UK respondents, most manage patients with genital oedema but only 2% felt current training was sufficient. Of 138 responding regarding supplemental training, only a half had completed genital oedema specific education, usually of 1-4 hours' duration. Confidence in knowledge was up to 22.5% higher in those with genital oedema education, even accounting for years of experience. The most common top three individual needs were compression, contemporary surgical and medical management and patient assessment. Educational resources are needed and both offline and online formats were suggested; collaborative events with urology/pelvic health are essential. Health professionals working in lymphoedema care have (unmet) specific education needs regarding genital oedema management. The desire for both offline and online resources reflects the necessity of accessing learning at a distance and on an 'as needed' basis.

Alternative approaches to lymphoedema care in lymphatic filariasis

Alternative approaches to lymphoedema care in lymphatic filariasis

Home management of lower limb lymphoedema with an intermittent pneumatic compression device: a feasibility study

BackgroundLymphoedema is a chronic condition that causes swelling in the body tissues. Presently, there is no cure for lymphoedema; instead, current treatment is aimed at lifelong management to help control symptoms. Intermittent pneumatic compression (IPC) therapy can be considered as an adjunct to standard lymphoedema care; however, research regarding the efficacy of this treatment modality is limited.MethodsTwenty participants were recruited from an outpatient lymphoedema clinic (South Wales, UK) to a feasibility randomised control trial designed to evaluate the efficacy of an IPC device (LymphAssist, Huntleigh Healthcare) in reducing lower limb volume. The primary objective was to assess feasibility in terms of (1) study feasibility, including recruitment, retention and assessment of outcome measures, and (2) intervention feasibility, including intervention fidelity and acceptability to participants. Participants were randomly assigned to a control group (n = 10) or intervention group (n = 10). The control group received their standard lymphoedema care only for a 6-month period, whereas the intervention group received their standard lymphoedema care plus an IPC device to use for 6 months. A bilateral lower limb assessment and quality of life survey were undertaken at baseline and 3- and 6-month time points.ResultsThe study recruited to target within the planned time frame with a retention rate of 80%. Issues relating to potential recruitment bias and study attrition were identified and possible solutions explored. In addition, supplementary primary outcome measures that are important to the study population were identified and will be incorporated into the design of future studies.ConclusionThis feasibility study identified that a larger randomised controlled trial investigating the efficacy of home use IPC devices is feasible with modifications to the study protocol.Trial registrationThis trial is registered with clinicaltrials.gov (NCT03825263).

Impact of two follow-up schemes on morbidity management and disability prevention (MMDP) programme for filarial lymphedema in Matara, Sri Lanka

Alleviating morbidity due to lymphatic filariasis (LF)—especially in elderly patients who are rather ignorant—is presently the biggest challenge for the national filariasis campaign. We introduced two follow-up schemes and compared each other to address three key programmatic issues (1) locating patients, (2) educating patients, family members on practice of lymphoedema self-care (3) well sustained daily self-care. Hundred and seven lymphoedema patients were introduced to the new Community Home Based Care (CHBC) programme as a part of MMDP programme at their homes. Twenty seven of 107 patients were selected by purposive sampling and followed-up under two schemes, 14 in Daily follow-up (DFU) scheme and 13 in Monthly follow-up (MFU) scheme. Impact was assessed using a KAP score, number of entry lesions (EL) and number of ADL episodes, limb volume, its appearance, changes in the quality of life and gained benefits. Visiting patients in their homes to introduce lymphoedema care programme was a success. KAP scores of the more important activities on lymphoedema care were significantly higher in DFU scheme. Number of patients (51.9%; 14/27) who had EL/s at baseline reduced significantly to 18.5% (5/27) at one year follow-up. The mean numbers of ADL episodes/year reduced significantly in both schemes. Six photographs of 27 showed obvious improvement in lymphoedema and its grade. Mean volume of lymphoedema reduced significantly in both schemes at one year no significant difference between schemes. Benefit score at one year revealed that the patients in DFU scheme received significantly higher amount of benefits compared to MFU scheme. In conclusion daily instruction has significantly motivated the patient and his/her family bringing a new hope.

Factors Associated with Lymphoedema Management Success Among Podoconiosis Patients in Wolaita Zone, Southern Ethiopia

Podoconiosis is non-filarial elephantiasis of lower legs which predominantly affects barefooted people. In later clinical stages, the disease manifests lymphoedema of the lower legs with mossy and nodular changes to the skin. The disease progressively disables patients when they are continuously exposed to irritant soils. The present study aimed to assess factors associated with lymphoedema management success among podoconiosis patients. A community based cross-sectional study was conducted from February to May, 2014 among podoconiosis patients. A two-stage sampling technique was employed to randomly select a total of 845 study subjects from 4 districts of Wolaita zone. To collect data, interviewer administered questionnaire was used along with observation. Data were entered and analyzed by using SPSS version 20. Bivariate and multivariable logistic regressions were used to select the candidate and the predictor variables respectively. Majority (71.2%) of the study subjects managed their lymphoedema successfully. Three fourth of the study participants were adhered to the stepwise lymphoedema management procedures. Acute dermato lymphangio adenitis (acute attack), was manifested rarely among 61.4% of the subjects after completion of the treatment. Patients' adherence to stepwise treatment procedures, completion of treatment regimen, duration of follow-up, attitude towards lymphoedema management, age and literacy were found to be the main predictors of lymphoedema management success. The present study assessed main factors associated with lymphoedema management success in podoconiosis. Duration of treatment follow-up, adherence to stepwise treatment procedure, completion of treatment, attitude on disease management and community perceptions towards patients were the main factors associated with successful lymphoedema management. Strict supervision and follow-up of patients to reinforce the home-based lymphoedema care is a vital precondition to successfully manage lymphoedema. Furthermore, longitudinal studies have to be conducted to bring a better lymphoedema management scenario with a higher success rate.

Prevalence and characteristics of lymphoedema at a wound-care clinic.

Lymphoedema is estimated to affect up to 300,000 Canadians but remains underrecognised and undertreated. A retrospective chart review was conducted to determine the clinical characteristics and treatment practices of lymphoedema in a Canadian wound care clinic. Data were collected retrospectively from dictated clinic notes of 326 lymphoedema patients at a wound clinic in a regional rehabilitation hospital. The mean age (±SD) of diagnosis was 66.8 (±15.5). Patients had 7.3 (±3.3) comorbidities and took 8.4 (±4.6) concomitant medications. The most common comorbidities were venous disease (73%), hypertension (60%), and obesity (46%). Clinic patients were less likely to be women, have arm lymphoedema, or have cancer-related aetiology compared with previous studies, reflecting a two-tiered model of care delivery in the area. Treatments prescribed by the clinic were consistent best practice recommendations for conservative treatment. A significant proportion of the wound clinic's patients had lymphoedema. Lack of resources, lack of awareness among primary care providers, and patient adherence are barriers to lymphoedema care.

Exciting times ahead for the BLS

British Journal of Community NursingVol. 20, No. Sup10 Society UpdateExciting times ahead for the BLSJane DurstonJane DurstonSearch for more papers by this authorJane DurstonPublished Online:29 Sep 2015https://doi.org/10.12968/bjcn.2015.20.Sup10.S28AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References National Cancer Action Team (2013) Lymphoedema Services in England: A Case for Change. www.thebls.com/files/1245.pdf (accessed 19 September 2015) Google ScholarNHS Scotland (2013) SMASAC Short Life Working Group on Lymphoedema - Lymphoedema Care in Scotland, Achieving Equity and Quality. www.gov.scot/Resource/0043/00438797.pdf (accessed 19 September 2015) Google Scholar FiguresReferencesRelatedDetails 1 October 2015Volume 20Issue Sup10ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 29 September 2015 Published in print 1 October 2015 Information© MA Education LimitedPDF download

Development and use of guideline‐derived quality indicators for community lymphoedema

Treatment of lymphoedema is complex and needs specific skills. There are no standards for the evaluation of quality of care. Development and application of indicators for the measurement of quality of care in lymphoedema. In a three-step process including a national Delphi expert consensus, quality indicators were derived from national and international guidelines. In a cross-sectional study involving a large spectrum of care providers, the quality of lymphoedema care in the community was assessed by transforming the indicators to one unweighted quality index (QI). A total of 12 quality indicators were identified and applied to n = 348 patients with lymphoedema and lipolymphoedema of any origin in the metropolitan area of Hamburg (90.8% female, mean age 57, SD 14.5 years). On average, 55% of the quality indicators were met, and 64.8% of the patients were satisfied with lymphoedema care. There was a significant correlation between QI and satisfaction. The quality indicators and the QI are feasible and valid for the evaluation of quality of care. They can support optimizing lymphoedema care.