Authors (including presenting author) :
Tam KL (1), Choi TL (1), Huang TW (1), Chan WY (1), Wong SW (1), Cheung TKR (1), Tsang HC (1), To YL (1), So WY (2)
Affiliation :
(1) Physiotherapy department (2) Hospital Chief Executive office, North District Hospital
Introduction :
Patients after breast cancer surgery have higher risk of developing secondary lymphedema and physiotherapy treatments are warranted when signs and symptoms of lymphedema developed. Since 2023, lymphedema index (L-Dex) was incorporated into our structured physiotherapy program to enhanced the monitoring of lymphedema severity. Comprehensive lymphedema assessment was performed in the first session of physiotherapy. Patients attended educational talk on self-management of lymphedema and home exercise program. Individualized treatments including shoulder mobilization exercise, muscle strengthening exercise and lymphatic drainage were prescribed in the subsequent physiotherapy sessions. Progress and severity of lymphedema, pain level and physical function were monitored regularly.
Objectives :
To evaluate the effectiveness of the enhanced physiotherapy service to patients with upper limb lymphedema.
Methodology :
Data of patients who were referred to outpatient physiotherapy for upper limb lymphedema from January 2023 to November 2024 were retrieved and analyzed retrospectively. Paired t-test was used for normally distributed data while Wilcoxon Signed-Rank Test was used for data which is not normally distributed. L-Dex, Numeric Pain rating scale (NPRS), hand grip strength, active shoulder ranges and Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (Quick-DASH) were used as outcome measures.
Result & Outcome :
A total of 32 patients with mean age of 64.0 (range: 46-79) received physiotherapy intervention for upper limb lymphedema. Average waiting time for the first appointment was 3.6 weeks from the date of referrals. The mean outpatient attendance was 18.6 (range: 4-51). No adverse event was reported. Significant improvements were found in severity of lymphedema in terms of L-Dex. The mean L-Dex improved from 28.1 to 22.7 after physiotherapy interventions (p=0.047). There were also significant improvements in shoulder flexion (p=0.006) and Hand behind back
(p=0.0.36). Clinical improvements were found in NPRS and Quick-DASH but not reaching statistical significance. No improvement was found in hand grip strength.
Conclusion:
Enhanced monitoring and multimodal physiotherapy interventions are effective in improving the severity of upper limb lymphedema. Early referral to physiotherapy service for lymphedema monitoring and treatment is beneficial to patients after breast cancer surgery.
