Associations between the treatments and outcomes of patients with upper and lower lymphoedema in Japan: A cross-sectional observational study

BACKGROUND: Lymphoedema is not currently curable, and it is important that symptoms are alleviated by appropriate treatment. Treatments aim to delay the progression of swelling and to improve patients' quality of life (QOL). There are many objective and subjective outcomes of lymphoedema, but it is unclear which outcomes should be used to evaluate lymphoedema treatments. OBJECTIVE: This study aimed to examine the associations between lymphoedema treatments and outcomes. DESIGN: A cross-sectional observational study. SETTING: Lymphoedema outpatient clinics in Japan. PARTICIPANTS: A total of 170 patients with lymphoedema were recruited from four outpatient clinics. METHODS: The data were collected from medical records, physical assessments, and interviews. The following objective outcomes were evaluated: circumference measurements, Stemmer sign, cellulitis, and skin hardness. The following subjective outcomes were evaluated: satisfaction with treatment, subjective symptoms, EuroQol-5 dimensions, and a quality of life measure for limb lymphoedema (LYMQOL). Multiple regression analysis was performed to examine the associations between lymphoedema treatments and their outcomes. RESULTS: Secondary lymphoedema was present in 158 patients (92.9%), and 91 patients (53.5%) had lower lymphoedema. The patients using compression garments were 2.63 times more likely to have a positive Stemmer sign and 2.85 times more likely to be satisfied with their treatment than those who were not using compression garments (p=0.02 for Stemmer sign, p< 0.01 for satisfaction). The patients treated with simple lymphatic drainage (SLD) exhibited a 2.26-fold greater level of satisfaction with treatment than those not receiving this treatment (p< 0.01). The patients treated with complete decongestive therapy (CDT) had higher QOL than did those not receiving this therapy (β=-0.19, p=0.04). CONCLUSIONS: The progression of swelling can be evaluated using the Stemmer sign with regard to compression therapy. The degree of satisfaction can be evaluated as the patient's satisfaction with their lymphoedema regarding compression garments and SLD, and improvements in QOL can be evaluated using the LYMQOL with regard to CDT. The subjective outcomes were not associated with every lymphoedema treatment in this study, and the effectiveness of lymphoedema treatment can be evaluated using several different outcomes.