Outcomes from a proof-of-concept specialist lymphoedema clinic in the community.

The Health and Safety Execultive lymphoedema model of care was published in 2018 highlighting the lack of dedicated lymphoedema services in Ireland. This led to the introduction of a proof-of-concept primary care specialist lymphoedema clinic. The clinic was responsible for all patients from their county. A comprehensive dataset was gathered which included the patient's history for 1 year prior to their presentation at clinic and then 6 monthly. A quality of life tool (LymQoL) and a patient satisfaction survey were completed. Completed 1-year data showed a significant reduction in GP and public health nurse visits as well as a reduction in the occurrence of cellulitis and associated hospital admissions. All areas of quality of life were improved and patient satisfaction was either excellent (89%) or very good (11%). The 1-year findings strongly support the roll-out of specialist clinics to all regional health areas.

Assessment, treatment goals and interventions for oedema/lymphoedema in palliative care.

BACKGROUND: Little is known about the treatment of oedema in palliative care patients. AIM: To outline the assessment, goals, and interventions for patients with oedema. METHOD: A 6-month chart review of a specialist physiotherapy-led oedema service was carried out. RESULTS: Of the sample group (n=63), 28.6% of patients had lymphoedema, 15.9% had non-lymphatic oedema, 46% had mixed oedema and 9.8% had lymphorrhoea; 58 patients (92%) had cancer. The most common interventions were providing education (100%, n=63), using compression garments (58%, n=37), bandaging (51%, n=32), exercise (38%, n=24), lymphatic massage and kinesio-taping (35%, n=22 each). Treatment regime differed depending on the type of oedema present. Treatment goals were pragmatic: the most common were to maintain skin quality (54%, n=34), reduce limb volume (52%, n=32), and improve quality of life (48%, n=30). CONCLUSION: Palliative care oedema can be treated using manual methods, including compression and massage. Goals differ from other oedema populations. Research is hampered by lack of suitable measures to record skin changes and quality of life.

Palliative Care Edema: Patient Population, Causal Factors, and Types of Edema Referred to a Specialist Palliative Care Edema Service.

BACKGROUND: Edema in palliative care patients is a common symptom, however, the research base for all aspects of its care is extremely poor. OBJECTIVE: To evaluate a specialist palliative care edema service in order to report on the patient population referred, the types of edema encountered, and the causes of edema. DESIGN: Prior to study, three different edema types were described for evaluation: lymphedema, nonlymphatic edema, and a combination of the two. Retrospective chart evaluation was completed from August 2013 through January 2014. SUBJECTS: Patients with edema assessed by the specialist palliative care physiotherapy edema service. RESULTS: Sixty-three cases were included, comprising 10.5% of all new palliative care referrals during the study period. Ninety-two percent (n = 58) had a diagnosis of cancer and 57% (n = 36) were female. Age ranged from 45-97 years. The most common edema type was a mixed edema (46%, n = 29), followed by lymphedema (27%, n = 18) and nonlymphatic edema (16%, n = 10). Lymphorrhea occurred in 9.5% of cases. The most common reasons for edema, based on clinical opinion, were blocked lymphatics (33%) and dependency from immobility (27%). The most common site for edema was in the lower limbs (89%, n = 56). The time lapse from the last treatment to death ranged from 1-225 days. Having a mixed edema type or lymphorrhea was a relatively poor prognostic sign. CONCLUSIONS: This is the first study to describe in detail the occurrence of edema in palliative care patients. Edema may be present for many months prior to death making the search for effective treatments imperative.

A profile of hospice-at-home physiotherapy for community-dwelling palliative care patients.

AIM: To profile a specialised palliative care physiotherapy service to community-dwelling patients. DESIGN: Retrospective audit. SETTING: Milford Care Centre, Limerick, Ireland. PARTICIPANTS: Patients referred to hospice-at-home physiotherapy during September 2010-February 2011. OUTCOME MEASURE: Edmonton Functional Assessment Tool (EFAT-2). RESULTS: 165 patients were referred, of whom 90% had cancer. Nurses referred 120 (73%). Referrals appeared to be increased by the presence of physiotherapists in the nursing bases. No asssessment was conducted for 55 referrals (33%), mainly owing to clinical deterioration. The remaining 110 patients were assessed, with 47 (43%) being contacted within 2 days of referral (mean 4 days, standard deviation 4.2, range 0-21 days). Physical function ranged from 0-18 (median 7, mode 4) on the EFAT-2 scale. The most commonly used treatments were exercises and advice/education. CONCLUSION: Referrals to the at-home physiotherapy service are heavily dependent on nurses and their understanding of the physiotherapy role. Patients tended to be relatively high functioning and tolerated numerous interventions.