Lower limb lymphedema disrupts both static and dynamic balance.

BACKGROUND: The impact of lower-limb-lymphedema on quality of life of patients regarding balance is unclear due to the scarcity of literature. The aim of this study was to determine the static and dynamic balance of patients with lower-limb-lymphedema in comparison with healthy subjects. METHODS: This case-control designed study included 30 lymphedema patients and 30 healthy individuals, of whom were 52 female and 8 male with a mean age of 50.63 ± 9.72 years. Static balance stability and anterior-posterior with lateral sway parameters on four conditions (eyes-opened-stable-ground, eyes-closed-stable-ground, eyes-opened-unstable-ground, eyes-closed-unstable-ground) and dynamic stability of all participants were evaluated. FINDINGS: The demographic variables were similar between the groups. Majority of the patients had lymphedema due to cancer surgery with a stage of 2. Dynamic stability was significantly disrupted in lymphedema group in comparison with controls (P = 0.049). Static balance parameters were impaired on all conditions except the eyes opened-stable ground in lymphedema patients (P = 0.048,P = 0.043,P = 0.017). The dynamic with static balance and lateral sway parameters were correlated with the duration of lymphedema(P = 0.046,P = 0.002,P = 0.005). Anterior-posterior sway on eyes-closed-unstable-ground condition was correlated with functional status (P = 0.02). Static balance on eyes-opened-unstable-ground condition and anterior-posterior sway parameters were correlated with physical activity level (P = 0.015,P = 0.016,P < 0.05). INTERPRETATION: Closing eyes and the deterioration of ground caused significant alteration of the static and dynamic balance both separately and together in patients with lower-limb-lymphedema compared to healthy subjects. Regarding the static and dynamic imbalance, we suggest the evaluation of balance and inclusion of balance exercises in routine lymphedema rehabilitation program, especially in the early period of disease.

Clinical properties and rehabilitation needs of earthquake survivors in a subacute rehabilitation setting.

BACKGROUND: This descriptive analysis examines the victims of the February 6, 2023, earthquakes in Kahramanmaras and Elbistan, Türkiye. It aims to detail the injury profiles related to neuro-musculoskeletal trauma, assess the rehabilitation needs of patients, and propose a comprehensive rehabilitation approach. METHODS: The study included patients injured in the Kahramanmaras-centered earthquake on February 6, 2023, who were transported to our hospital based on their rehabilitation needs. Data from patients treated at our hospital were recorded retrospectively. This included demographic information, accompanying pathologies, laboratory findings, rehabilitation programs, and treatments received during their hospital stay. Statistical analyses were conducted to examine the data. RESULTS: A total of 141 patients with musculoskeletal injuries were admitted due to injuries sustained from the earthquake. The mean age of the participants was 39.76 years, with a slight female predominance (56.7%). The majority of patients sustained injuries while trapped under debris (90.1%), with an average duration of 10 hours under rubble. Fractures were the most common form of injury (53.2%), predominantly affecting the lower extremities. Peripheral nerve injuries were present in 41.1% of patients, and amputations were observed in 30.5%. Complications included compartment syndrome (46.1%), crush syndrome (36.2%), and various infections. Pain was prevalent among patients, with somatic pain being the most reported type. Individualized rehabilitation programs were implemented, incorporating physical therapy, wound care, pain management, and psychosocial support. CONCLUSION: This study highlights the critical rehabilitation needs of earthquake survivors and emphasizes the importance of early and comprehensive rehabilitation interventions. Multidisciplinary rehabilitation programs were crucial in addressing medical issues, functional limitations, and psychological challenges faced by the survivors. The findings contribute to a deeper understanding of earthquake-related injuries and underscore the significance of well-coordinated rehabilitation strategies in disaster responses.

Hypothyroidism and autoimmune thyroid disorders in rheumatoid arthritis: relationship with disease activity.

Background and aims: Thyroid function abnormalities and thyroid autoantibodies have previously been described in rheumatoid arthirits (RA) with limited data. In some studies, a relationship was found between thyroid autoantibodies and RA disease activity. However, there are not strong studies in the literature indicating the relationship between thyroid diseases and RA. The aim of this study was to determine the frequency of hypothyroidism and to investigate the relationship between thyroid hormone levels, autoantibodies and disease activity in patients with rheumatoid arthritis (RA). Methods : 1017 patients with the diagnosis of RA were recruited. This observational study was conducted between January 2014 and July 2015. Demographic variables were recorded. Anti-nuclear antibodies (ANA), anti-cyclic citrulli-nated peptide antibody (anti-CCP), Rheumatoid Factor (RF), C reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR), thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), anti-microsomal antibody (anti-TPO )and anti-thyroglobulin antibody (anti-TG) were determined. Visual analog score and Disease Activiy Score 28 (DAS-28) ESR and DAS-28 CRP were recorded. The relationship between thyroid hormone levels and thyroid antibodies and disease activity parameters were determined. Results: 98 (%9,7) patients had hypothyroidism and 61 (%6) patients had hyperthyroidism. 210 (20,7%) patients with RA was positive for TPOAb and 165(16,3%) for anti-TG. Positive correlation was detected between anti-TPO positivity and anti-CCP levels (p:0.005, r:0,274). In anti-TG antibody positive patients, there was a significant positive correlation of thyroid hormone levels with CRP and DAS 28-CRP (p:0.01, r:0,120; p:0.01, r:0,169). Conclusion: Thyroid autoantibodies were found to be positive in 16-21% of patients with RA. Though hypothyroidism is not very frequent in RA patients, autoimmune thyroid disease is quite common, which may be related to disease activity.

Factors associated with cellulitis in lymphoedema of the arm - an international cross-sectional study (LIMPRINT).

BACKGROUND: Lymphoedema is a globally neglected health care problem and a common complication following breast cancer treatment. Lymphoedema is a well-known predisposing factor for cellulitis, but few have investigated the risk factors for cellulitis in this patient cohort on an international level. The aim of this study was to identify the frequency of cellulitis in patients with lymphoedema of the arm, including potential risk factors for cellulitis. METHODS: An international, multi-centre, cross-sectional study including patients with clinically assessed arm lymphoedema. The primary outcome was the incidence of cellulitis located to the arm with lymphoedema within the last 12 months, and its potential associated risk factors. The secondary outcome was life-time prevalence of cellulitis. Adults with clinically-assessed arm lymphoedema/chronic oedema (all causes) and able to give informed consent were included. End-of-life-patients or those judged as not in the patient's best interest were excluded. Both univariable and multivariable analysis were performed. RESULTS: A total of 2160 patients were included from Australia, Denmark, France, Ireland, Italy, Japan, Turkey and United Kingdom. Secondary lymphoedema was present in 98% of the patients; 95% of these were judged as related to cancer or its treatment. The lifetime prevalence of cellulitis was 22% and 1-year incidence 11%. Following multivariable analysis, factors associated with recent cellulitis were longer swelling duration and having poorly controlled lymphoedema. Compared to having lymphoedema less than 1 year, the risk increased with duration: 1-2 years (OR 2.15), 2-5 years (OR 2.86), 5-10 years (OR 3.15). Patients with well-controlled lymphoedema had a 46% lower risk of cellulitis (OR 0.54, 95% CI 0.39-0.73, p < 0.001). More advanced stages of lymphoedema were associated with cellulitis even after adjustment for swelling duration and control of swelling by logistic regression (stage II OR 5.44, stage III OR 9.13, p = 0.002), demonstrated in a subgroup analysis. CONCLUSION: Patients with advanced arm lymphoedema are at particular risk of developing cellulitis. Prevention of lymphoedema progression is crucial. The results lend towards a positive effect of having well-treated lymphoedema on the frequency of cellulitis.

Prevalence of Fibromyalgia Syndrome in Women with Lipedema and Its Effect on Anxiety, Depression, and Quality of Life.

Background/Aim: The aim of this study was to determine the frequency of fibromyalgia syndrome (FMS) in patients with lipedema and to evaluate the effects of FMS on anxiety, depression, and quality of life (QoL) in this patient group. Methods: Patients with lipedema were invited to participate in a Survey-Monkey questionnaire (according to inclusion and exclusion criteria) that was announced on the facebook page of the lipedema patient community. The demographic and clinical properties, including age, body mass index (BMI), education, marital status, and types and stage of lipedema, were collected. Presence of fibromyalgia was assessed by the questions based on American College of Rheumatology 2016 FMS diagnostic criteria. The Hospital Anxiety and Depression Scale and Short Form-12 (SF-12) were used to assess the anxiety and depression, and QoL respectively. The demographic and clinical characteristics, as well as anxiety/depression level and QoL of lipedema patients were evaluated in regard to the presence (Group 1) and absence (Group 2) of FMS. Results: A total of 354 participants with a mean age of 43.18 ± 9.53 years and BMI of 30.61 ± 6.86 were included. The majority of them were married and had university education. Most of the patients had types 1, 2 and commonly stages 1 and 2 lipedema. One hundred twenty-four patients (35%) satisfied FMS criteria. The demographic characteristics except pain intensity were similar between the groups. The mean anxiety and depression scores of Group 1 were significantly higher compared with Group 2 (13.11 ± 4.2 vs. 9.87 ± 4.65, 10.23 ± 3.79 vs. 8.26 ± 4.15, respectively, p < 0.001). The mental and physical subgroup scores of SF-12 (35.37 ± 8.59 vs. 42.55 ± 10.15, 35.27 ± 8.49 vs. 40.38 ± 11.36, respectively) were significantly lower in Group 1 than in Group 2 (p < 0.001). Conclusion: More than every 3 lipedema patient may have FMS. This comorbidity may increase depression and anxiety, and impair QoL. Therefore, FMS must be kept in mind especially in the assessment of painful lipedema patients to decrease anxiety/depression and enhance the QoL of them.

Static and Dynamic Imbalance in Patients with Breast Cancer-Related Lymphedema.

Background: Breast cancer-related lymphedema (BCRL) was associated with postural imbalance, but the immature knowledge introduced debate about which component of the balance was affected by BCRL in the literature. The aim of this study was to determine the static and dynamic balance of patients with BCRL in comparison with healthy subjects. Methods and Results: This case-control designed study recruited 30 BCRL patients and 30 healthy individuals. The demographic and clinical variables of the subjects were recorded. The static balance stability parameters on four conditions (eyes opened-stable ground, eyes closed-stable ground, eyes opened-unstable ground, eyes closed-unstable ground) and dynamic stability of all participants were evaluated. The values of both stable ground conditions were similar between the groups (p < 0.05). However, values of both eyes opened-unstable ground (p = 0.032) and eyes closed-unstable ground (p = 0.034) conditions were significantly impaired in BCRL in comparison with controls. Besides, comparison of sway area of the opened versus closed eyes conditions on unstable ground (p = 0.036), and movement speed while correcting the center of pressure on unstable ground (with opened and closed eyes, p = 0.014 and p = 0.004 respectively) revealed increased values in the BCRL group. Likewise, the dynamic stability was significantly disrupted in the BCRL group (p = 0.043). Conclusion: Closing eyes did not affect the postural balance in patients with BCRL, whereas the deterioration of ground altered the balance significantly in the BCRL group compared with healthy subjects. We suggest the inclusion of balance exercises and guidance for selection of correct shoes and insoles in routine lymphedema rehabilitation program.

Investigation of physical activity, fear of falling, and functionality in individuals with lower extremity lymphedema.

PURPOSE: To investigate the fear of falling, physical activity, and functionality in patients with lymphedema in the lower extremities. METHODS: Sixty-two patients who developed stage 2-3 lymphedema in the lower extremities due to primary or secondary causes (age: 56.03 ± 7.83 years) and 59 healthy controls (age: 54.61 ± 5.43 years) were included in the study. The sociodemographic and clinical characteristics of all individuals included in the study were recorded. In both groups, fear of falling was evaluated with the Tinetti Falls Efficacy Scale (TFES), lower extremity functionality with the Lower Extremity Functional Scale (LEFS), and physical activity with the International Physical Activity Questionnaire-Short Form (IPAQ-SF). RESULTS: There was no statistically significant difference between the demographic characteristics of the groups (p > 0.05). The primary and secondary lymphedema groups had similar LEFS (p = 0.207, d = 0.16), IPAQ (p = 0.782, d = 0.04), and TFES (p = 0.318, d = 0.92) scores. However, the TFES score of the lymphedema group was significantly higher than that of the control group (p < 0.01, d = 0.52), while the LEFS (p < 0.01, d = 0.77) and IPAQ scores (p = 0.001, d = 0.30) were significantly higher in the latter. There was a negative correlation between LEFS and TFES (r = -0.714, p < 0.001) and between TFES and IPAQ (r = -0.492, p < 0.001). LEFS and IPAQ were positively correlated (r = 0.619, p < 0.001). CONCLUSION: It was determined that individuals with lymphedema developed a fear of falling, and their functionality was negatively affected. This negative effect on functionality can be attributed to reduced physical activity and an increased fear of falling.

Clinical awareness and knowledge of breast cancer-related lymphedema among a group of psychiatrists in Turkey - An online survey.

Background: The point-of-view and role of physiatrists are important in the clinical care of breast-cancer-related-lymphedema (BCRL) patients to set up management and rehabilitation strategies. Aim: The aim of this study was to determine the awareness and knowledge of BCRL among a group of physiatrists regarding its causes, symptoms, treatment, and management in Turkey. Subjects and Methods: The participants were asked to answer a 10-min web survey, including 19 questions. In addition to their demographical and logistic properties, the questionnaire elicited data on the knowledge, education, and awareness of the physiatrists on the diagnosis and treatment of BCRL. Results: In total, 127 female and 44 male physiatrists completed the survey. Also, 71% of the participants were aged between 31 and 50 years, mostly working in metropoles and tertiary hospitals for more than 5 years. Further, 63.7% of the participants expressed that they had knowledge about BCRL; however, detailed knowledge of lymphedema treatment was low, as 67.9% of the physiatrists reported that they had no comprehensive information about complete-decongestive-therapy. Nearly half of the participants did not believe that once lymphedema has clinically manifested, a patient can eventually be treated for BCRL. Also, 87% of the participants had attended less than two educational events related to BCRL in the past 5 years. In all, 94.7% of the physicians determined a great need for education and awareness of the current literature about BCRL. Conclusion: The awareness and knowledge of lymphedema is moderate but detailed information, knowledge, and education about lymphedema and its treatment are low among a group of physiatrists. With the growing number of breast cancer survivors, physiatrists' awareness and education about BCRL are crucial to improve the quality of care of patients.

The Comparative Frequency of Breast Cancer-Related Lymphedema Determined by Bioimpedance Spectroscopy and Circumferential Measurements.

Objective: The survival of patients with breast cancer has prolonged due to early diagnosis and modern methods of treatment and lymphedema has become the most important morbidity secondary to the treatment of the disease. Early detection and timely intervention have potential to reduce advanced breast cancer-related lymphedema. The aims of this study were to comparatively determine the frequency of subclinical/clinical lymphedema by using prospective monitoring with bioimpedance spectroscopy (BIS) and circumferential measurements in a group of patients who underwent breast cancer surgery. Materials and Methods: Patients having breast cancer surgery were recruited between October 2018 and December 2019. Demographical and surgical properties were recorded. Extremity volumes by circumferential and BIS measurements were performed after surgery (baseline) and monitorizations were carried out at third and sixth months, in order to determine the frequency of subclinical/clinical lymphedema. L-Dex value of >6.5 was recently taken attention as subclinical lymphedema and values >7 were considered as clinical lymphedema. The presence of subclinical and clinic lymphedema was assessed by inter-limb volume difference (>5% and >10 respectively) based on the serial circumferential measurements in both affected and non-affected extremities. The functional status and quality of Life (QoL) were determined by quick-DASH and LYMQOL-Arm questionnaires respectively. The relationship between volume measurements, functional status and QoL scores were determined. Results: Eighty-two female patients with a mean age of 49.6 years were included to the study. 30 (36.5%) and 21 (25.6%) of patients were determined as having subclinical/clinical lymphedema by BIS, while 18 (21.9%) and 19 (23.1%) of patients had subclinical/clinical lymphedema by circumferentialmeasurements at third-and-sixth months respectively. The functional and QoL scores were not correlated with circumferential volume measurements and BIS scores. There was a moderate-high correlation with BIS and circumferential measurements. Conclusion: In conclusion 36.5% and 25.6% of our study group had subclinical and clinical lymphedema by BIS respectively during the 6 months surveillance period. Periodic monitoring of women with BIS allows early detection for lymphedema in more patients than in circumferential volume measurements, which may have implications for timely and necessary management.

Combined Complete Decongestive Therapy Reduces Volume and Improves Quality of Life and Functional Status in Patients With Breast Cancer-Related Lymphedema.

BACKGROUND: The aim of this study was to evaluate the effects of complete decongestive therapy (CDT) in patients with breast cancer-related lymphedema (BCRL), in regard to volume reduction, functional status and quality of life (QoL). METHODS: Fifty patients with unilateral BCRL were included. The demographic variables focusing on lymphedema were recorded. All patients received combined phase 1 CDT including skin-care, manual lymphatic drainage, multilayer bandaging and supervised exercises, 5 times a week for 3 weeks, as a total of 15 sessions. Patients were assessed by limb volumes and excess volumes according to geometric approximation derived from serial circumference-measurements of the limb, prior and at the end of third week. The functional disability was evaluated by quick disability of arm, shoulder and hand questionnaire (Q-DASH). QoL was assessed by the European Organization for Research and Treatment of Cancer Core Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast-cancer-module (EORTC QLQ-BR23). RESULTS: Fifty females with mean age of 53.22 ± 11.2 years were included. The median duration of lymphedema was 12 months. There were 22 patients in stage1, 26 in stage2 and 2 patients in stage3. The mean baseline limb and excess volumes were significantly decreased at the end of therapies (3262 ± 753 cm³ vs. 2943 ± 646.6 cm³ and 31.36% ± 16.5% vs. 19.12% ± 10.4%, pP= 0.000 respectively). The Q-DASH and EORTC QLQ-C30 and BR23 scores were also decreased significantly (pP< 0.05). The improvements in volumes were related negatively with the duration of lymphedema, and the stage of lymphedema. CONCLUSION: In conclusion phase 1 CDT in a combined manner performed daily for 3 weeks, greatly reduces the volumes as well as improves the disability and QoL, especially when performed earlier.

The effect of a self-management lymphedema education program on lymphedema, lymphedema-related symptoms, patient compliance, daily living activities and patient activation in patients with breast cancer-related lymphedema: A quasi-experimental study.

PURPOSE: This study was undertaken to determine the effects of self-management lymphedema education program (SMLEP) on lymphedema, lymphedema-related symptoms, patient compliance, activities of daily living (ADL) and patient activation in patients with breast cancer-related lymphedema (BCRL). METHODS: A quasi-experimental design without a control group was used to conduct this study in a lymphedema center of a university hospital in Ankara. A total of 44 patients with BCRL participated in the study. Patients (n = 44) received a SMLEP in the form of face-to-face sessions and information booklet at the beginning of the study. Patients were evaluated for upper extremity (UE) volume, and they were followed for 12 months. UE volume, symptom severity, physical function, patient compliance, ADL and patient activity level were measured at the beginning and end of the study. RESULTS: A significant reduction was found in the UE volume (P = 0.000; ES = -0.79) and swelling and numbness symptom scores (P = 0.016; ES = - 0.26; P = 0.002; ES = -0.45, respectively). In addition, a significant increase was found in patient compliance (P = 0.001; ES = -0.29), ADL (P = 0.018; ES = -0.16) and patient activity level (P = 0.000; ES = -0.39) compared to those at the baseline. CONCLUSION: The present study results showed that SMLEP reduced UE volume and lymphedema-related symptoms. In addition, results demonstrated its effectiveness on patient compliance and activity level, and independent performance of ADL. The results suggest that SMLEP is an effective approach in long-term lymphedema self-management.

Stewart-Treves Syndrome: A Rare But Aggressive Complication of Breast Cancer-Related Lymphedema.

Stewart-Treves syndrome (STS) is an angiosarcoma that usually develop in an extremity with longstanding lymphedema. Most affected patients have a history of breast cancer treated with radical mastectomy. Here, we report a case of STS with breast cancer-related lymphedema (BCRL) for a period of seven years. A 56-year-old woman presented with chronic lymphedema of the left arm. Nine years previously she had modified radical mastectomy for grade 2, invasive, ductal breast cancer. Upon physical examination, a tender, purplish lesion on the medial half of the affected arm was observed. The lesion spread rapidly with different-sized, scattered, purple-colored lesions in the affected area. A prompt skin biopsy was reported as STS. An immediate arm amputation was performed. However, a few months later she presented with new lesions on the anterior thorax and subsequent local recurrence around the scar. She received radiation-therapy. However, six months later the angiosarcoma had spread to the pelvic and upper limb area with scattered skin lesions. She had several problems during the chemotherapy and radiation-therapy, although she survived beyond 20 months. In conclusion, STS is a rare but aggressive and important complication of BCRL. Awareness of rapidly progressing skin lesions and detailed investigation, as well as prompt surgery is necessary for patients with BCRL in order to relatively increase the survival time.

The efficacy of different bandaging methods in patients with breast cancer-related lymphedema: A prospective, randomized study.

OBJECTIVES: The aim of this study was to evaluate the comparative efficacy of 3MTM CobanTM 2 layer system and conventional multi-layer short-stretch bandaging in terms of volume reduction, ultrasonographic measurements, functional status, and quality of life (QoL) in the treatment of patients with breast cancer-related lymphedema (BCRL). PATIENTS AND METHODS: This prospective, single-blind, randomized study included a total of 60 BCRL patients (60 females; mean age 54.9±9.6 years; range, 30 to 73 years). The patients were randomly allocated to Group 1 (n=30) and Group 2 (n=30). Both groups received complex decongestive therapy (CDT) including skin care, lymphedema exercises, and manual lymphatic drainage (MLD) combined with traditional multi-layer short-stretch bandaging five times per week for three weeks in Group 1 and with 3MTM CobanTM 2 layer system bandaging two times per week for three weeks in Group 2. Differences in volumes, excess volumes, ultrasonographic measurements, QoL, and functional assessment scores were evaluated at baseline, after three weeks of intensive treatment period, and at two months of follow-up. Functional status was evaluated by the Quick Disability of Arm Shoulder and Hand Questionnaire (Q-DASH), while the QoL was assessed using the Turkish version of Lymphedema Quality of Life Questionnaire-Arm (LYMQOL-Arm). The duration and easiness of applying bandages by physiotherapists and comfortableness of bandages according to patients and physiotherapists were also evaluated using a questionnaire. RESULTS: The demographic and clinical properties were similar between the groups. There were significant improvements in the volumes, excess volumes, ultrasonographic measures, functional scores, and QoL scores in both groups at the end of treatment. The improvements were sustained at two months of follow-up. CONCLUSION: The 3MTM CobanTM 2 layer bandaging as a part of CDT twice a week for a period of three weeks can significantly reduce the volume and improve the disability and impaired QoL, similar to conventional short-stretch multi-layer bandages. In addition, treatment with this layer system enables a time-efficient, easy, and comfortable application of bandaging with increased mobility of the upper extremity.

Lived Experiences for Supportive Care Needs of Women with Breast Cancer-Related Lymphedema: A Phenomenological Study.

This descriptive phenomenological study was conducted to explore the lived experiences for supportive care needs of women with breast cancer-related lymphedema. Purposive sampling was used to recruit participants. In-depth, semi-structured interviews were conducted to collect data. Thematic analysis method was used for data analysis. Data saturation was achieved after interviewing 19 participants. The study was divided into four main themes and nine subthemes: physical (caused by difficulties in performing household chores, limitations in performing self-care activities, and challenges in shopping), psychosocial (being addicted to someone else in daily life, uncertainty about the future, social, and religious support), healthcare systems and information (attention from healthcare professionals, education and lifestyle advices, and access to healthcare sources), and financial supportive care needs. Women experience various SCNs in their daily lives. Provision of supportive care from both family members or others and healthcare professionals could ease the daily lives, improve physical, and psychosocial well-being.

Polypharmacy, Physical and Nutritional Status, and Depression in the Elderly: Do Polypharmacy Deserve Some Credits in These Problems?

Background: To investigate the association of polypharmacy with physical function, nutritional status, and depression in the elderly. Method: The study included 675 people aged over 65 years from 8 centers in various geographical regions. The polypharmacy status was categorized as non-polypharmacy (0-4 drugs), polypharmacy (≥5 drugs). The subjects' physical function was assessed based on their "physical activity levels, Holden ambulation scores, gait speeds, and hand grip strengths"; their nutritional status based on the "Mini Nutritional Assessment (MNA)"; and their psychological status based on the "Center for Epidemiologic Studies Depression Scale -CES-D". Results: The presence of polypharmacy in this population was found to be 30% (n = 203). A statistically significant difference was found between the groups on the level of physical activity, Holden ambulation score, and nutrition status (p < .05). There was a statistically significant difference between the groups also on hand grip strength, MNA score, Charlson score (p < .05). Conclusion: Polypharmacy was observed to have a significant association with physical function, nutrition, and depression in the elderly aged ≥ 65 years.

LIMPRINT Study: The Turkish Experience.

Background: Lymphedema and chronic edema is a major health care problem in both developed and nondeveloped countries The Lymphoedema Impact and Prevelance - International (LIMPRINT) study is an international health service-based study to determine the prevalence and functional impact in adult populations of member countries of the International Lymphoedema Framework (ILF). Methods and Results: A total of 1051 patients from eight centers in Turkey were recruited using the LIMPRINT study protocol. Data were collected using the core and module tools that assess the demographic and clinical properties as well as disability and quality of life (QoL). Most of the Turkish patients were recruited from specialist lymphedema services and were found to be women, housewives, and having secondary lymphedema because of cancer treatment. The duration of lymphedema was commonly <5 years and most of them had International Society of Lymphology (ISL) grade 2 lymphedema. Cellulitis, infection, and wounds were uncommon. The majority of patients did not get any treatment or advice before. Most of the patients had impaired QoL and decreased functionality, but psychological support was neglected. Although most had social health security access to lymphedema centers, nevertheless access seemed difficult because of distance and cost. Conclusion: The study has shown the current status and characteristics of lymphedema patients, treatment conditions, the unmet need for the diagnosis and treatment, as well as burden of the disease in both patients and families in Turkey. National health policies are needed for the prevention, diagnosis, and treatment in Turkey that utilize this informative data.

LIMPRINT in Specialist Lymphedema Services in United Kingdom, France, Italy, and Turkey.

Background: There is no standardized international model for specialist lymphedema services, which covers the types of lymphedema treated and the treatments provided. The aim of this study was to provide a profile of patients attending specialist lymphedema services in different countries to explore similarities and differences. Methods and Results: The LIMPRINT core tool was used in specialist lymphedema services in the United Kingdom, France, Italy, and Turkey. Services in Turkey saw a slightly younger age group, with a higher proportion of female patients reflecting a particular focus on breast cancer-related lymphedema. There were higher levels of obesity and restricted mobility in patients in the United Kingdom compared with other countries. Italy and France saw the highest percentage of patients with primary lymphedema. Diabetes was a common comorbidity in the United Kingdom and Turkey. The United Kingdom saw the largest number of patients with lower limb lymphedema. Conclusions: The results show a wide range of complexity of patients treated in specialist lymphedema services. Some of the differences between countries may reflect different stages in the evolution of specialist lymphedema services, rather than a true difference in prevalence, with those with "younger" services treating a high proportion of patients with cancer and those with more established services treating a wider range of different types of lymphedema, including more elderly people with multiple comorbidities.

The reliability and validity of Lymphedema Quality of Life Questionnaire-Arm in Turkish patients with upper limb lymphedema related with breast cancer.

OBJECTIVES: This study aims to adapt Lymphedema Quality of Life Questionnaire-Arm (LYMQOL) into Turkish and to test its reliability and validity in Turkish patients with upper limb lymphedema related with breast cancer. PATIENTS AND METHODS: Between June 2015 and November 2015, the Turkish LYMQOL-Arm was obtained using forward-backward translation method and administered to a total of 135 female patients (mean age 51.8±9.8 years; range, 31 to 82 years) with upper limb lymphedema with European Organization for Research and Treatment of Cancer-QoL Breast Cancer-specific version (EORTC QLQ-BR23) and Functional Assessment of Cancer Therapy-Breast-4 (FACT-B+4) questionnaires. A test-retest interval of seven-days was used to assess the reliability. The validation studies were carried-out by means of construct-validity using Spearman's rank correlation-coefficient. Internal consistency and test-retest-reliability were assessed using Cronbach's alpha and intra-class correlation-coefficient (ICC), respectively. RESULTS: 135 patients completed the questionnaire with upper limb lymphedema related with breast cancer completed the questionnaires. The mean lymphedema duration was 21.1±28.7 (median: 6) months. Internal consistency and reliability of the Turkish LYMQOL-Arm was good with Cronbach's alpha (0.88-0.90) and test-retest ICC (0.45-0.71). External construct validity was highly confirmed by expected correlations with comparator scales, EORTCQLQ-BR23 and FACT-B+4 (p<0.01). CONCLUSION: The Turkish version of the LYMQOL-Arm is a valid and reliable tool for evaluating QoL in female patients with upper limb lymphedema related with breast cancer.

The Importance of Awareness and Education in Patients with Breast Cancer-Related Lymphedema.

Upper extremity lymphedema occurs in one of five women after breast cancer treatment and causes significant morbidity. Women often report being uninformed regarding awareness of lymphedema and other side effects after the cancer surgery. The aim of the study was to assess the postoperative information and education about lymphedema in patients with lymphedema related to breast cancer surgery in the rehabilitation unit of a tertiary hospital. One hundred eighty patients who had admitted to lymphedema rehabilitation unit between September 2013 and February 2015 were recruited to the study. The demographic properties of women, duration, and grade of lymphedema were recorded. The patients were asked whether they had received any information about awareness of lymphedema or whether they have been educated for reducement of the risk of lymphedema after the breast cancer surgery. One hundred eighty women with a mean age of 52.9 ± 10.7 years (27-53) and with a mean lymphedema duration of 19.8 ± +39.4 months were included. Ninety-eight (54.4 %) patients had grade 1, 80 (44.4 %) patients had grade 2, and 2 (1.11 %) patients had grade 3 lymphedema. Among the participants, only 35 (19.5 %) had reported that they had received information or education about lymphedema. One hundred forty-five patients (80.5 %) were not informed or trained about the development of lymphedema. The degree and duration of lymphedema were lower in patients that had been informed or educated about lymphedema as compared to the patients who had not been informed or educated, but the difference was not statistically significant (p = 0.052). Only a minor group of patients (19 %) had received information and education about lymphedema and there is an unmet need for education or information about lymphedema after breast cancer treatment, especially in developing countries. The nonsignificant correlation between education and the degree and duration of lymphedema was thought to be related with the incongrous numbers of the subgroups. In conclusion with the growing population of breast cancer survivors, patient awareness and education about postoperative lymphedema risk after the cancer surgery is warranted.