Efficacy and efficiency of a new therapeutic approach based on activity-oriented proprioceptive antiedema therapy (TAPA) for edema reduction and improved occupational performance in the rehabilitation of breast cancer-related arm lymphedema in women: a controlled, randomized clinical trial.

BACKGROUND: Breast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current evidence advocates transdisciplinary oncological rehabilitation. Therefore, research in this area is necessary since limited consensus having been reached with regard to the basic essential components of this rehabilitation. Consensus has, however, been reached on the use of decongestive lymphedema therapy (DLT), but due to a lack of tests, the necessary dosages are unknown and its level is moderately strong. This study attempts to verify both the efficacy of activity-oriented proprioceptive antiedema therapy (TAPA), as compared to conventional treatments such as DLT or Complex Physical Therapy (CPT), as well as its efficiency in terms of cost-effectiveness, for patients affected by breast cancer-related arm lymphedema. METHODS: Controlled, randomized clinical trial with dual stratification, two parallel arms, longitudinal and single blind. 64 women with breast cancer-related arm lymphedema will take part in the study. The experimental group intervention will be the same for stage I and II, and will consist of neuro-dynamic exercises oriented to the activity, proprioceptive neuromuscular facilitation activities and proprioceptive anti-edema bandaging. The control group intervention, depending on the stage, will consist of preventive measures, skin care and exercise-prescribed training in the lymphedema workshop as well as compression garments (Stage I) or conservative Complex Decongestive Therapy treatment (skin care, multi-layer bandaging, manual lymphatic drainage and massage therapy) (Stage II). RESULTS: Sociodemographic and clinical variables will be collected for the measurement of edema volume and ADL performance. Statistical analysis will be performed on intent to treat. DISCUSSION: It has been recommended that patient training be added to DLT, as well as a re-designing of patient lifestyles and the promotion of health-related aspects. In addition, clinical trials should be undertaken to assess neural mobilization techniques and proprioceptive neuromuscular facilitation should be included in the therapy. Cohesive bandaging will also be performed as an early form of pressotherapy. The proposed study combines all of these aspects in order to increased comfort and promote the participation of individuals with lymphedema in everyday situations. LIMITATIONS: The authors have proposed the assessment of the experimental treatment for stages I and II. One possible limitation is the lack of awareness of whether or not this treatment would be effective for other stages as well as the concern for proper hand cleansing during use of bandages, given the current COVID-19 pandemic situation. TRIAL REGISTRATION: This trial was registered in ClinicalTrials.gov ( NCT03762044 ). Date of registration: 23 November 2018. Prospectively Registered.

The effect of kinesio taping with the web strip technique on pain, edema, and trismus after impacted mandibular third molar surgery.

BACKGOUND: There are many methods used to alleviate edema, trismus, and pain after impacted third molar (3M) removal, one of which is Kinesio Taping (KT). AIMS: This study aimed to evaluate the effectiveness of Kinesio Taping with Web Strip technique on postoperative morbidity after impacted mandibular 3M extraction. METHODS: The study employed a split-mouth and controlled randomized clinical trial design. A total of 60 patients were scheduled for surgical extractions of bilateral lower 3Ms. They were randomly divided into two groups, and KT was applied to one group while the others was determined as a control group without KT application. Tape was applied directly after surgery and maintained for postoperative (post-op) 7 days. Pain intensity was recorded subjectively using a Visual Analogue Scale (VAS). Pain and analgesic usage were recorded on the post-op 1st, 2nd, 3rd, and 7th days. Trismus was evaluated before the surgery and on the post-op 2nd and 7th days. Facial edema was analyzed on the post-op 2nd and 7th days by VAS and by measuring the lengths of three lines using a flexible plastic tape measure. RESULTS: VAS pain scores were statistically lower in the KT group on the post-op 1st, 3rd and 7th days. Total analgesic usage was also significantly lower in the KT group. On the post-op 2nd day, measurement of the lengths of three lines showed a statistically less edema in the KT group. Similar results were obtained from the measurement of edema using VAS. Maximum mouth opening was statistically higher in the KT group on the post-op 2nd and 7th day. CONCLUSION: KT with the web strip technique should be considered more economic and less traumatic than other approaches, as it is free from systemic side effects and is a simple method to carry out to decrease morbidity.

Working on my own terms.

Six months after being named nurse of the year in 2007, Justine Whitaker left the NHS in a blaze of publicity, citing her disillusionment with increasing red tape and a culture of fear. Now an independent nurse, lecturer and business owner, she says NHS reforms still directly affect her.

Nutritional repletion of children with severe acute malnutrition does not affect VLDL apolipoprotein B-100 synthesis rate.

VLDL apo B-100 is essential for the secretion of liver fat. It is thought that synthesis of this lipoprotein is impaired in childhood severe acute malnutrition (SAM), especially in the edematous syndromes, and that this contributes to the common occurrence of hepatic steatosis in this condition. However, to our knowledge, it has not been confirmed that VLDL apo B-100 synthesis is slower in edematous compared with nonedematous SAM and that it is impaired in the malnourished compared with the well-nourished state. Therefore, VLDL apo B-100 kinetics were measured in 2 groups of children with SAM (15 edematous and 7 nonedematous), aged 4-20 mo, at 3 stages during treatment. Measurements were done at 4 ± 1 d postadmission, mid- catch-up growth in weight, and at recovery (normal weight-for-length). VLDL apo B-100 synthesis was determined using stable isotope methodology to measure the rate of incorporation of (2)H(3)-leucine into its apoprotein moiety. The fractional and absolute synthesis of VLDL apo B-100 did not differ between the groups or from the initial malnourished stage to the recovery stage. Concentrations of VLDL apo B-100 were greater in the edematous than in the nonedematous group (P < 0.04) and did not differ from the initial stage to recovery. The data indicate that VLDL apo B-100 synthesis is not reduced when children develop either edematous or nonedematous SAM.

A randomized clinical controlled study comparing the effect of modified manual edema mobilization treatment with traditional edema technique in patients with a fracture of the distal radius.

STUDY DESIGN: Randomized controlled clinical trial. INTRODUCTION: Manual edema mobilization (MEM) is a method of edema reduction based on the lymphatic system's ability to drain and resolve subacute edema. PURPOSE OF THE STUDY: To investigate the effect of a modified MEM approach and compare it with a traditional edema technique in patients with subacute hand/arm edema after a distal radius fracture. METHOD: The patients were randomized into one of two treatment groups: a group that received traditional edema treatment and a group that received a modified MEM treatment. All patients were examined for edema, active range of motion (AROM), pain, and activities of daily living (ADL). The number of edema sessions and the number of all sessions were counted. RESULT: No statistically significant changes were observed in edema reduction, AROM, pain, and ADL at six and nine weeks between the treatment groups. A statistically significant improvement was observed in ADL after three weeks after inclusion (p=0.03) in the modified MEM group compared with the control group. Furthermore, fewer edema treatment sessions were needed (p=0.03) in the modified MEM group. At six weeks, we observed a difference between the two groups' needs for further edema treatment (p=0.04). CONCLUSION: Neither the traditional nor the modified MEM treatment program was superior in terms of edema reduction, although the modified MEM resulted in fewer sessions to decrease subacute hand/arm edema compared with using traditional edema reduction techniques in patients after distal radius fracture. LEVEL OF EVIDENCE: 1.

Loss of knee-extension strength is related to knee swelling after total knee arthroplasty.

OBJECTIVE: To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA). DESIGN: Prospective, descriptive, hypothesis-generating study. SETTING: A fast-track orthopedic arthroplasty unit at a university hospital. PARTICIPANTS: Patients (N=24; mean age, 66y; 13 women) scheduled for primary unilateral TKA were investigated 1 week before surgery and on the day of hospital discharge 2.4 days postsurgery. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We assessed all patients for knee-joint circumference, knee-extension strength, and functional performance using the Timed Up & Go, 30-second Chair Stand, and 10-m fast speed walking tests, together with knee pain during all active test procedures. RESULTS: All investigated variables changed significantly from pre- to postsurgery independent of knee pain. Importantly, knee circumference increased (knee swelling) and correlated significantly with the decrease in knee-extension strength (r=-.51; P=.01). Reduced fast-speed walking correlated significantly with decreased knee-extension strength (r=.59; P=.003) and decreased knee flexion (r=.52; P=.011). Multiple linear regression showed that knee swelling (P=.023), adjusted for age and sex, could explain 27% of the decrease in knee-extension strength. Another model showed that changes in knee-extension strength (P=.009) and knee flexion (P=.018) were associated independently with decreased performance in fast-speed walking, explaining 57% of the variation in fast-speed walking. CONCLUSIONS: Our results indicate that the well-known finding of decreased knee-extension strength, which decreases functional performance shortly after TKA, is caused in part by postoperative knee swelling. Future studies may look at specific interventions aimed at decreasing knee swelling postsurgery to preserve knee-extension strength and facilitate physical rehabilitation after TKA.

Edema can be a handicap in treatment of anorexia nervosa.

Anorexia and bulimia nervosa are common in western civilized countries. They are among the psychiatric disorders in that they are often accompanied by a variety of life-threatening physical abnormalities. These patients need a close follow-up of the pediatrician in collaboration with the psychiatrist since the changes in bodily functions affect the psychiatric therapy. The challenge to the physician is to use the traditional tools of medicine to diagnose and treat these physical abnormalities using careful medical history, a complete physical examination and appropriate laboratory testing. Peripheral edema is seen as a physical finding in anorexia nervosa (AN) and it is not rare. The estimated frequency is up to 20% among adolescent patients. Peripheral edema in this setting can be easily confused as weight gain. There are five possible mechanisms for its occurrence: hypoproteinemia, electrolyte imbalance, hormonal changes, rapid refeedings, and abuse of laxative, diuretics and diet pills. Patients with eating disorders may ingest a large number of drugs in an attempt to control their weight. We present a case of a female adolescent with AN and peripheral edema who terminated her psychiatric treatment during the refeeding phase because of the unbearable anxiety caused by this edema that affected her body image dramatically. With this case study, we point out the importance of assessing peripheral edema and discriminating it from true weight gain.

Reliability and minimal detectable change for the figure-of-eight-20 method of, measurement of ankle edema.

STUDY DESIGN: Single-session, repeated-measures design, with 3 raters. OBJECTIVES: To determine the intrarater and interrater reliability and the minimal detectable change score for a modified version of the figure-of-eight method of measurement of ankle edema (figure-of-eight-20) developed for patients with severe injuries. BACKGROUND: The precise quantification of ankle edema is necessary to determine the relative effectiveness of interventions aimed at reducing swelling, and to monitor individual progress during treatment. METHODS AND MEASURES: Thirty subjects (mean +/- SD age, 46 +/- 16 years; 9 female and 21 male) with ankle edema following surgery for malleolar fracture took part in the study. Each of 3 raters performed 3 measurements of the affected ankle without marking landmarks and 3 measurements of both ankles using skin markings. The order of the raters was randomized and the raters were blinded to each other's results. RESULTS: The figure-of-eight-20 method showed high intrarater and interrater reliability (intraclass correlation coefficients greater than .99). The minimal detectable change (MDC95%) for the swollen ankle was 9.6 mm when measured without skin marks and 73 mm with marks. The difference in circumference of the affected and unaffected ankle (mean +/-SD, 33.8+/-12.1 mm) consistently exceeded the MDC95,, even in patients with only mild edema. CONCLUSIONS: The standardized figure-of-eight-20 offers a good option for reliably measuring ankle circumference in patients with severe ankle trauma. In repeated assessments, greater accuracy is likely to be obtained when the landmarks for measurement are marked and the same rater carries out the measurements.

The use of foot pumps compression devices in the perioperative management of ankle fractures: Systematic review of the current literature.

BACKGROUND: Ankle fractures account for 9% of all fractures seen in the United Kingdom. 15,000 of these fractures undergo operative fixation each year. Soft tissue swelling impacts on timing of fixation due to fears of infection and wound dehiscence. The use of arterio-venous foot pumps (AVFP) is increasing in this population although the evidence for their efficacy is unclear. In order to address this, we present an overview of the evidence for AVFP device use following ankle fracture. METHODS: In September 2015 an electronic literature search was undertaken of studies comparing two or more methods of swelling reduction in patients with ankle fractures. Of 326 screened, 5 papers ultimately were included. RESULTS: Two studies reported a statistically significant reduction in swelling (p=0.03) and (p=0.03 at 24 hours, p=0.05 at 48 hours) after using AVFP devices compared to the controls (leg elevation +/ ice therapy). Stockle et al. reported a greater reduction in the preoperative ankle, midfoot and forefoot circumference at 24 hours in their AVFP group (53% versus 32% and 10% in their continuous cryotherapy and cool pack cryotherapy groups respectively). Whereas, Rohner-Spengler et al. observed improved preoperative swelling reduction in patients treated with a multilayer compression bandage when compared to their AVFP group. Keehan et al. reported that time to surgery was considerably reduced in patients treated with an AVFP device, (2.3 days) compared to those treated with leg elevation (4.6 days) (p=0.02). Length of stay (LOS) was not influenced by any of the tested interventions. CONCLUSIONS: AVFP devices have been shown to reduce time to surgery and degree of swelling before operative intervention better than other methods but the strength of evidence to support this remains poor.

[The use of Ginkor Fort in the program of multimodality rehabilitation treatment of CYI patients with edematous syndrome].

Edematous syndrome is one of the most frequently occurring manifestations of chronic venous insufficiency (CVI). This paper analyzes an experience with conservative treatment of CVI patients with edematous syndrome. A complex of rehabilitation measures was used in addition to therapy by the phleboprotector Ginkor Fort. Based on the study of microcirculatory changes, malleolar volume, the thickness of subcutaneous fat as well as on subjective sensations and the quality of life in 117 patients with the edematous forms of CVI the authors have demonstrated the high efficacy of combined pharmacotherapy by Ginkor Fort and rehabilitation treatment in the given patient group.

Compression stockings and rubber floor mats: do they benefit workers with chronic venous insufficiency and a standing profession?

Chronic venous insufficiency (CVI) is a burden to many workers, especially to those with a standing profession. Preventive measures are seldom taken. A quasirandomized parallel group trial was performed in 114 male workers with CVI and a standing profession. For 3 months, class II compression stockings or rubber floor mats were used vs controls. Outcome measures were diurnal volume changes (leg swelling) and complaints of the lower legs. With the stockings, a significant decrease in complaints was found, as well as a significant decrease in leg swelling. Rubber mats were often not suitable for hygienic and safety reasons. The decrease in complaints in the group using rubber mats was less pronounced, and leg swelling did not differ from that of the control group. Compression stockings appeared to be superior to rubber mats with regard to applicability, diminishing subjective complaints, and decrease of diurnal leg swelling.

The edematous hand.

The purpose of this article is to increase the therapist's awareness of the effects of edema on the hand and the need for early treatment. The physiology of tissue fluid production and the two basic types of edema are discussed. The use of elevation, compression, and active exercise are the primary methods of controlling edema in the hand. Various modalities and commercial compression dressings are helpful for intractable edema; however, early intervention and treatment of the edematous hand can prevent subsequent hand dysfunction and sequelae.

String wrapping versus massage for reducing digital volume.

The purposes of this study were 1) to compare the relative effectiveness of two common methods of treating hand edema, retrograde massage and string wrapping, and 2) to compare these two methods with two techniques of combining them. Fifty-six digits of the hands of 14 subjects were studied. Because all of the subjects demonstrated generalized hand edema, comparisons of different digits of the same subject could be made on each visit. Effectiveness rankings of the treatment methods were made after each visit. A clear pattern of effectiveness emerged that suggested that superimposing massage on an already-wrapped digit was more effective than either massage or string wrapping alone. Average circumferential reductions of digits further supported the hypothesis that a combination of string wrapping and massage would be more effective than the individual string-wrapping or massage techniques. No significant difference in effectiveness was found between massage and string wrapping when used singularly.

Effects of electrical stimulation on edema formation in different strains of rats.

BACKGROUND AND PURPOSE: Although electrical stimulation (ES) is commonly used to curb edema formation, efficacy has been demonstrated in only one species of frog and one strain of rat. The purpose of this study was to determine whether different strains of rats respond differently to ES. SUBJECTS AND METHODS: Feet of Sprague-Dawley, Zucker-Lean, and Brown Norway rats were injured in a uniform manner. One foot served as a control, and the other foot received four 30-minute exposures to cathodal high-voltage pulsed current at amplitudes 10% less than those required to induce visible muscle activity. Each treatment period was followed by a 30-minute rest period. Limb volumes were measured before and after trauma and after each treatment and rest period. Changes from pretrauma volumes were analyzed by repeated-measures analysis of variance. RESULTS: Edema formation was curbed in Zucker-Lean and Brown Norway rats but not in Sprague-Dawley rats. CONCLUSION AND DISCUSSION: The finding that two of the three strains of rats responded to ES suggests that some strains of rats may be suitable models for the study of edema. That frogs and rats respond to high-voltage pulsed current suggests that humans might respond similarly.

Relationship between ankle invertor H-reflexes and acute swelling induced by inversion ankle sprain.

STUDY DESIGN: Single group, post-test design using the uninvolved lower extremity as the experimental control. OBJECTIVES: To determine relationships between ankle swelling and flexor digitorum longus and peroneus longus H-reflex amplitude and latency. BACKGROUND: Primary capsuloligamentous injury, neural injury, and joint effusion and swelling may contribute to H-reflex changes following inversion ankle sprain. The relationship between ankle swelling and invertor or evertor H-reflexes has not been reported. METHODS AND MEASURES: Fifteen subjects with acute grade I or II inversion ankle sprains (mean +/- SD) 6.5 +/- 3 days after onset participated in this study. Swelling was estimated using a tape measure and the figure-of-eight girth assessment method. H-reflexes were determined using standard techniques. Paired t-tests were used to compare mean differences in ankle girth (swelling) and ankle invertor or evertor H-reflex amplitude and latency between the involved and uninvolved limbs. Pearson product moment correlations were used to assess relationships between swelling and H-reflex variables. RESULTS: Involved limb ankle girth was increased with respect to the uninvolved limb (1.5 +/- 0.9 cm) and the involved ankle flexor digitorum longus latency was delayed (0.72 +/- 0.7 ms). There was a moderate positive association (r = 0.73) between the latency delay in the involved ankle flexor digitorum longus and swelling. There were no significant differences in H-reflex amplitude and peroneus longus latency between ankles. CONCLUSIONS: Grade I or II inversion sprains and the related swelling appear to delay involved ankle flexor digitorum longus latency to a greater extent than peroneus longus latency. Clinicians need to direct greater attention to the ankle invertors when designing and implementing ankle rehabilitation programs, particularly during the swelling management phase of treatment.

The use of the edema bar for the treatment of burn patients.

The edema bar is a new device that therapists can add to their repertoire of treatment approaches for burn patients. This article looks at the challenges therapists encounter while working with burn patients and describes the edema bar's design, its application to the burn rehabilitation process, and the multidisciplinary approach to its use.

Effects of continuous passive motion and elevation on hand edema.

The purpose of this study was to evaluate the efficacy of the use of continuous passive motion (CPM) of the digits in combination with limb elevation to reduce hand edema. The effects of 30 min of CPM of the digits with the limb elevated were compared with the effects of 30 min of limb elevation alone. Each of 16 subjects with hand edema of varied etiology received both treatments, one on each of 2 consecutive days. Measures of hand volume, finger circumference, and finger stiffness were taken before and after each treatment. Analyses comparing mean percentage change scores for both treatments showed large and significant treatment effects for all three dependent measures. The findings indicate that, for this sample, CPM with limb elevation was a more effective treatment for the reduction of hand edema than limb elevation alone. The results of analyses performed on a subgroup of 11 subjects with hemiplegia were similar, thus suggesting that CPM with limb elevation may be an effective method by which to reduce hand edema for this patient population.

[Medical rehabilitation of breast cancer patients]. / O meditsinskoi reabilitatsii bol'nykh rakom molochnoi zhelezy.

While in hospital, 100 patients with breast cancer received a course of medical rehabilitation (vacuum drainage of the wound, exercise therapy, etc). After 3 months, among the most frequent postoperative complications were edema (64%) and disturbed function of the extremities (23%). In most patients, these complications were mild or of medium severity. Among the major factors of long-term postoperative complication development were prolonged radiation therapy before surgery, extent of exeresis and complications which developed immediately after operation.