ABSTRACT
Abstract Introduction: Head and neck lymphedema is considered a chronic and complex complication with potential to cause physical, functional, emotional and social impairment. Objective: To identify the approaches to physical therapy used to treat head and neck cancer-related lymphedema. Method: A bibliographic search was conducted in February and March 2012 in books and electronic databases, LILACS, MEDLINE, SCIELO, Cochrane, PEDro, and BDTD using the following keywords: lymphedema, treatment, head and neck cancer, and physical therapy connected by the Boolean operator AND without a specific time frame. Results and discussion: Early diagnosis and assessment is key to properly managing and effectively treating lymphedema. Diagnosis is reached through clinical history and physical assessment by measuring the distance between two anatomical landmarks, circumference measures, and lymphedema rating scales. Complex decongestive therapy, which includes manual lymph drainage, compressive bandaging, kinesiotherapy and skin care, is the technique most frequently used and currently considered to be the gold standard. Conclusions: No consensus is reported in the literature in regard to a standard procedure to assess and treat head and neck cancer-related lymphedema. Assessments and treatments described in the literature are mainly restricted to the limbs; therefore, further studies are needed to support effective clinical actions in the physical therapy approach to this condition.
Resumo Introdução: O linfedema de cabeça e pescoço é considerado uma complicação crônica e complexa que pode provocar prejuízos físicos, funcionais, emocionais e sociais importantes. Objetivo: Identificar as abordagens fisioterapêuticas utilizadas no linfedema pós-tratamento de câncer de cabeça e pescoço. Método: Para o delineamento dessa revisão, foi realizado levantamento bibliográfico nos meses de fevereiro e março de 2012, em livros e nas bases de dados eletrônicas LILACS, MEDLINE, SCIELO, Cochrane, PEDro, BDTD utilizando as palavras-chave: linfedema, tratamento, câncer de cabeça e pescoço, fisioterapia ligadas pelo operador boleano AND, sem estabelecer data limite para a publicação. Resultados e discussão: O diagnóstico precoce e a avaliação são fundamentais para o manejo adequado e tratamento efetivo do linfedema. O diagnóstico é realizado através da história clínica e do exame físico pela medida da distância entre dois pontos anatômicos, das medidas de circunferência e escalas de intensidade do linfedema. A fisioterapia complexa descongestiva ou linfoterapia que inclue: drenagem linfática manual, bandagem compressiva, cinesioterapia e cuidados com a pele, é a técnica mais utilizada na intervenção do linfedema, considerada padrão ouro atualmente. Conclusões: De acordo com a literatura revisada, não há consenso sobre o procedimento padrão para avaliação e tratamento do linfedema após o câncer de cabeça e pescoço. A avaliação e o tratamento para linfedema descritos na literatura estão restritos, principalmente, a membros, sendo assim, novos estudos devem ser realizados a fim de subsidiar ações clínicas efetivas na abordagem fisioterapêutica desta sequela.
ABSTRACT
Introduction: The published literature shows an increased occurrence of adverse events, such as human immunodeficiency virus (HIV)-associated lipodystrophy syndrome, that are associated with the continuous use of antiretroviral therapy. This study was performed to estimate the prevalence and factors associated with lipodystrophy in acquired immune deficiency syndrome (AIDS) patients. Methods: We conducted a cross-sectional study between October 2012 and February 2013. The sample consisted of patients with AIDS who attended the Outpatient Treatment Center for Infectious Diseases at Nereu Ramos Hospital, Florianópolis, State of Santa Catarina, Brazil. We collected information on demographics, lifestyle, HIV infection, and clinical aspects of the disease. Self-reported signs of lipodystrophy and body measurements were used for lipodystrophy diagnosis. Results: We studied 74 patients (mean age 44.3±9.2 years; 60.8% men). Among the patients, 45.9% were smokers, 31.1% consumed alcoholic beverages, and 55.4% were sedentary. The prevalence of lipodystrophy was 32.4%, and sedentary subjects had a higher prevalence of lipodystrophy compared with physically active individuals. Conclusions: The prevalence of lipodystrophy was 32.4%. Physical activity was considered an independent protective factor against the onset of HIV-associated lipodystrophy. .