252 Lymphatic Filariasis Related Lymphedema; A Systematic Review of Self-Care Interventions for Secondary Lymphedemas Jan Douglass BHSc (Hons), Assoc Prof Sue Gordon PhD, Assoc Prof Patricia Graves PhD, Lynne Zeldenryk PhD School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville and Cairns, Australia
[email protected]
American Society of Tropical Medicine and Hygiene Annual Meeting, Washington DC, November 13-17. 2013
Aims
To evaluate the evidence for basic self-care practices to manage lymphedema after either infection with LF or treatment for cancer Ito identify successful self care practices which are transferrable across geographic and cultural borders Databases: Medline (OVID) & Scopus March 24, CINAHL, October 7 , 2013 Leg lymphoedema after LF infection
Search 1: ((lymphoedema or lymphedema or elephantiasis) and filariasis) Search 2 : ((lymphoedema or lymphedema or elephantiasis) and (cancer or oncology)) Search 3: 1 or 2
Search 4: (self-care or "self care" or basic-care or "basic care" or "community based home care" or "community-based home-care" or "self management" or self-management or selftreatment or "self-treatment" or self-massage or "self massage" or "partner massage" or home-care or "home care" or limb-care or "limb care" or foot-care or "foot care" or hygiene or breathing or exercise) Search 5: 3 and 4
Included
Search results
Individual records returned n=880 Excluded by title or abstract n=840 Records identified through other sources n = 11
Full text peer reviewed papers screened Included in this review Lymphedema after LF Lymphedema after cancer therapy
n = 51 n= 23 n= 14 n=9
Before and after assessment of clinical outcomes or subjective symptoms Excluded interventions where results for a placebo or control group using self -care only can be clearly identified (results on the self-care group are shown)
Results Key for Population & Methodological Quality Lymphoedema after LF High Moderate Low Quality Quality Quality
Education in Self Care Author, year,
Study Design,
location, duration Reviewer Rating
Breast Cancer related Lymphoedema High Moderate Low Quality Quality Quality
Mass drug administration studies Therapist performed or inpatient intervention Use of a commercial treatment device
Wilson, S. F., Guarner, J., Valme, A. L., Louis-Charles, J., Jones, T. L., & Addiss, D. G. (2004). Histopathologic improvement with lymphedema management, Leogane, Haiti. Emerging Infectious Diseases, 10(11), 1938-1946.
Author, year,
n=40 Grade I, II ADLA incidence Joseph et al 2004 n= 20 Grade III, IV RCT* Limb volume, India High Lymphoedema grade, =73% , FU=90% 24 months Wound serology. Compliance 49.85yrs (12.5/11.1SD) n=91 FU =9.6% Wilson et al 2004 Prospective Histopathological changes in Haiti Cohort epidermis, dermis and =80% 12 months Moderate subcutaneous adipose tissue 39yrs (16-75) Kerketta et al ADLA incidence RCT# n=100 FU=84% 2005, India Limb volume and circumference Moderate 14—65 years 12 months Lymphoedema grade n=40 FU=100% Hagrass et al Self reported symptoms Cohort 2012 Egypt Quality of Life (ULL-27) =100% Moderate 3 months Compliance 39.6yrs (±3.6 SD) n=375 FU=84.3% Budge et al 2013 Prospective ADLA incidence, India Cohort Lymphoedema stage, WHO =59% 24 months Moderate Disability Assessment Scale II 57.2yrs (±13.62 SD) n=39 FU=100% Shenoy et al # RCT 1998 India ADLA incidence =42.5% Low 12 months 40yrs (18-65) n=60 FU=95% Shenoy et al # RCT 1999 India ADLA incidence =58% Low 24 months 45yrs (18-66) n=127 Suma et al 2002, Retrospective ADLA incidence India Cohort Number of entry lesions =56.7% 12 months Low Lymphoedema grade Compliance 45yrs (18-67) n=15 FU=73.3% McPherson 2003 Prospective ADLA incidence Guyana Cohort Dermatology Life Quality Index =82% 12 months Low (DLQI) 47yrs (21-65) n=48 FU=100% Addiss et al 2010 ADLA incidence Cohort Haiti Leg volume =77.1% Low 12 months Compliance 39.2yrs (12-75) n=200 FU=98.5% Addiss et al 2011 ADLA incidence RCT Haiti Number of entry lesions =87% Low 12 months Lymphoedema grade Compliance 37yrs (11-77) ADLA incidence n=325 FU=30.8% Akogun & Badaki Quasi RCT^ Warts, folds, odours, entry lesions, 2011 Nigeria =67% Low size perception 12 months ≥40yrs=72% (≤19-≥50) Social relationships. Compliance n=1578 FU=69% Jullien et al 2011 Cohort ADLA incidence during the previous Burkina Faso =74.5% Low 1 month 4.5 months 46.6yrs (10-98)
Results
A
Limb volume increased during and after ADLA Self-care including use of either zinc-oxide or antibiotic ointment reduced incidence of ADLA Non adherence increased risk of ADLA Hyperkeratosis of epidermis, thick collagen bundles in dermis and chronic perivascular infiltrate reduced with self-care Self-care reduced limb circumference at 90 days p
