Comparison of real-time ultrasound imaging for manual lymphatic drainage on breast cancer-related lymphedema in individuals with breast cancer: a preliminary study원문보기
Seo, Dongkwon
(Department of Physical Therapy, College of Medical Science, Konyang University)
,
Lee, Seungwon
(Department of Physical Therapy, College of Health Science and Social Welfare, Sahmyook University)
,
Choi, Wonjae
(Institute of SMART Rehabilitation, Sahmyook University)
Objective: Breast cancer-related lymphedema (BCRL) is a major sequela after surgery or radiotherarpy for breast cancer. Manual lymphatic drainage (MLD) is designed to reduce lymph swelling by facilitating lymphatic drainage. This study attempted to determine the histologic changes in the skin and su...
Objective: Breast cancer-related lymphedema (BCRL) is a major sequela after surgery or radiotherarpy for breast cancer. Manual lymphatic drainage (MLD) is designed to reduce lymph swelling by facilitating lymphatic drainage. This study attempted to determine the histologic changes in the skin and subcutaneous layer, and the immediate effect of MLD in decreasing lymphedema using ultrasound imaging, which is the method used most commonly to eliminate BCRL. Design: A single-group experimental study. Methods: Five subjects who were diagnosed with hemiparetic upper extremity lymphedema more than six months after breast cancer surgery participated in the study. MLD was performed for 60 minutes in the order of the thorax, breast, axilla, and upper arm of the affected side. In order to determine the effect of MLD, ultrasound imaging and limb volume were assessed. Two measurement tools were used for asessing lymphedema thickness among the pretest, posttest, and 30-minute follow-up period. Results: Significant diferences in ultrasound imaging and upper limb volume were found between the affected side and non-affected side (p<0.05). On the affected side, although ultrasound imaging showed a significant decrease after MLD (p<0.05), there were no significant difference in upper limb volume when compared to the baseline. Conclusions: In this study, a significant decrease in lymphedema by MLD was demonstrated by ultrasound imaging, which is considered to be more useful in assessing histological changes than limb volume measurements. Further research on the protocol for eliminating lymphedema will be needed.
Objective: Breast cancer-related lymphedema (BCRL) is a major sequela after surgery or radiotherarpy for breast cancer. Manual lymphatic drainage (MLD) is designed to reduce lymph swelling by facilitating lymphatic drainage. This study attempted to determine the histologic changes in the skin and subcutaneous layer, and the immediate effect of MLD in decreasing lymphedema using ultrasound imaging, which is the method used most commonly to eliminate BCRL. Design: A single-group experimental study. Methods: Five subjects who were diagnosed with hemiparetic upper extremity lymphedema more than six months after breast cancer surgery participated in the study. MLD was performed for 60 minutes in the order of the thorax, breast, axilla, and upper arm of the affected side. In order to determine the effect of MLD, ultrasound imaging and limb volume were assessed. Two measurement tools were used for asessing lymphedema thickness among the pretest, posttest, and 30-minute follow-up period. Results: Significant diferences in ultrasound imaging and upper limb volume were found between the affected side and non-affected side (p<0.05). On the affected side, although ultrasound imaging showed a significant decrease after MLD (p<0.05), there were no significant difference in upper limb volume when compared to the baseline. Conclusions: In this study, a significant decrease in lymphedema by MLD was demonstrated by ultrasound imaging, which is considered to be more useful in assessing histological changes than limb volume measurements. Further research on the protocol for eliminating lymphedema will be needed.
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문제 정의
A previous study that used ultrasound imaging only measured and compared the thickness of lymphedema in the non-affected side and affected side of the subjects but no study has proven the histologic changes between the skin and subcutaneous layer rwhen MLD is used to decrease lymphedema [11]. Therefore, the aim of this study was to determine the histologic changes in the skin and subcutaneous layer using ultrasound imaging as well as the immediate effect of MLD in decreasing lymphedema.
This study is a single-group experimental study design.This study recruited six women who underwent breast cancer surgery and were diagnosed with upper extremity lymphedema at Konyang University Hospital by the convenience sampling method.
제안 방법
Therefore, this study used ultrasound imaging to measure the lymphedema decrease in the skin and subcutaneous layer. In addition, in order to check the result after MLD on ultrasound images, the measurement was performed immediately after MLD, and was followed up for evaluation for any continued effect.
Use of the maximal compression method can allow for attainment of more accurate measurement values because ultrasound imaging is evenly distributed, and because ultrasound imaging is not affected by demographic and clinical data (age, body weight, and metastasis), and therefore making it possible to obtain objective measurements. In this study, the maximal compression method was used for objective and accurate evaluation. In a pilot test, use of the maximal compression method showed no pain or discomfort.
Use of a ruler is common for measurement of edema, and this method has been used in many previous studies. In this study, volume measurements were compared with ultrasound imaging.
Limb volume measurements were performed in the same position as the ultrasound imaging measurement, with the same measurement location; a ruler was used for repeated measurements, performed three times. Measurements were performed at pre-intervention, post-intervention, and follow-up periods.
5 MHz lineartransducer. Pre-intervention, post-intervention, and follow up periods were measured separately; in pre-intervention both the non-affected side and the affected side were measured and compared, and for post-intervention and follow up, only the affected side was measured in order to check the effect of MLD. Each measurement was repeated three times and the average was used.
The limitation of this study was designed by a single group experimental study and the small number of subjects,thereby limiting the ability to generalize the results. Cancer patients had less participation due to decreased social activities because of depression and mental disorders.
However, a recent study used ultrasound imaging to prove the therapeutic effects of lymphedema between skin and subcutaneous layer [11]. Therefore, this study used ultrasound imaging to measure the lymphedema decrease in the skin and subcutaneous layer. In addition, in order to check the result after MLD on ultrasound images, the measurement was performed immediately after MLD, and was followed up for evaluation for any continued effect.
On the forearm, it was placed 10 cm distal from the elbow crease along the line between the midline and lateral epicondyles and the midpoint of the radial and ulnar styloid processes. Ultrasound imaging used the maximal compression method, and this study used the sum of the skin and subcutaneous layer for lymphedema thickness (Figure 1) [18].
In this study, the effect of MLD on decreasing lymphedema in the skin and subcutaneous layer was proven by ultrasound imaging. With ultrasound imaging, this study demonstrated the possibility of using real-time ultrasound images to show objective data to patients. MLD should be used more actively to decrease lymphedema and to show thetreatment effect by real-time ultrasound imaging.
대상 데이터
The results from five subjects, excluding one without edema, were obtained. General characteristics such as age,height, weight, injury sites, and cancer stages are shown in Table 1.
이론/모형
In this study, lymphedema thickness was measured using the maximal compression method suggested by a previous study [18]. Use of the maximal compression method can allow for attainment of more accurate measurement values because ultrasound imaging is evenly distributed, and because ultrasound imaging is not affected by demographic and clinical data (age, body weight, and metastasis), and therefore making it possible to obtain objective measurements.
, Chicago, IL, USA).The Mann-Whitney U-test was used for comparison of lymphedema thickness between the non-affected and the affected sides. The repeated measures ANOVA was used forthe three repeated measurements of post-MLD effect in the affected side.
This study is a single-group experimental study design.This study recruited six women who underwent breast cancer surgery and were diagnosed with upper extremity lymphedema at Konyang University Hospital by the convenience sampling method. The inclusion criteria of this study was individuals with hemiparetic upper extremity lymphedema for more than six months after breast cancer surgery and with 10% greater volume of lymphedema in the affected side.
성능/효과
This study recruited six women who underwent breast cancer surgery and were diagnosed with upper extremity lymphedema at Konyang University Hospital by the convenience sampling method. The inclusion criteria of this study was individuals with hemiparetic upper extremity lymphedema for more than six months after breast cancer surgery and with 10% greater volume of lymphedema in the affected side.The exclusion criteria was individuals with peripheral nerve injury, drug intoxication, nephritic syndrome, those who use diuretics or other edema treatments.
The results of this study showed a significant decrease in ultrasound imaging measurement after MLD; however,limb volume measurement did not show a significant decrease. Application of MLD on individuals with lymphedema resulted in decreased edema in the skin and subcutaneous layer, and showed a continued effect.
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