Does digital Physiotherapy Demostrate Effectiveness in Both Short and Long term Management of Lower Extremity Lymphedema?

Abstract

Objectives: The objective of this study is to demonstrate the applicability of digital physiotherapy in treating unilateral and bilateral lower extremity lymphedema (LEL). The study aimed to examine the effect of digital physiotherapy on extremity volumes in patients with lower extremity lymphedema after a 4-week treatment and a 12-week follow-up.Background: Lower extremity lymphedema may arise as either a primary or secondary condition. Combined decongestive therapy is the gold standard treatment for lymphedema, known for its effectiveness in both short and long-terms. Digital physiotherapy for lymphedema patients is a modified form of combined decongestive therapy with the help of technology. Digital physiotherapy represents a modern approach that can promote treatment adherence and consistency.Methods: The study included patients with unilateral and bilateral lower extremity lymphedema who were admitted to the outpatient clinic. The circumferences of the extremities were measured from the first metatarsophalangeal joint to the proximal with 4-cm intervals for each. Circumference measurements were taken pre-treatment (V0), post-treatment (V1), and follow-up (V2). During the initial session, which was conducted face-to-face, patients received basic introduction to skin care and risk reduction training. A trained physiotherapist demonstrated the self-bandaging and self-manual lymphatic drainage techniques while the caregiver videotaped it. Patients learned gluteal sets, knee sets, toe flexion-extension and breathing exercises and received booklets with instructions. After the first session, treatment was provided remotely for 4-weeks using digital telecommunication technologies. After 4-weeks of treatment, self-bandaging was replaced by compression stocking and patients were followed for 12-weeks.Results: The study involved 82 (n=129 legs) patients with lower extremity lymphedema, with a mean age of 56.53±18.36 years (63 female/19 male, 47 bilateral/35 unilateral LEL, 37 primary/45 secondary LEL). The mean extremity volume of the patients in the pre-treatment evaluation was 5027.71±1826.05 mL. After 4-weeks of digital physiotherapy, mean extremity volume of the patients was 4682.31±1746.05 mL. Digital physiotherapy showed significant positive changes in lower extremity lymphedema patients (V0-V1=345.40±762.03 mL; p<0.001). The mean extremity volume at 12-week follow-up was 4310.52±1380.24 mL. In the long-term, digital physiotherapy continued to demonstrate significant positive effects in patients with lower extremity lymphedema (V1-V2=371.79±648.66 mL; p<0.001).Conclusions: Our study found that the application of combined decongestive therapy as a digital physiotherapy method was effective for extremity volume reduction in lower extremity lymphedema patients. This approach has demonstrated both short-term and long-term efficacy for patients with lower extremity lymphedema. Therefore, digital physiotherapy offers lower extremity lymphedema patients an alternative method to combined decongestive therapy. Keywords: lower extremity lymphedema, combined decongestive therapy, digital physiotherapy, self-management