Browsing by Author "Way, Liesl"
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- ItemThe effect of an evidence-based management plan on upper limb and trunk lymphoedema, function and quality of life in breast cancer survivors : a series of N=1 studies(Stellenbosch : Stellenbosch University, 2022-12) Way, Liesl; Williams, Leonie; Leibbrandt, Dominique; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.ENGLISH SUMMARY: Introduction: Breast cancer-related lymphoedema is a chronic, degenerative disease for which there is no cure, and which requires lifelong monitoring and management. Breast cancer-related upper limb and trunk lymphoedema is a complication arising from damage and trauma to the regional lymphatic system sustained during breast cancer treatment. While upper limb BC is well documented in the literature, little is known about the occurrence of, and the risk factors and interventions for, truncal lymphoedema following breast cancer treatment. Breast cancer-related lymphoedema is an independent predictor for reduced quality of life and has a negative socio-economic and psycho-social impact on breast cancer survivors. Objectives: The main aim of this study was to investigate the effect of an evidence-based multimodal management plan on upper limb and trunk lymphoedema, function and quality of life in breast cancer survivors with upper limb and trunk lymphoedema. Methodology: A non-concurrent series of N=1 experimental baseline (A1B1A2B2A3) design was utilised. Five participants who met the inclusion criteria, and gave informed consent, were included in the study. Baseline measurements were taken during the initial assessment to establish the presence and stage of lymphoedema, and these were repeated at the beginning and end of each phase of the study. Upper limb circumference was assessed using circumferential tape measurements which were converted to volume, in millilitres, using the truncated volume formula. The percentage tissue water content for the trunk was measured using the Moisture Meter D®. The function score was extracted from the function domain of the LYMQOL Quality of life was measured using the LYMQOL questionnaire. Two two-week intervention phases were administered, consisting of the following multimodal treatment techniques, namely: manual lymph drainage; compression therapy to the upper limb; skin care; exercise; deep breathing exercises; as well as adjunct low-level laser therapy and the application of Kinesio® tape to the trunk. Paired t-tests according to Satterthwaite’s method were used to perform all data analysis. A p-value of ≤0.05 was considered statistically significant. Clinical significance was determined using the prescribed minimal detectable change (MDC) values for each specific outcome measure. Results: The study participants (n=5) had a median age of 58 years (with a range of 47 to 64 years), a median body mass index (BMI) of 28.7kg/m2, and presented with stage 0 or 1 upper limb, and stage 2 trunk lymphoedema. The main finding of this study was a significant reduction in the volume of the affected upper limb for all participants between baseline and B2 (p=0.01, mean 188 and 95% CI [55.7,287.8]. This significant reduction (p=0.02, mean 243.4 and 95%CI [4.6,334.3] was maintained at the 10-week follow-up assessment (A3). A statistically significant reduction in the percentage tissue water content was found for the axilla region of the trunk from baseline to phase A3. A clinically non-meaningful reduction in the percentage of tissue water content was demonstrated for the chest area from baseline to A3; whereas the back region demonstrated a clinically meaningful increased percentage of tissue water content from baseline to A3. The results also showed a clinically meaningful improvement in function (0.82 points) for all participants, with a greater improvement for the youngest participant with the most recent diagnosis and medical management from phase B to A3. Finally, the participants all experienced a statistically significant improvement in overall quality of life (p=0.005). The significant improvement of quality of life was noted from phase B1 until the 10-week follow-up assessment phase (A3) for the study participants. Conclusion: The current study’s findings showed that an evidence-based multimodal management plan has a significant, positive effect on reducing the volume of the affected upper limb, as well as the percentage of tissue water content in the axilla region of the trunk. Furthermore, a clinically meaningful improvement in function, and a statistically significant improvement in the quality of life, of five breast cancer survivors presenting with upper limb and trunk lymphoedema, was noted. Further studies are recommended to investigate the long-term maintenance of effects of the multimodal management plan, as well as to determine the effectiveness of the individual components of the multimodal management. The design and validation of a quality-of-life questionnaire for the trunk region, and a screening tool for lymphoedema risk factor identification, would be of value for further research and clinical use.