Effects of Inpatient Rehabilitation in Leg Lymphedema: A Naturalistic Prospective Cohort Study With Intra-individual Control of Effects

Felix Angst; Thomas Benz; Susanne Lehmann; Peter S Sándor; Stephan Wagner

doi:10.1016/j.apmr.2023.06.001

Effects of Inpatient Rehabilitation in Leg Lymphedema: A Naturalistic Prospective Cohort Study With Intra-individual Control of Effects

Arch Phys Med Rehabil. 2023 Dec;104(12):2035-2042. doi: 10.1016/j.apmr.2023.06.001. Epub 2023 Jun 16.

Authors

Felix Angst¹, Thomas Benz², Susanne Lehmann³, Peter S Sándor³, Stephan Wagner⁴

Affiliations

¹ Research Department, Rehaklinik Bad Zurzach, ZURZACH Care Group, Bad Zurzach, Switzerland. Electronic address: fangst@vtxmail.ch.
² Research Department, Rehaklinik Bad Zurzach, ZURZACH Care Group, Bad Zurzach, Switzerland; ZHAW Zurich University of Applied Sciences, School of Health Sciences, Institute of Physiotherapy, Winterthur, Switzerland.
³ Research Department, Rehaklinik Bad Zurzach, ZURZACH Care Group, Bad Zurzach, Switzerland.
⁴ Department of Angiology, Rehaklinik Bad Zurzach, ZURZACH Care Group, Bad Zurzach, Switzerland.

PMID: 37329968
DOI: 10.1016/j.apmr.2023.06.001

Abstract

Objective: To quantify therapy-attributable effects of a comprehensive inpatient rehabilitation program for lower limb lymphedema (LLL) and to compare the levels of health-related quality of life (HRQL) to population-based norms.

Design: Naturalistic prospective cohort study with intra-individual control of effects.

Setting: Rehabilitation hospital.

Participants: Patients with LLL (N=67; 46 women).

Interventions: Comprehensive, multidisciplinary inpatient rehabilitation with 45-60 hours of therapy.

Main outcome measures: Short Form 36 (SF-36) for HRQL, lymphedema-specific Freiburg Quality of Life Assessment for lymphatic disorders, Short Version (FLQA-lk), knee-specific Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), and Symptom Checklist-90Standard (SCL-90S). Observed pre/post rehabilitation effects were individually corrected by subtracting the home waiting-time effects and expressed as standardized effect sizes (ESs) and standardized response means (SRMs). Score differences to norms were quantified by standardized mean differences (SMDs).

Results: Participants were on average aged 60.5 years, not yet obese, and had 3 comorbidities (n=67). The greatest improvement was in HRQL on the FLQA-lk with ES=0.767/SRM=0.718, followed by improvements in pain and function with ES/SRM=0.430-0.495 on the SF-36, FLQA-lk, and KOS-ADL (all P<.001). Vitality, mental health, emotional well-being, and interpersonal sensitivity improved most by ES/SRM=0.341-0.456 on all 4 measures (all P≤.003). Post rehabilitation scores were significantly higher than population norms on SF-36 bodily pain (SMD=1.140), vitality (SMD=0.886), mental health (SMD=0.815), and general health (SMD=0.444) (all P<.001), and comparable on the other scales.

Conclusions: Those affected by LLL stages II and III benefited substantially from the intervention, attaining equal or higher levels of HRQL than expected compared with the general population norms. Multidisciplinary, inpatient rehabilitation should be recommended for LLL management.

Keywords: Complex decongestive therapy; Effect; Health-related quality of life; Lymphedema; Rehabilitation; SF-36.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Female
Humans
Inpatients
Leg
Lymphedema*
Pain
Prospective Studies
Quality of Life*