Incorporating pelvic floor exercises in complete decongestive therapy for females with lower extremity lymphedema, with and without genital involvement, to improve volumetric and quality of life outcomes
DiCecco, Shelley Smith
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Millions of people are diagnosed with lymphedema, a treatable condition that may be considered disabling to those inflicted. The research available on lymphedema treatment, outcomes from the treatment, and overall the impact the condition has on individuals is significantly limited. There has been little advancement in the standard physical therapy treatment since the 1970s. There is a need for increased attention in the medical community on lymphedema; especially on how the edema is measured, how quality of life is affected, and on possible modifications to the current treatment. Water displacement is the gold standard for the quantitative documentation of volume of those with lymphedema. A study was completed comparing the gold standard to the truncated cone method and found an excellent relationship between the two methods for lower extremity edema. The study also found excellent intertester reliability with the truncated cone method. The Quality of Life Index (QLI), a quality of life (QOL) tool, was completed by 20 females with lower extremity lymphedema. The study showed that lymphedema does impact the overall QOL of females with lower extremity lymphedema as compared to the general population. No difference in the overall QLI scores was found when comparing those with to those without one of the symptoms of interest: pain, urinary incontinence, or sexual dysfunction. The small sample size did provide initial data related to QOL using the QLI. Overall, the study showed a need for the medical community to address QOL when treating lymphedema. A final study was completed to compare the current Casley-Smith complete decongestive treatment (CDT) method for lymphedema and a modified form of treatment incorporating the pelvic floor muscles. The focus was on volumetric reductions and improvement in quality of life (QOL) for females with lower extremity lymphedema, with and without genital involvement. Ten females participated. All participants showed a reduction in volume and improvement in QLI scores post treatment. The study also showed there was a significant difference in these changes when the control and experimental groups were compared. The modified CDT with the addition of pelvic floor muscle contractions had a greater impact on the volume and QOL changes. There needs to be additional research in the future with larger populations. This research should not only further investigate the addition of the pelvic floor muscles with CDT for the lower extremities of females; it should also consider different muscle groups that may improve lymphedema in other areas and should look at both genders. Those treating lymphedema should continue to search for additional understanding of the condition and for ways to improve the efficiency and efficacy of treatment.