Quéré, I., Presles, E., Coupé, M., Vignes, S., Vaillant, L., Eveno, D., . . . POLIT Study investigators. (2014). Prospective multicentre observational study of lymphedema therapy: POLIT study. Journal des Maladies Vasculaires, 39, 256–263. 

DOI Link

Study Purpose

To observe volume variation in patients receiving unilateral lymphedema treatment based on Decongestive Lymphedema Therapy (DLT) during the intensive phase and six months later with secondary purposes of assessing the frequency of \"heaviness\" limiting limb function, noting volume variation between the end of intensive DLT and follow-up, identifying predictors for volume reduction at the end of the intensive phase, and recording DLT adverse outcomes

Intervention Characteristics/Basic Study Process

All patients received DLT divided into two phases. The intensive treatment phase was administered over a one to three-week time period (daily treatment for at least five consecutive days), and the maintenance phase mainly was carried out by the patient and his or her family members at home. Limb volume was measured on days 5, 12, 19, and 195.

Sample Characteristics

  • N = 219  
  • MEAN AGE = 59.9 years (SD = 14.3 years)
  • MALES: 10.1% (most were lower-extremity participants), FEMALES: 89.9% (most were following breast cancer treatment)
  • KEY DISEASE CHARACTERISTICS: Patients with upper or lower extremity unilateral lymphedema
  • OTHER KEY SAMPLE CHARACTERISTICS: Lymphedema was the primary reason for clinical treatment.

Setting

  • SITE: Multi-site    
  • SETTING TYPE: Outpatient    
  • LOCATION: France

Phase of Care and Clinical Applications

  • PHASE OF CARE: Late effects and survivorship
  • APPLICATIONS: Elder care 

Study Design

Observational, prospective, longitudinal cohort study

Measurement Instruments/Methods

  • Demographic data
  • Lymphedema volume was measured using the truncated cone formula.
  • Excess limb volume was calculated using the formula (LLV – HLV)/HLV x 100.

Results

Initial intensive lymphedema treatment resulted in a 31% volume reduction, but the benefits were somewhat abolished when volume increased by 16.5% during the six-month maintenance phase. The only independent variable predictive of volume reduction after intensive therapy was the presence of previous intensive DLT. The most frequent adverse events were skin redness (18.4% of patients) and compression marks (42.3% of patients). Blisters requiring that treatment be stopped were uncommon (1.4% of patients).

Conclusions

There is a need for large, randomized trials to identify which components or combinations of components are most effective. There is a need to identify techniques to improve patient outcomes during the maintenance phase in trials for the long-term control of lymphedema.

Limitations

  • Risk of bias (no control group)
  • Risk of bias (sample characteristics)
  • Findings not generalizable
  • Subject withdrawals ≥ 10%

Nursing Implications

Nurses should be aware of this intervention as a potential treatment for patients with lymphedema, making this an important point of education. The early identification of lymphedema using \"heaviness\" as a descriptor may help refer patients for treatment sooner. The fact that results may diminish after intensive treatment should be considered, and this could point to the importance of adhering to strict maintenance schedules and encouraging physical activity for long-term benefits.