Liao, S.F., Li, S.H., & Huang, H.Y. (2012). The efficacy of complex decongestive physiotherapy (CDP) and predictive factors of response to CDP in lower limb lymphedema (LLL) after pelvic cancer treatment. Gynecologic Oncology, 125(3), 712–715.

DOI Link

Study Purpose

To evaluate the efficacy of an intensive complete decongestive physical (CDP) therapy program and identify predictive factors of response in lower-limb lymphedema

Intervention Characteristics/Basic Study Process

Women with unilateral LLL underwent a CDP program of 10–24 sessions that included 45 minutes of manual lymph drainage, compression therapy for 23 hours a day, and remedial exercise and instructions for skin and nail care.

Sample Characteristics

  • The sample was comprised of 44 female patients.
  • Mean age of the sample was 62.2 years with a range of 38–83 years.
  • All patients had cervical, endometrial, or ovarian cancers. 
  • Lymphedema onset was an average of 64 months after treatment.
  • Average excess volume in the affected limb was 1,764 ml with a range of 296 ml–4,112. 
  • Forty-one percent of patients had radiotherapy.

Setting

The study was conducted at a single-site with multiple settings in Taiwan.

Phase of Care and Clinical Applications

The study looked at mutliple phases of care.

Study Design

The study used a retrospective review design.

Measurement Instruments/Methods

Circumference measurements were used to calculate lymphedema volume.

Results

  • Post CDP lymphedema volume decreased an average of 755 ml and percentage of excess volume (PEV) comparison to the unaffected limb 18.8% (p < 0.001).
  • PEV was found to be the only factor correlated with response to CDP (r = 0.57, p < 0.001).

Conclusions

Findings suggest that CDP is beneficial for management of lower-limb lymphedema. The lymphedema volume difference in the affected limb was directly correlated with response to CDP.

Limitations

  • The sample size was small with fewer than 100 patients.
  • The study had no control group, binding, or randomized assignment. 
  • No information was included regarding patient compliance with all aspects of the CDP program. 
  • A retrospective design was used.

Nursing Implications

Findings suggest that CDP is beneficial for management of lower-limb lymphedema in patients treated for pelvic cancers. This is one of few studies for lower-limb lymphedema management. Nurses can educate and support patients in adhering to a CDP program to manage lymphedema. The authors noted that compliance with compression bandaging is a critical component of CDP, and nurses need to emphasize this with patients.