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TURKISH VERSION, VALIDITY AND RELIABILITY OF THE PATIENT BENEFIT INDEX-LYMPHEDEMA
ELIF DUYGU, PT, MSC.1, YESIM BAKAR, PT, PhD, Prof.1 İLKE KESER, PT, PhD, Assoc. Prof.2
1 Abant Izzet Baysal University School of Physical Therapy and Rehabilitation, Bolu, Turkey
2 Gazi University, Faculty for Health Science, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
Introduction: Benefit of lymphedema treatments are very important in clinical settings especially from patients’ perspective. Objective: To investigate the Turkish adaptation, validity and reliability of Patient Benefit Index–Lymphedema (PBI-L) ensuring
direct assessment of the benefit in patients with lymphedema, lipedema and lipolymphedema.
Materials and Methods: Eighty-one patients whose mean age was 47.66±14.23 years, diagnoses were lymphedema, lipedema and lipolymphedema, and who were treated or planned to be treated for these diagnoses were included in the study. PBI-L was adapted to Turkish by considering the stages of the cultural adaptation process and PBI-L was applied to the patients and repeated after one-week interval for the test retest reliability. Short Form (SF-36) was applied for the validity of PBI-L. The test retest validity was analyzed by Intraclass Correlation Coefficient (ICC) and internal consistency was estimated by Cronbach’s alpha, and the consistency of the data to factor analysis was evaluated by Kaiser-Meyer-Olkin (KMO) test.
Results: It was determined that ICC value was 0.73 (p<0.0001) and Cronbach alpha value ranged between 0.80-0.89. Considering the sub dimensions of PBI-L and SF-36 was used for validity. Low correlation was found between PBI-L total score, mental health, physical function sub dimensions of SF-36 (r=0.2, p<0.05). Result of KMO statistics was 0.6 and it was found that the questionnaire was not consistent for factor analysis.
Conclusions: The Turkish version of PBI-L is valid and reliable in patients with lymphedema, lipedema and lipolymphedema. However, reassessment of PBI-L validity may be suggested by using a disease specific quality of life questionnaire.
Keywords: Patient Reported Outcome, Lymphedema, Lipedema, Turkish adaptation, Treatment Benefit.
POSSIBILITIES OF COMBINED APPLICATION OF GRAVITATIONAL THERAPY AND SURGICAL TREATMENT FOR PATIENTS WITH LYMPHEDEMA OF LOWER LIMBS
MYSHENTSEV P., KATORKIN S.
Samara State Medical University, Samara, Russia
Relevance: In Accordance with WHO various disorders of peripheral lymphatic drainage have 10% of the world's population and the number of newly diagnosed patients increases. Despite some achievements of the last years, many aspects of diagnosis and treatment of patients with lymph edemas of limbs are far from the final solution.
Purpose: Optimization of the results of patient’s surgical treatment with lymphedema of lower limbs.
Materials and Methods: There was made an observation of 24 patients (19-64 years old) with lymphedema of lower limbs, who received surgical treatment during complex of antioedematous therapy. Stage I, II and III of disease had 3, 17 and 4 patients respectively. During pre-surgery period they had intermittent pneumatic compression, magnetotherapy, gravitational therapy (Russian patient No 2441635, 10/02/2012). Lymphoveinous shunting operations were performed for: 5 patients with primary lymphedema and with signs of hypoplastic proximal lymphatic vessels; 19 patients with secondary lymphedema of mainly post-traumatic nature. Gravitational therapy course (5-7 sessions; 8-10 minutes on each) was given again beginning with the 5th day of post-operational period.
Results: Complex treatment led to disappearance or reduction of heaviness and bloating in the affected limbs of all patients; the decrease of limb perimeter for 12-15% in 13 patients of I and II stages. Ultrasonic scanning of soft tissues limbs showed: changes of structure (disappearance or reduction of hypoechoic formations in the subcutaneous layer; no considerable changes of III stage patients (reduction of limb perimeters for 5%). Based on results of lymphotropic sample and lymphoscintigraphy there was improvement of lymphatic drainage resorption for 20-22% in 9 patients with I and II stages of the disease.
Conclusion: Thus, the efficiency of gravitational therapy for complex treatment of patients with lymphedema of lower limbs (in case of similar indications to lymphoveinous shunting) mainly depends on the stage of the disease. Provided that I and II stages of lymphedema (characterized by preservation of the structure of lymphatic vessels and soft tissues, and also by functionality of lymphangions), the stimulating effect on the lymph circulation is higher. With the increase of diffuse fibromatous reconstruction of soft tissues limb and with the decrease of perimeter of functioning lymph vessels to III stage of disease, the stimulation of lymphatic drainage with gravitational therapy is less effective.
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THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXIX - Nr. 76 - 2017