EFFICIENCY OF DECONGESTIVE PHYSIOTHERAPY METHODS IN PATIENTS WITH LYMPHEDEMA

Abstract

As we learned in school, the lymphatic system is a separate circulatory system that interfaces with the blood vessels to carry away fluid and waste proteins from the interstitial space or extracellular matrix (ECM). The lymph system plays a prominent role in immune function, as this fluid also carries lymphocytes, dendritic cells, and immunoglobulins to fight off pathogens or regulate the body during infection. In addition, lymphatics help with the absorption and transport of free fatty acids from the digestive system.

According to Ginger Nash (2018), what we didn’t learn in school was that the web of delicate lymphatic vessels that permeate almost every part of our body, including our brains, is intimately connected with the extracellular matrix in such a way that the nervous system uses it as “command control.” The astonishing number of proteins found in the extracellular matrix have a dynamic interplay with the entire circuitry of the nervous system in both developing children and adults [Barros CS, Franco SJ, Müller U. (2011)]. When the flow of lymph is impeded, edema ensues, creating a build-up of toxic wastes and potential for systemic dysregulation of the nerve synapses. Removal of excess proteins and wastes from the interstitial space is an absolutely essential function. We must therefore address the lymphatic system in order to ensure optimal health, including hormonal health in women. Our experiences show that the use of decongestive physotherapy has many positive effects in female patients with lymphedema.

The aim of this study is to determine the effectiveness of decongestive physiotherapy methods in patients with lymphedema

Methods of research: The research was conducted in PHI "Oasis" - office for physical therapy and medical massage - Delchevo. The study included 21 female patients in menopause with hormonal imbalance, aged 42 to 59 years (mean age 48.6 years), diagnosed with bilateral lower limb lymphedema. Out of the total number, 15 patients are with normal body weight and 6 of them are overweight. Patients are classified according to age, type (primary / secondary) and stage of lymphedema (zero, first, second or third stage).

Patients are divided into two groups: Control (n=11) and Experimental (n=9).

Patients in the Control group applied conservative treatment consisting of a complete decongestant physiotherapy of lymphedema, which includes the following procedures: Manual lymphatic drainage, Compression bandaging, Kinesitherapy, Skin care, Patient education. 

In patients from the Experimental group, in addition to the conservative treatment for decongestant physiotherapy of lymphedema, is applied Color Energy - Physiological Medi Tapping (CEPMT). It can be applied to everyone, from the acute to the final stage of rehabilitation. By applying the methods for complete decongestant physiotherapy and Color Energy - Physiological Medi taping, lymphatic transport is increased, new pathways of lymphatic drainage are created, collagen fibers are broken down and the activity of macrophages is increased.

Complex Decongestive Therapy (CDT) was implemented in all patients for 20 sessions in a four-week treatment period, 1 hour a day, 5 days a week. CDT included manual lymphatic drainage, intermittent pneumatic compression pump, multilayer compression bandaging, lymphedema exercises, and skin care.

Pre- and post-treatment BMI, and average and maximum circumference of the edematous extremities were analyzed. The edema's measurements were carried out four times in the treatment period. At the end median value was measured.

Results: A significant reduction in BMI, and average and maximum circumference of the edematous extremities in both groups was achieved between the pre-treatment and post-treatment values after 20 interventions.

In patients from the Control group with normal body weight, before the start of the treatment, the average value of BMI was 23.9, and after the end of the treatment, the BMI was -22.3 (achieved difference -1.6).

. In the 6 overweight patients from the Control group, before the start of the treatment the average value of BMI is 26.2, and after the end of the treatment BMI is - 25.3 (achieved difference -0.9).

In patients from the Experimental group, before the start of the treatment, the average value of BMI was 23.9, and after the end of the treatment, the BMI was -21.8 (achieved difference -2.1).

Both groups demonstrated similar efficacy in reducing limb volume and circumference, but Color Energy - physiological Medi Taping (CEPMT) showed greater efficacy in reducing the maximum circumference. The lowest effectiveness of the treatment is observed in the overweight subjects.

Discusion: Lower limb lymphedema is a chronic condition that impacts negatively on the individual. Limb volume measurements demonstrated a reduction in edema from the beginning of treatment until the end of the fourth week. No side effects from the treatment were recorded during CDT. The proper treatment of the CDT ensures safety and a great reduction in edema in patients with lower limb lymphedema. However, there were fluctuations in limb volume over the maintenance period of six months after treatment as the patients endeavoured to engage in self-care.

Conclusions: This study aimed to evaluate the effectiveness of Complex Decongestive Therapy (CDT) for treating lower extremity lymphedema. The results revealed that Complex decongestive therapy CDT was effective in reducing the volume and edema of affected limbs and improves quality of life (QoL). Compression bandaging and Color Energy - physiological Medi Taping (CEPMT) is a vital component of CDT. Maximum lymphedema reduction during therapy and maintaining its effect cannot be achieved without it. It also demonstrates its effectiveness as an independent method, which can reduce therapy cost and accessibility.

Obesity is a factor that deteriorates the CDT efficacy. Early treatment, before developing fat accumulation and fibrosis, must be primary goal in the treatment of lymphedema. However, given the fluctuations in edema post-treatment, individuals need greater support to maintain active engagement in effective self-care strategies.