Persistence of Lymphedema Reduction Over 36 Months After Non-Invasive Complex Lymphedema Therapy
Marvin Boris, M.D., Stanley Weindorf, M.D., Bonnie B. Lasinski, B.S. P.T., M.A. Lymphedema Therapy, Woodbury, New York
All 119 consecutive patients with lymphedema who were treated with Complex Lymphedema Therapy (CLT) at the Lymphedema Therapy facility are included in this study. 56 patients had a single affected arm, 2 patients had both arms affected, 38 patients had one affected leg, and 23 patients had both legs affected. The reductions after the course of CLT were 62.6% in patients with one affected arm, and 68.6% in the group with one affected leg. In the group with bilateral affected lower limbs, there was a 3681 cm. decrease in the right lower extremity, and 3433 cc. decrease in the left lower extremities. The group with bilateral affected arms consisted of 2 members and was too small to statistically analyze.
CLT consists of lymphatic drainage, compression bandaging, skin care, and patient specific physical therapy exercises. The basic concept of CLT is to maximize central lymphatic drainage. This is accomplished by opening collateral vessels to channel peripheral lymph into normally functioning lymphotomes.
Analysis was made of the 36 month follow-up. The demographic characteristics of each group did not differ with regard to age, sex, type of lymphedema, grade and duration of lymphedema. In individuals with 1 affected arm, the reduction increased minimally to 63.8% at the end of 36 months, from 62.6% at the completion of CLT. In the group with 1 affected leg, the reduction was maintained close to the initial 68.6% reduction at 62.7%.
In the group with bilateral affected legs, the amount of reduction at the completion of CLT was considered for statistical analysis to be 100%. Over the 36 month period, the right leg was maintained at 99.59% and the left leg at 120% of the initial reduction. In our study, compliance was evaluated by the percent of time the patients wore a compression garment and their adherence to special physical therapy exercises. No additional courses of CLT were administered to the study group.
In the individuals with 1 affected arm, those who were 100% compliant, increased their reduction to 79%. The non-compliant individuals had their reduction reduced to 43% from the initial 62.6%. In the individuals with 1 affected leg, the 100% compliant group increased to 79%, while the non-compliant group decreased to 28% of the initial reduction. In summary, CLT affords excellent reduction of lymphedema. Over a 36 month follow-up period, without regard to compliance, the reduction obtained through CLT had not only been maintained, but increased in several groups. When the reductions are evaluated by compliance, patients who were compliant markedly increased the amount of reduction, while non-compliant patients lost the reduction from the initial course of CLT.
Marvin Boris, MD