DOI: 10.25881/BPNMSC.2019.16.82.014

Authors

Aphanova T.V.1, Sapelkin S.V.2, Kulchickaya D.B.1

1 National Medical Research Center for Rehabilitation and Balneology, Moscow

2 National Medical Research Center of Surgery named after. A.V. Vishnevsky, Moscow

Abstract

Based on the 10-year experience of using the Method of Complete Decongestive Therapy (CPT), we identified negative side effects of the CPT Method, significantly reducing the Quality of life of patients, as well patients’ compliance to treatment. The aim of the study was to study the effect of the CPT method on the Quality of life (QoL) scores of patients with lymphedema of the lower extremities of the I–III stages. The study included 60 patients with lymphedema of the lower extremities of the I–III stages, 51 of whom were women, the average age of the patients was 48.5±5.4 years. All patients were randomly divided into the following groups: group 1 (n = 30) received CPT, including sequentially: Manual Lymphatic Drainage, skin care, short-stretch elastic Bandaging of limbs and physical exercises; group 2 (n = 30) received basic therapy with oral flavonoid (combination of diosmin and hesperidin) 1000 mg per day for 3 weeks, as well as elastic compression using a standard elastic stocking of the 3rd compression class (comparison group). As a result of the treatment carried out in patients of the 1st group, along with a pronounced decongestive effect, a positive dynamics of QoL score on pain, physical and social scales (CIVIQ2). However, the application of the CPT Method in patients of group 1 was also accompanied by psychological discomfort, leading to a decrease in the QoL score on the psychological scale, caused by the “burden” of short-stretch elastic bandaging of limbs.

Keywords: lymphedema, lower limbs, manual lymphatic drainage, limb bandaging, quality of life.

References

1. Gerasimenko, M.Yu., Knyazeva, T.A., Aphanova, T.V., Kul’chickaya, D.B. Primenenie metoda kineziotejpirovaniya v nemedikamentoznoj kompleksnoj reabilitacii bol’nyh limfedemoj nizhnih konechnostej. // Voprosy kurortologii, fizioterapii LFK. 2015, № 5. Р. 22–27.

2. Lobastov, K.V., Barinov, V.E., Laberko, L.A., Kuznecov, N.A. Kompressionnyj bandazh: sovremennyj vzglyad. Rezul’taty izmereniya davleniya i zhestkosti in vivo. // Flebologiya. 2011, № 4, Р. 65–71.

3. Pokrovskij, A.V., Sapelkin, S.V. Proizvodnye polusinteticheskogo diosmina v lechenii bol’nyh s hronicheskoj venoznoj nedostatochnost’yu – rezul’taty prospektivnogo issledovaniya s primeneniem preparata Flebodia 600. // Angiologiya i sosudistaya hirurgiya. 2005, T. 11, № 4. Р. 73–79.

4. Stojko, Yu.M., Gudymovich, V.G. Monitoring kachestva zhizni u bol’nyh varikoznoj bolezn’yu ven nizhnih konechnostej s ispol’zovaniem preparata Venarus. // Hirurgiya. ZHurnal im. Pirogova N.I. 2010; 6: 46–51.

5. Fionik, O.V., Bubnova, N.A., Petrov, S.V., Erofeev, N.P., Ladozhskaya-Gapeenko, E.E., Semenov, A.Yu. Limfedema nizhnih konechnostej: algoritm diagnostiki i lecheniya. // Novosti hirurgii. 2009, T. 17, № 4; S. 49–64.

6. Diagnosis and Treatment of Secondary Lymphedema, Technology Assessment Report. McMaster University Evidence-based Practice Center. Prepared for Agency For Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services. May 28, 2010; 148 p.

7. Földi, M., Földi, E., Kubik, S. Textbook of Lymphology. Urban &Fischer; 2003.

8. Földi, M., Strossenreuther, R. Foundations of Manual Lymph Drainage, 3rd Edition, Elsevier, 2004; 110 p.

9. Hirai, M., Niimi, K., Iwata, H., Sugimoto, I., Ishibashi, H., Ota, T., Nakamura, H.A. Сomparison of interface pressure and stiffness between elastic stockings and bandages.// Phlebology, 2009, Vol. 24, № 3; P. 120–124.

10. Launois, R., Reboul-Marty, J., Henry, B. Construction and validation of a quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ). // Quality of life research. 1996; 5(6): 539-554.

11. Lee, B.B., Nicolaides, A.N., Myers, K., Meissner, M. et al. Venous hemodynamic changes in lower limb venous disease: the UIP consensus according to scientific evidence. // International Angiology. 2016 Jun; 35(3): 236-352.

12. Lee, B.B., Rockson, S.G., Bergan, J. Lymphedema. A Concise Compendium of Theory and Practice. // Springer International Publishing, Edition 2, 2018; 972 p.

13. Mosti, G., Cavezzi, A., Partsch, H. et al. Adjustable Velcro compression devices are more effective than inelastic bandages in reducing venous edema in the initial treatment phase: a randomized controlled trial. // Eur J Vasc Endovasc Surg. 2015; 50: 368-74.

14. Mosti, G., Partsch, H. Self-management by firm, non-elastic adjustable compression wrap device. // J Vasc Surg: Veins and Lymphatics. 2017; Vol. 6: 7003, P. 88–90.

15. Navrátilová, Z. at al. Efficacy of a 6-month treatment with Daflon 500 mg in patients with venous edema. // Phlebolymphology, 2010; 17 (3): 137.

16. Partsch, H., Clark, M., Mosti, G. at al. Classification of compression bandages: practical aspects. Dermatol Surg, 2008; 34; P. 600–609.

17. Rabe, E., Partsch, H., Hafner, J., Lattimer, C. et al. Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement. // Phlebology, 2018 Apr; 33(3): 163–184.

18. Robert, J. Damsrta. Diagnostic and therapeutical aspects of lymphedema. //Rabe Medical Publishing, Bonn, Germany. – 2010. 277 p.

19. The Diagnosis and Treatment of Peripheral Lymphedema: 2016 Consensus Document of the International Society of Lymphology. // Lymphology, 2016 (49): P. 170–184.

For citation

Aphanova T.V., Sapelkin S.V., Kulchickaya D.B. Influence of the method of complete decongestive therapy (method of M. Foldi) on the indicators of the quality of life in patients with lymphedomal lower limbs. Bulletin of Pirogov National Medical & Surgical Center. 2019;1(14):68-71. (In Russ.) https://doi.org/10.25881/BPNMSC.2019.16.82.014