Lymphoedema, a significant health problem in Israel: A descriptive community-based study

Abstract

Lymphoedema (LE) is recognised as a chronic disabling disease. Knowledge on patient characteristics, treatments, and outcomes in Israel is lacking. The aim of the study was to (a) describe demographic and health characteristics, treatments, utilisation, and functional outcomes of patients receiving physical therapy due to LE in a large nationwide healthcare provider in Israel; and (b) assess the feasibility of conducting a future practice-based evidence (PBE) study. This is a retrospective observational cohort study. Descriptive analyses of an electronic medical record database were performed. Data from 6013 patient episodes were analysed. A high proportion of patients had two or more comorbidities (80%) and chronic medication use (85%) with increasing rates over the 8-year period. The most frequent LE classification was stage 2 (45%). A majority of LE was in the lower limbs (51%) with increasing rates over the years. The most frequent treatment-related activity was measuring limb circumference and the most frequent intervention was educating for self-management. This study provides a first comprehensive description of patient characteristics receiving physical therapy for LE in Israel. The available database offers an opportunity for PBE studies. Recommendations for improvements in specific data collection processes were identified.

Keywords: classification; comorbidities; lymphoedema; physical therapy; treatment.

FIGURE 1

Discharged episodes over time (2010‐2017) (N = 6013). Note: differences in % are from the previous year increase over the years (P < .001)

FIGURE 2

Body parts treated for lymphoedema over the years (%) (N = 6013). Note: Over time, rates of lower extremity and combinations of body parts increased (P < .001, .02, respectively), upper extremity decreased (P < .001), and head and neck and central showed no change (P = .47, .77, respectively)

FIGURE 3

Different stages of lymphoedema within the upper limb of discharged episodes over the years (N = 1312*). Note: *Upper limb with classification of stage. Over time, stages 0, 2, and 3 had no change (P = .07, .7, .21, respectively), and stage 1 increased (P < .001)

FIGURE 4

Different staging of lymphoedema within the lower limb over the years of discharged episodes (N = 2009). Note: lower limb with a classification of stage. Stages 0 and 3 had no change (P = .45, .75, respectively), stage 1 decreased (P < .001), and stage 2 increased (P < .001)

FIGURE 5

Documentation of treatment‐related activities and interventions over time (%) (N = 6013). Note: MLD reduced over the years (P < .001), circumferential measurement decreased in the years 2010–2013 (P < .001) and did not change over the last 4 years (P = .86). Bandaging increased between the years 2010–2013 (P < .001) and did not change in the last 4 years (P = 0.37). Measurement for a garment, education for self‐management, and intermittent compression pump codes increased (P < .001)

FIGURE 6

Documentation of treatment codes over the years in the management of the lower limb (n = 3626). Note: Education for self‐management, measurement for a garment, bandaging, and intermittent compression pump codes increased (all, P < .01), MLD decreased (P < .001), and circumferential measurement no change over the years (P = .18)

FIGURE 7

Documentation of treatment‐related activities and interventions over the years in the management of the upper limb (n = 1873). Note: Measurement for a garment, bandaging, and intermittent compression pump codes increased (P < .001, .046, and .04, respectively). No change over the years 2010 to 1013 (P = 0.16) was observed for circumferential measurement code, with an average of 80%. In 2014, there was a decrease to 73%, which was stable (P = .55) until 2017. Education for self‐management and MLD did not change over the years (P = .08, .22, respectively)