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. 2020 Dec 17;9(12):4077.
doi: 10.3390/jcm9124077.

Addition of Lymphatic Stimulating Self-Care Practices Reduces Acute Attacks among People Affected by Moderate and Severe Lower-Limb Lymphedema in Ethiopia, a Cluster Randomized Controlled Trial

Jan Douglass  1 , Fikre Hailekiros  2 , Sarah Martindale  1 , Hayley Mableson  1   3 , Fikre Seife  4 , Tesfahun Bishaw  4 , Mekdes Nigussie  4 , Kadu Meribo  4 , Mossie Tamiru  4 , Getnet Agidew  4 , Susan Kim  5 , Hannah Betts  1 , Mark Taylor  1 , Louise Kelly-Hope  1
Affiliations

Addition of Lymphatic Stimulating Self-Care Practices Reduces Acute Attacks among People Affected by Moderate and Severe Lower-Limb Lymphedema in Ethiopia, a Cluster Randomized Controlled Trial

Jan Douglass et al. J Clin Med. .

Abstract

Lymphedema causes disability and exacerbates poverty in many countries. The management of lymphatic filariasis (LF) and podoconiosis-related lymphedema involves daily hygiene to reduce secondary infections, but self-massage and deep-breathing, which have proven beneficial in cancer-related lymphedema, are not included. A cluster randomized trial in northern Ethiopia investigated the effects of lymphatic stimulation for people affected by moderate to severe lymphedema. Participants were allocated to either standard (control n = 59) or enhanced (intervention n = 67) self-care groups. Primary outcomes were lymphedema stage, mid-calf circumference, and tissue compressibility. Secondary outcomes were the frequency and duration of acute attacks. After 24 weeks, fewer patients were assessed as severe (control -37.8%, intervention -42.4%, p = 0.15) and there were clinically relevant changes in mid-calf tissue compressibility but not circumference. There was a significant between-group difference in patients who reported any acute attacks over the study period (control n = 22 (38%), intervention n = 7 (12%), p = 0.014). Daily lymphedema self-care resulted in meaningful benefits for all participants with a greater reduction in acute episodes among people performing lymphatic stimulation. Observations of a change in lymphedema status support earlier findings in Bangladesh and extend the demonstrated benefits of enhanced self-care to people affected by podoconiosis.

Keywords: breathing; exercise; filariasis; lower limb; lymphatic massage; lymphedema; podoconiosis; self-care; skin mobilisation.

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Conflict of interest statement

The authors declare no conflict of interest. The study sponsor and funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; and no input into publication of study outcomes.

Figures

Figure 1
Figure 1
Map of all included HP in Simada District by allocation group.
Figure 2
Figure 2
Flow of patients through the study.
Figure 3
Figure 3
Change in proportion of legs by group and stage.
Figure 4
Figure 4
Change in mid-calf circumference by group and stage.
Figure 5
Figure 5
Change in Indurometer scores by group and stage.
Figure 6
Figure 6
Frequency of acute attacks by group.
Figure 7
Figure 7
Frequency of acute attacks by stage.
Figure 8
Figure 8
Duration of acute attacks by stage.
Figure 9
Figure 9
Duration of acute attacks by group.
Figure 10
Figure 10
Number of lost working days by group.
Figure 11
Figure 11
Number of lost working days by stage.
See this image and copyright information in PMC

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