Global Preventive and Management Strategies and Their Effectiveness in Patients With Secondary Lymphedema: A Scoping Review

Abstract

Secondary lymphedema arises from lymphatic damage, often due to infections, inflammatory conditions, cancer treatments, or trauma, leading to fluid retention, swelling, and mobility issues that impact the quality of life. This scoping review examined global preventive and management strategies for secondary lymphedema, assessing their effectiveness and feasibility, particularly in low-resource settings. Additionally, it explored causative agents and knowledge gaps among patients and healthcare workers in endemic communities. This review followed the Joanna Briggs Institute (JBI) methodology and reported findings using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. The search strategy targeted four databases, including PubMed, Embase, Web of Science, and African Index Medicus. The inclusion criteria included all studies that focused on lower or upper limb secondary lymphedema, and reported on either preventive or management interventions or strategies globally, and were published between 2014 and 2024 in English. Data extraction involved two reviewers, with discrepancies resolved through discussion. A descriptive and narrative synthesis was performed to highlight preventive and management strategies and their effectiveness. A total of 3192 published articles were retrieved from searches of the selected databases, that is, PubMed (n=1467), Embase conference (n=386), Embase articles (n=550), Web of Science (n=713), and Africa Index Medicus (n=76). After the elimination of duplicate and ineligible articles, 45 articles were included in the final qualitative synthesis. Microsurgical techniques are more effective than conservative treatments. Self-care and hygiene-based strategies were more widely used for filarial lymphedema and podoconiosis in endemic areas, whereas the Mass Drug Administration (MDA) and Morbidity Management and Disability Prevention (MMDP) programs had limited success in halting disease progression. Adjunct therapies, including low-level laser therapy, cryotherapy, and kinesio taping, have shown potential in enhancing limb function and quality of life. The primary causes of secondary lymphedema vary geographically, with lymphatic filariasis dominant in tropical regions, podoconiosis in volcanic highlands, and cancer-related lymphedema in high-income areas. Knowledge gaps and misconceptions among patients, healthcare workers, and communities hinder effective disease management, with stigma and misinformation remaining key barriers despite educational efforts. While microsurgical interventions offer quick, effective clinical outcomes, hygiene-based interventions and self-care practices are the most scalable strategies for the treatment and management of filarial and podoconiosis-related lymphedema in low-resource settings.

Keywords: filariasis; kamwenge; lymphedema; neglected tropical diseases; podoconiosis; uganda.

Figure 1. PRISMA flow diagram of article selection

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses