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Effect of an Enhanced Self-Care Protocol on Lymphedema Status among People affected by Moderate to Severe Lower-Limb Lymphedema in Bangladesh, a Cluster Randomized Controlled Trial

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Douglass, Janet, Mableson, Hayley, Martindale, Sarah, Tahmina Jhara, Sanya, Jahirul Karim, Mohammad, Mujibu, Muhammad, Al Kawsar, Abdullah, Khair, Abul, Mahmood, ASM Sultan, Rahman, AKM Fazlur, Chowdhury, Salim Mahmud, Kim, Susan, Betts, Hannah, Taylor, Mark ORCID: https://orcid.org/0000-0003-3396-9275 and Kelly-Hope, Louise ORCID: https://orcid.org/0000-0002-3330-7629 (2020) 'Effect of an Enhanced Self-Care Protocol on Lymphedema Status among People affected by Moderate to Severe Lower-Limb Lymphedema in Bangladesh, a Cluster Randomized Controlled Trial'. Journal of clinical medicine, Vol 9, Issue 8, p. 2444.

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Abstract

Background: Lymphatic filariasis (LF) is a major cause of lymphedema, affecting over 16 million people globally. A daily, hygiene-centered self-care protocol is recommended and effective in reducing acute attacks caused by secondary infections. It may also reverse lymphedema status in early stages, but less so as lymphedema advances. Lymphatic stimulating activities such as self-massage and deep-breathing have proven beneficial for cancer-related lymphedema, but have not been tested in LF-settings. Therefore, an enhanced self-care protocol was trialed among people affected by moderate to severe LF-related lymphedema in northern Bangladesh. Methods: Cluster randomization was used to allocate participants to either standard- or enhanced-self-care groups. Lymphedema status was determined by lymphedema stage, mid-calf circumference, and mid-calf tissue compressibility. Results: There were 71 patients in each group and at 24 weeks, both groups had experienced significant improvement in lymphedema status and reduction in acute attacks. There was a significant and clinically relevant between-group difference in mid-calf tissue compressibility with the biggest change observed on legs affected by severe lymphedema in the enhanced self-care group (∆ 21.5%, −0.68 (−0.91, −0.45), p < 0.001). Conclusion: This study offers the first evidence for including lymphatic stimulating activities in recommended self-care for people affected by moderate and severe LF-related lymphedema

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WB Practice of Medicine > Therapeutics > WB 327 Self care
WH Hemic and Lymphatic Systems > Lymphatic System > WH 700 Lymphatic system. Lymphatic diseases (General)
Faculty: Department: Biological Sciences > Department of Tropical Disease Biology
Digital Object Identifer (DOI): https://doi.org/10.3390/jcm9082444
Depositing User: Cathy Waldron
Date Deposited: 04 Aug 2020 13:55
Last Modified: 23 Sep 2020 09:11
URI: https://archive.lstmed.ac.uk/id/eprint/15193

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