Authors: (including presenting author): :
Chang HY (1) Chak YT (1) Lau WY (1) Wu CY (1) Cheung PC (1) To WK (2)
Affiliation: :
(1)Physiotherapy Department, Pok Oi Hospital (2)Physiotherapy Department, Tuen Mun Hospital
Keyword 2: :
Physiotherapy
Keyword 3: :
Patient Empowerment
Keyword 4: :
Complete Decongestive Therapy
Introduction: :
Lymphedema is a lifelong condition characterized by abnormal lymphatic fluid accumulation, resulting in tissue swelling and functional impairment. Lymphedema management historically required frequent follow‑up appointments, creating challenges for the public healthcare system. Since late 2019, the Physiotherapy Department of Pok Oi Hospital has implemented a comprehensive structured lymphedema management program integrating Complete Decongestive Therapy (CDT) with strong emphasis on self‑management and patient empowerment. A pilot study in 2021 which analyzed data collected from 2019 to 2021 demonstrated promising outcomes, including a reduction in the average number of treatment sessions from 20 to 6.
Objectives: :
This study aims to evaluate the long‑term efficacy of the structured program in enhancing treatment adherence and sustaining clinical outcomes through continued self‑management in the community.
Methodology: :
Patients diagnosed with stage 1 or above lymphedema and with Lymphoedema Index (L‑Dex) score greater than 10 between 1 April 2021 and 31 March 2025 were enrolled. Exclusion criteria included active cancer, conditions that hindered outcome measurements (e.g., acute limb fractures), or contraindications to CDT. Participants were categorized into upper limb and lower limb groups based on the affected limb. The structured lymphedema management program introduced CDT to patients with adequate practice of self-compression bandage, manual lymphatic drainage and remedial exercise, as well as education on skin care and individualized CDT regime to enhance confidence in self-management. Primary outcome measures included L‑Dex score, total limb circumference, total limb volume, and the Numeric Global Rating of Change Scale (NGRCS). Pre‑ and post‑intervention outcomes were compared using paired t‑tests. In addition, the study monitored relapse by evaluating the rate of recurrent referrals among patients who had completed the structured program since 2019.
Result & Outcome: :
A total of 59 participants with mean age of 60.3 (SD=12.3) were included: 25 in the upper limb group and 34 in the lower limb group with the average numbers of physiotherapy sessions were 5.4 (SD=2.0) and 6.1 (SD=3.4), respectively. Both groups demonstrated significant improvements across all outcome measures. In the upper limb group, the mean NGRCS improved from 0 to 5 out of 10 (p< 0.001), with mean reductions of 17.7 in L‑Dex score (p=0.002), 4.2 cm in total limb circumference (p=0.009), and 260.6 ml in total limb volume (p=0.008). Similarly, the lower limb group showed significant improvements, with the mean NGRCS increased from 0 to 4.4 out of 10 (p< 0.001), and mean reductions of 10.8 in L‑Dex score (p< 0.001), 5.1 cm in total circumference (p=0.003), and 623.9 ml in total limb volume (p< 0.001). The recurrent referral rate among patients who completed the program was 9.3%.
