Authors: (including presenting author): :
Lee KM(1), Lee T(1)
Affiliation: :
(1) Physiotherapy department, Caritas Medical Centre
Keyword 1: :
Complete Decongestive Therapy
Keyword 3: :
A modified, lower-intensity CDT protocol
Introduction: :
Complete Decongestive Therapy (CDT), the gold-standard treatment for lymphoedema, requires long-term intensive care which presents a significant challenge in Hospital Authority (HA) settings. Traditional CDT integrates manual lymphatic drainage, compression therapy, exercise, and skin care with high treatment frequency in the first phase, which requires five sessions per week for four weeks. A modified, lower-intensity CDT protocol was therefore adopted to evaluate its clinical efficacy and feasibility, with the goal of optimizing patient outcomes and reducing clinical costs within HA.
Objectives: :
This study aimed to evaluate the clinical effects of a modified CDT protocol for oncological patients with secondary lymphoedema in an HA setting and to explore its practical application and long-term maintenance.
Methodology: :
A longitudinal case study by adopting the modified CDT protocol consisted of an intensive Phase 1, delivered twice weekly for six weeks, followed by a self-maintained Phase 2, which included structured follow-ups at one, three, and six months, supplemented with optional telehealth support. Data is collected at baseline, post-phase 1 intervention, 1-month and 6-month follow-ups. The participant, recruited from the Physiotherapy Outpatient Department, who had unilateral Stage 1 lymphoedema following cancer treatment, was selected with a demonstration of high adherence potential. Her primary complaint was significant edema causing stiffness, heaviness, and difficulty with ADLs. Outcome measures included limb volume, average limb water percentage, grip strength, and LYMQOL-arm questionnaire scores.
Result & Outcome: :
The participant was a 76-year-old woman with left upper limb lymphoedema post-left mastectomy and axillary node dissection performed in 2024. Following the modified CDT intervention, she showed a 17% reduction in limb volume, maintained at 6 months follow-up. The average limb water content decreased by 12.3%, and grip strength improved by 6%. The LYMQOL-arm questionnaire indicated a 33.3% improvement in overall QoL and a 23% improvement in function. The positive outcomes observed in this case study suggest that the modified, lower-intensity CDT protocol which was adopted to evaluate clinical efficacy and feasibility is viable and shows promise for managing secondary lymphoedema in high-compliance patients. By educating patients in effective self-management, this approach aims to reduce long-term dependency on clinical services and associated costs. Trends in limb volume reduction, extracellular fluid content, and improved patient-reported outcomes provide a preliminary evidence base that the protocol can optimize patient outcomes within a Hospital Authority (HA) setting. These findings will inform the design and parameters of a subsequent large-scale randomized controlled trial to establish its definitive efficacy.
