Page 53 - VOL 26 N. 72 - 2015

June 4, 2015 - Auditoire A. Tissot
WORKSHOP 2 (English)
HOW TO MEASURE LYMPHOEDEMA TREATMENT OUTCOME?
VOLUME ASSESSMENT
WAGNER S.
Switzerland
MEASURING TREATMENT OUTCOME AND FOLLOW-UP. HOW WE DO IT!
HÅKAN BRORSON 1, MD, PhD, KARIN OHLIN OT 2, BARBRO SVENSSON, PT, LT 2
1 Associate Professor (Lund University), Professor (EGAMA, Buenos Aires), Senior Consultant Plastic Surgeon Email: hakan.brorson@med.lu.se
2 Lymphedema Center, Department of Clinical Sciences, Lund University, Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
Introduction: Outcomes of lymphedema treatment very seldom present results as excess volume or excess volume reduction. Instead circumference measurements, taken at random sites along the extremity, are used making it very difficult to estimate the true outcome as well as to compare various studies. Also continuous follow-up of treatment outcome is important.
Material and Methods: Volume measurement, either using plethysmography or based on circumference measurements, is an easy and quick method to objectively assess treatment outcome and to increase the scientific impact when presenting results.
The most reliable way to measure the volume of an extremity is plethysmography according to Archimedes’ principle, i.e., the limb is immersed in a volume meter and the drained water is weighed. The weight in grams equals the volume in milliliter and also includes the hand and foot volume. For both the arm and leg volume meter it is important that the draining pipe is be placed high enough so that the entire limb can be measured. The diameter of the draining hose should be large so that the water can flow quickly. It is important that the limb is immersed into the volume meter at exactly the same depth each time.
Another method is circumference measurements on well-defined distances along the limb. The volume is calculated by the use of different formulas. Circumference measurements also provide information of the localization of the swelling. Hand and foot volumes cannot be calculated.
In order to follow the outcome of treatment Excel sheets have been constructed for easy use and data are directly linked to figures showing outcome.
Conclusion: To only make single circumference measurements (for example the middle of the upper arm, elbow, middle of the forearm) is not adequate either for clinical use or scientific study. Both plethysmography and circumference measurements are useful and show satisfactory validity and reliability. Plethysmography is recommended if only one method is used. Volume measurement of both extremities must be performed at the same time in order to get a reliable measure of the excess volume, which is the most important factor when evaluating outcome after any treatment. Long-term follow-up is made easy by the use of Excel sheets linked to figures.
TISSUE DIELECTRIC MEASUREMENT
LAHTINEN T.
Finland
June 4, 2015 - Auditoire A. Yersin
WORKSHOP 2 (French)
COMMENT MESURER L’ÉFFICACITÉ DU TRAITEMENT PAR PHYSIOTHÉRAPIE?
50
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015
MESURES VOLUMÉTRIQUES. Comment évaluer les changements de volume avant et après traitement par physiothérapie
SCHUCHHARDT C.
Freiburg, Allemagne
Le développement des standards de qualité de thérapie et des directives basées sur l’évidence concernant la thérapie décongestionnante complexe du lymphoedème demande un principe volumétrique internationalement accepté. Des différentes manières d’objectivation du volume des extrémités sont utilisées: Circonférence en cm par décamètre à ruban, plétysmographie et le mesurage optométrique par rayons infrarouges (péromètre, legreader ou similaires). Les différents avantages ou sources de défauts seront discutés. Il faut se rendre compte, que toutes les différentes techniques de volumétrie ne permettent pas le dépistage précoce d’un lymphoedème, c‘est à dire la phase où une imbibition tissulaire ou une fibrose a commencé, mais pas encore une augmentation de volume.