Most studies and clinics use volume to assess the efficacy of the treatment. Some studies have specifically looked at quality of life issues. Other useful measures are tissue quality, pain levels, limb movement and function, susceptibility to infection etc though these can be less easy to quantify. An Arm & a Leg has followed up a group of patients 6 months after treatment and found that the majority have continued to improve (in contrast to what was happening before they attended clinic) and none has relapsed to their pre clinic state. (see also below)
ResearchThere is quite a body of research (of varying quality) most coming from Continental Europe and the US.
Ko et al (Arch Surg Vol 133 Apr 1998 452-458) carried out a prospective study of 299 patients to define the immediate and long-term volumetric reduction following complete decongestive physiotherapy (aka decongestive lymphatic therapy) for lymphoedema. Lymphoedema reduction was measured following completion of treatment and at 6 and 12 month follow-up visits.
149 of patients in the sample had lymphoedema of the upper extremities and 150 of the lower. Phase 1 treatment (see Lymphoedema Treatment) was carried out daily for an average duration of 15.7 days. Lymphoedema reduction averaged 59.1% after upper extremity DLT and 67.7% after lower. With an average follow-up of 9 months, this improvement was maintained in compliant patients (86%) at 90% of the initial reduction. Non-compliant patients lost a third of their reduction. The incidence of infections decreased from 1.10 infections per patient per year to 0.65 infections per patient per year after a complete course of DLT. The Summary Conclusion: DLT is a highly effective treatment for both primary and secondary lymphoedema. The initial reductions in volume achieved are maintained in the majority of the treated patients. These patients typically report a significant recovery from their previous cosmetic and functional impairments and also from the psychosocial limitations they experienced from a physical stigma they felt was often trivialised by the medical and payer communities.
Boris et al (Oncology) Sept 1994 95-106 carried out Phase 1 intensive DLT on 38 patients (16 with arm lymphoedema, 18 with unilateral leg lymphoedema and 4 with bilateral leg disease) for 1 month. Reduction of oedema averaged 73% among patients with arm disease and 88% for those with leg lymphoedema. 30 patients were followed up for up to 1 year. During this period, their average reduction in lymphoedema of 80% improved to 86%. Boris et al concluded that DLT significantly and safely reduces lymphoedema. Reductions not only are maintained after the initial therapy but may increase in magnitude. They cite another German study which involved a 3 year follow up program which added weight to the conclusion of cumulative gains. Those findings indicate that the reductions of lymphoedema from DLT in compliant patients have long-term benefits – reductions not only persist but even improve slightly. This implies that collateral pathways are functioning and have remained opened after the initial course of DLT. DLT is a safe, rapid, non-invasive treatment for a disabling disease. The reduction in lymphoedema not only improves patients’ quality of life but also decreases the incidence of severe secondary infections. The economic savings are substantial. The marked reduction in medical expenses coupled with the patient’s ability to function better in society is a major benefit.