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Measurement Decisions for Clinical Assessment of Limb Volume Changes in Patients With Bilateral and Unilateral Limb Edema

HN Mayrovitz, PhD, is Professor of Physiology, College of Medical Sciences, Nova Southeastern University, 3200 S University Dr, Ft Lauderdale, FL 33328 (USA)
J Macdonald, MD, FACS, Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Coral Gables, Fla
S Davey, OTR/L, CLT-LANA, Healing Hands of Lymphatics, Hallandale Beach, Fla
K Olson, PT, DPT, CLT, Healing Hands of Lymphatics
E Washington, MS, College of Medical Sciences, Nova Southeastern University

Address all correspondence to Dr Mayrovitz at: mayrovit{at}nova.edu

Background and Purpose: Therapy-related changes in limb volumes often are estimated using summated segmental volumes based on adjacent circumference measurements. The purposes of this study were: (1) to determine the effect of different segment lengths on calculated volume reductions after complete decongestive therapy and (2) to determine the effect of excluding posttherapy control limb volumes on calculated reductions in edema volume in patients with unilateral limb lymphedema.

Subjects: This two-part retrospective study was conducted using data from patients with bilateral leg lymphedema (n=70) and data from patients with unilateral arm lymphedema (n=75) and patients with unilateral leg lymphedema (n=45).

Methods: For the bilateral leg lymphedema group, pretreatment to posttreatment changes in limb volume were determined using segment lengths of 4, 8, and 12 cm. For the unilateral lymphedema group, pretreatment to posttreatment changes in edema volume were determined and compared using or not using posttreatment control limb volumes.

Results: Bilateral leg volume changes were similar for all segment lengths but not significantly different from each other. Unilateral edema volume changes were significantly overestimated in both arms and legs when posttherapy control limb volumes were not used.

Discussion and Conclusion: The results indicate that segment lengths of 4 cm generally are not needed to obtain adequate estimates of leg volume changes. Both limb volumes should be measured to properly assess therapeutic outcomes in patients with unilateral limb lymphedema.