Ann Rehabil Med.  2020 Jun;44(3):238-245. 10.5535/arm.19102.

Bioimpedance Analysis for Predicting Outcomes of Complex Decongestive Therapy for Gynecological Cancer Related Lymphedema: A Feasibility Study

• Bae SH
• Kim WJ
• Seo YJ
• Kim J
• Jeon JY

• KMID: 2504444
• DOI: http://doi.org/10.5535/arm.19102

Abstract

Objective
To determine whether the bioimpedance analysis (BIA) ratios of upper to lower extremities could predict treatment outcomes after complex decongestive therapy (CDT) for gynecological cancer related lymphedema (GCRL).
Methods
A retrospective study, from March 2015 to December 2018, was conducted. The study sample comprised patients receiving CDT, 30 minutes per day, for 10 days. Bioimpedance was measured pre- and post-CDT. Circumference measurements were obtained at 20 and 10 cm above the knee (AK) and 10 cm below the knee (BK). We calculated the expected impedance at 0 Hz (R0) of extremities and upper/lower extremity R0 ratios (R0_U/L). We evaluated the relationship between R0_U/L and changes in R0_U/L and circumferences, pre- and post-CDT.
Results
Overall, 59 patients were included in this study. Thirty-one lower extremities in 26 patients comprised the acute group, and 38 lower extremities in 33 patients comprised the chronic group. Pre-treatment R0_U/L was significantly correlated with R0_U/L change after adjusting for age and BMI (acute: R=0.513, p<0.01; chronic: R=0.423, p<0.01). In the acute group, pre-treatment R0_U/L showed a tendency to be correlated with circumference change (AK 20 cm: R=0.427, p=0.02; AK 10 cm: R=0.399, p=0.03).
Conclusion
Our study results suggested that pre-treatment BIA could predict volume reductions after CDT in the early stages of GCRL. These findings implied that BIA value could be one possible parameter to apply in treatment outcomes prediction, during the early stage of GCRL. Therefore, further large-scale prospective studies will be beneficial.

Keyword

Lymphedema; Lower extremity; Gynecological cancer; Bioelectric impedance; Rehabilitation outcome

Figure

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  Fig. 1. Correlation of pre-treatment R0U/L and changes of lower extremity circumferences in the acute group (A, B, and C) and in the chronic group (D). R0U/L, upper/lower extremity impedance ratio at 0 Hz; pre-treatment R0U/L, R0U/L before complex decongestive therapy; ΔR0U/L, R0U/L change pre- and post-treatment; ΔCircumference, circumference change pre- and post-treatment; AK, Above knee; Pre, circumference before complex decongestive therapy; R, correlation coefficient in Spearman correlation analysis. *p<0.05, statistically significant in Spearman correlation analysis.

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