Comparative analysis of the effects of complex decongestive physiotherapy on functional capacity, quality of life and patient expectations in patients with lower limb lymphedema and lipedema

In our prospective study, in which we aimed to analyze the functional capacities of individuals with lower limb lymphedema and lipedema Complex Decongestive Physiotherapy (KDF), the extent to which it affects their physical and psychosocial quality of life and the extent to which individuals objectively benefit from treatment, 26 individuals with lymphedema (15 unilateral, 11 bilateral) and 26 individuals diagnosed with pure lipedema with an average age of 56.7±14.6 years were included. Within the scope of the study, both treatment groups; considering the stage of the disease and the edema volume of the extremity, KDF consisting of manual lymph drainage, skin care, compression bandage and exercises was applied for an average of 3-6 weeks, 5 days/session per week, 45 min-1 hour. The criterion for discontinuing treatment was the maximum thinning decided by daily circumference measurements. In the evaluation of individuals, circumference measurements and Frustum method for the level of existing edema and extremity volume, Visual Analogue Scale (VAS) for pain intensity-feeling of fullness, Patient Benefit Index-Lymphedema (PBI-L) for treatment benefit and patient expectations, disease-specific quality of life. Lymphedema Quality of Life Questionnaire-Leg (LYMQOL-L) in evaluation of patients' functional levels, sedentary life levels and functional capacities respectively; Lower Extremity Functional Scale (AEFS), Sedentary Behavior Questionnaire (SDA), 6 Minute Walking Test (6 DYT) and Social Appearance Anxiety Scale were used for social appearance anxiety level. All measurements and scales were applied twice, before and after the treatment. It was observed that outcome measures improved in all evaluated parameters of individuals with lymphedema after KDF (p<0.05). In individuals with lipedema, positive improvement was observed (p<0.05) in all parameters except lower extremity functions (p>0.05). However, except for the widest point of the ankle and calf (p>0.05), there were differences between individuals with lymphedema and lipedema in the circumference measurements of all other reference points (metatarsophalangeal joint, middle of the dorsum of the foot, circumference of the head of the fibula, mid-knee, widest part of the thigh and ingiunal line), extremity volume differences, disease-specific quality of life and pre-treatment expectations of individuals and post-treatment benefits (p<0.05). The results of the study showed that in lower extremity lymphedema and lipedema, KDF reduces edema and pain-fullness, improves functional capacity, improves quality of life, meets expectations before treatment, and improves individuals' sedentary life level and perception of social appearance. In addition, unlike individuals with lymphedema, it was not effective in improving the functions of the lower extremities in individuals with lipedema. Positive findings in the results of all parameters evaluated in individuals with lymphedema once again proved that KDF is an optimal treatment option for lower extremity lymphedema. In the management of lipedema, the completely unsatisfactory results in lower extremity functions suggested that an encouraging self-management program, including participation in daily living activities and functional exercise, should be used in addition to KDF.