Health-related quality of life and assessment in patients with lower limb lymphoedema: a systematic review
To determine the impact of lower limb lymphoedema (LLL) on health-related quality of life (HRQoL), and to identify the methodologies used to assess HRQoL and their adherence to the World Health Organization (WHO)-recommended HRQoL dimensions.
A systematic review was used following the PRISMA guidance. Studies were eligible if they assessed HRQoL in adult patients with LLL. The search was conducted between September 2019 and February 2020 using CINAHL, PubMed, Scopus, EMBASE and the Cochrane Library database. Data were placed onto a pre-developed data extraction table and analysed using a narrative synthesis. Evidence-based librarianship (EBL) was used for quality appraisal.
A total of 18 studies were identified, among which 10 were cross-sectional and eight were longitudinal studies. Twelve HRQoL questionnaires were identified and the Lymphoedema Quality of Life tool (LYMQoL) was the most commonly used. All of the studies except one had an EBL validity score of ≥75%. Although LLL causes a considerable impairment in HRQoL, the findings varied across the studies. All the studies considered at least four of the six WHO recommended dimensions, with none considering the spirituality dimension. Furthermore, physical functioning and wellbeing were discovered to be the worst affected HRQoL dimensions.
LLL adversely affects physical function, wellbeing and thus the HRQoL. The LYMQoL is the most commonly used questionnaire; despite this, all elements of the WHO recommendations were not captured in the included studies. However, accurate information on HRQoL indicating the impact of the disease on survivors’ lives and complete wellbeing is needed to inform evidence-based decision-making. Furthermore, having a universally accepted, disease-specific methodology will facilitate comparison and contrasting of HRQoL in patients with LLL.
Lymphoedema is a progressive swelling of a body part, usually an extremity, occasioned by congenital lymphatic abnormalities (primary forms) or acquired (secondary forms) lesions of the lymphatic system.1
Lymphoedema arises from the accumulation of protein-rich fluid in interstitial tissue spaces due to insensitivity or malfunction of the lymphatic system. This results in inflammation and cell damage. The most common symptoms of lymphoedema are pain, swelling, numbness, heaviness and impaired movement.2
Globally, about 250 million people are affected by lymphoedema.3 In Ireland, the prevalence of lymphoedema is estimated to be 2.63%,4 and this prevalence rate is on the rise with age, malignancies and other comorbid conditions as risk factors.5
Lower limb lymphoedema (LLL) is more common and complicated than lymphoedema of upper extremities. This is due to the effects of gravity and compression on the lymphatic system, especially when there is a pathological condition in the abdomen or pelvic cavity.1 Consequently, LLL impairs quality of life (QoL) of the patient through an increase in skin turgor, loss of dexterity, heaviness in the affected limbs, pain, discomfort, recurrent infections and psychological complications.
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