Self-Care for Management of Secondary Lymphedema: A Systematic Review.
Self-Care for Management of Secondary Lymphedema: A Systematic Review.
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DOI：
10.1371/journal.pntd.0004740
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发表时间：
2016-06
影响因子：
3.8
通讯作者：
Gordon S
中科院分区：
文献类型：
--
作者：
Douglass J;Graves P;Gordon S
淋巴水肿是一个衰弱和毁容后遗症不堪重负的淋巴系统。继发性水肿的最常见原因是淋巴丝虫病（LF），这是一种病媒传播的寄生虫病，在73个热带国家流行，在发达国家用于治疗癌症。淋巴水肿是无法治愈的，需要终身护理，因此确定有效的淋巴水肿管理对于改善生活质量、减轻家庭资源负担和造福当地社区至关重要。本综述旨在评估有效的水肿自我护理策略的证据，这些策略可能适用于所有类型的继发性水肿的管理。2015年3月在Medline、CINAHL和Scopus数据库中进行了检索。纳入了在测量水肿状态或急性感染频率之前和之后报告的研究。使用适当的关键评估技能计划检查表评估方法学质量。描述性综合和荟萃分析被用来评估报告的结果的有效性。纳入了28篇论文;发现两项RCT具有较强的方法学，总体而言，57%的研究被评为方法学薄弱。来自丝虫病相关性水肿（FR-LE）研究的证据表明，以苯妥英为中心的自我护理可将急性发作的频率和持续时间减少54%，而在癌症相关性水肿（CR-LE）中，包括深呼吸在内的家庭运动与单独的标准自我护理相比可显著减少体积。自我护理实践培训的强度和监测改善结果的频率。文化和经济因素以及获得保健服务的机会影响了所提供的干预措施的类型以及如何衡量结果。有证据表明，通过补救措施的管理FR-LE和更强调自我治疗的做法与CR-LE的人。增强水肿患者的能力，使他们能够通过获得支持性专业援助来照顾自己，能够优化自我管理做法，改善有限卫生资源的成果。继发性水肿是世界范围内残疾的主要原因。最常见的原因是癌症治疗或淋巴丝虫病感染。在这两种情况下，淋巴系统受损，无法执行其清除细胞外液和废物的正常功能。富含蛋白质的液体积聚在受影响的区域，如果不加以治疗，可能会进展为“象皮病”，其特征是肢体明显扩大和皮肤增厚。淋巴水肿是无法治愈的，需要终身护理和心理支持，但早期干预和良好的自我管理实践可以阻止进展，保持生活质量，并保持参与正常工作和社会活动的能力。目前的治疗方法因环境而异。在发达国家，癌症相关淋巴水肿是基于治疗师的，旨在早期干预和预防疾病进展。与淋巴丝虫病相关的水肿与贫困有关，影响生活在发展中国家的人们，在这些国家，建议对早期阶段进行最低限度的干预。通过确定可以跨越文化和经济边界转移的有用做法，可以使患有水肿的人有能力照顾自己并改善其长期结果。
Lymphedema is a debilitating and disfiguring sequela of an overwhelmed lymphatic system. The most common causes of secondary lymphedema are lymphatic filariasis (LF), a vector-borne, parasitic disease endemic in 73 tropical countries, and treatment for cancer in developed countries. Lymphedema is incurable and requires life-long care so identification of effective lymphedema management is imperative to improve quality of life, reduce the burden on family resources and benefit the local community. This review was conducted to evaluate the evidence for effective lymphedema self-care strategies that might be applicable to management of all types of secondary lymphedema. Searches were conducted in Medline, CINAHL and Scopus databases in March 2015. Included studies reported before and after measures of lymphedema status or frequency of acute infections. The methodological quality was assessed using the appropriate Critical Appraisal Skills Program checklist. Descriptive synthesis and meta-analysis were used to evaluate effectiveness of the outcomes reported. Twenty-eight papers were included; two RCTs were found to have strong methodology, and overall 57% of studies were rated as methodologically weak. Evidence from filariasis-related lymphedema (FR-LE) studies indicated that hygiene-centred self-care reduced the frequency and duration of acute episodes by 54%, and in cancer-related lymphedema (CR-LE) home-based exercise including deep breathing delivered significant volume reductions over standard self-care alone. Intensity of training in self-care practices and frequency of monitoring improved outcomes. Cultural and economic factors and access to health care services influenced the type of intervention delivered and how outcomes were measured. There is evidence to support the adoption of remedial exercises in the management of FR-LE and for a greater emphasis on self-treatment practices for people with CR-LE. Empowerment of people with lymphedema to care for themselves with access to supportive professional assistance has the capacity to optimise self-management practices and improve outcomes from limited health resources. Secondary lymphedema is a major cause of disability worldwide. The most common causes are treatment for cancer or infection with lymphatic filariasis. In both cases, the lymphatic system is damaged and unable to perform its normal function of removing extracellular fluid and wastes. Protein rich fluid accumulates in the affected area, and if left untreated may progress to ‘elephantiasis’, which is characterised by a grossly enlarged limb and thickening of the skin. Lymphedema is incurable, requires lifelong care, and psychosocial support, but early intervention and good self-management practices can halt progression, preserve quality of life and maintain the ability to participate in normal work and social activities. Current approaches to treatment vary depending on the setting. In developed countries, cancer related lymphoedema is therapist-based and aims to intervene early and prevent disease progression. Lymphatic filariasis related lymphedema is associated with poverty, affecting people living in developing countries where minimal intervention is recommended or available for early stages. By identifying useful practices that can be transferred across cultural and economic borders, people living with lymphedema can be empowered to care for themselves and improve their long term outcomes.