ORCID Profile
0000-0002-8024-8641
Current Organisations
University of Sydney Faculty of Health Sciences
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University of Sydney
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Publisher: Elsevier BV
Date: 2006
Publisher: Mary Ann Liebert Inc
Date: 12-2013
Abstract: The aim of this study was to determine the impact of dominance and severity on tissue composition changes with lymphedema using dual-energy X-ray absorptiometry (DXA), and to determine the relationships between the DXA-determined tissue volumes and the clinical outcomes determined by perometry and bioimpedance spectroscopy. Fifty-six women with secondary lymphedema and 44 women without a history of breast cancer or lymphedema underwent measurement of their upper limbs with DXA, perometry, and bioimpedance spectroscopy. Whether the affected side was the dominant or nondominant arm influenced inter-limb tissue volumes differences (F=16.31 to 35.14 all p<0.001) and interacted with the severity of lymphedema (F=3.22 to 11.07 all p<0.05). In the control group, the dominant limb had more lean tissue but less fat than the nondominant limb. In the lymphedema group, increases in fat in the affected arm were not related to generalized increases in whole body adiposity when the dominant arm was affected. Perometry-measured volumes and BIS ratios were moderately to highly correlated with inter-limb fat, volume, and total tissue differences found by DXA (r=0.39 to 0.86). The direction and magnitude of limb composition changes in those with lymphedema are impacted by whether the affected side is the dominant or nondominant limb, as well as the severity of the condition. The stage of tissue composition change may impact on the diagnosis and monitoring as well as treatment of secondary lymphedema.
Publisher: Informa UK Limited
Date: 2006
DOI: 10.1080/09638280600638307
Abstract: Purpose. To determine the extent to which inter-limb coordination in the execution of unimanual and bimanual tasks was impaired following stroke.Methods. Thirteen stroke survivors aged 55 - 77 years and 13 healthy, neurologically intact participants aged 57 - 86 years performed a unimanual and two bimanual tasks involving the relocation of single and paired objects. Movements were recorded using electromagnetic sensors attached to the wrists and a series of micro switches placed under the objects. Main outcome measures included time to complete components of the tasks comparison between sides deviation of the hands from a linear trajectory coordination of the two sides as indicated by relative phase angle.Results. Stroke survivors took longer to complete the bimanual tasks, but did not deviate from the optimal trajectories more than the healthy participants. Both groups performed unimanual tasks faster than bimanual and stroke participants were only slightly less synchronised when performing bimanual tasks.Conclusions. In conclusion, in a group of stroke patients with reasonable strength, inter-limb coordination was mildly impaired. This impairment in coordination was not due to lateral deviation of the impaired limb.
Publisher: Journal of Athletic Training/NATA
Date: 03-2011
DOI: 10.4085/1062-6050-46.2.133
Abstract: The Hertel model of chronic ankle instability (CAI) is commonly used in research but may not be sufficiently comprehensive. Mechanical instability and functional instability are considered part of a continuum, and recurrent sprain occurs when both conditions are present. A modification of the Hertel model is proposed whereby these 3 components can exist independently or in combination. To examine the fit of data from people with CAI to 2 CAI models and to explore whether the different subgroups display impairments when compared with a control group. Cross-sectional study. Community-dwelling adults and adolescent dancers were recruited: 137 ankles with ankle sprain for objective 1 and 81 with CAI and 43 controls for objective 2. Two balance tasks and time to recover from an inversion perturbation were assessed to determine if the subgroups demonstrated impairments when compared with a control group (objective 2). For objective 1 (fit to the 2 models), outcomes were Cumberland Ankle Instability Tool score, anterior drawer test results, and number of sprains. For objective 2, outcomes were 2 balance tasks (number of foot lifts in 30 seconds, ability to balance on the ball of the foot) and time to recover from an inversion perturbation. The Cohen d was calculated to compare each subgroup with the control group. A total of 56.5% of ankles (n = 61) fit the Hertel model, whereas all ankles (n = 108) fit the proposed model. In the proposed model, 42.6% of ankles were classified as perceived instability, 30.5% as recurrent sprain and perceived instability, and 26.9% as among the remaining groups. All CAI subgroups performed more poorly on the balance and inversion-perturbation tasks than the control group. Subgroups with perceived instability had greater impairment in single-leg stance, whereas participants with recurrent sprain performed more poorly than the other subgroups when balancing on the ball of the foot. Only in iduals with hypomobility appeared unimpaired when recovering from an inversion perturbation. The new model of CAI is supported by the available data. Perceived instability alone and in combination characterized the majority of participants. Several impairments distinguished the sprain groups from the control group.
Publisher: Mary Ann Liebert Inc
Date: 06-2022
Publisher: BMJ
Date: 21-06-2011
DOI: 10.1136/BMJ.D3442
Publisher: Mary Ann Liebert Inc
Date: 06-2012
Abstract: Assessment of lymphedema is frequently based upon measuring the increase in volume of the affected region compared to that of a comparable unaffected region. This requires methods that can measure the volume of body regions that are not only accurate and sensitive but also suitable for use in clinical practice. To date, bioimpedance spectroscopy has been used to measure volume increase due to lymphedema in whole arms but excluding the hand. We report here an impedance-based method for the measurement of hand volume. Impedance measurement electrodes were located on the dorsum of the hand, with the sense electrodes at the level of ulnar styloid and metacarpal-phalangeal joint of the third finger and current drive electrodes on the forearm and at the nail bed of the third finger. The impedances of the hands of 50 participants were measured and hand volumes computed. These were compared with the hand volumes measured by perometry. The region of the hand defined by the impedance measurements was determined, both in vivo and using a hand phantom. The region of the hand measured by the impedance technique was limited to the palmar volume (i.e., excluding the thumb). Palmar volumes computed from impedance measurements were significantly correlated (r=0.88) with those measured by perometry but were, on average, 8% larger. The impedance technique was sufficiently sensitive to detect the change in hand volume elicited by decrease in vascular volume due to blood draining from the hand on elevation. An impedance technique was developed that has the potential to measure the change in hand volume when affected by lymphedema. Bioimpedance spectroscopy has the advantage over currently used perometric or water displacement techniques in that it can measure specifically the change in extracellular fluid, including lymph, rather than simply total hand volume.
Publisher: Elsevier BV
Date: 10-2012
Publisher: Springer Science and Business Media LLC
Date: 02-12-1997
Abstract: The present study assessed changes in perceived heaviness of weights lifted by the thumb, index, ring and little fingers during anaesthesia of the "lifting" digit. Subjects (n = 19) lifted weights solely by flexion of the distal joint of the digit, using a bilateral weight-matching paradigm. Changes in perceived heaviness during anaesthesia differed in both their sign and magnitude for the different digits. Anaesthesia of the thumb and index finger produced large increases in perceived heaviness (median, thumb: +41% index finger: +13%), whereas anaesthesia of the ring finger decreases perceived heaviness (-14%). Anaesthesia of the little finger also reduced perceived heaviness (median, -21% n = 6). Because perceived heaviness is biased by signals of motor commands, these findings suggest a net facilitatory reflex effect of the digital nerve inputs from the thumb and index fingers onto their respective flexor motoneurones with the corresponding effect for the ring and little fingers being inhibitory.
Publisher: BMJ
Date: 10-2006
Publisher: Springer Science and Business Media LLC
Date: 02-07-2014
DOI: 10.1007/S11764-014-0378-Y
Abstract: This study aimed to explore differences in physical activity and fitness between women with metastatic breast cancer compared to healthy controls and factors associated with their physical activity levels. Seventy-one women with metastatic breast cancer, aged (mean (SD)) 57.7 (9.5) and 2.9 (3.1) years after the onset of metastatic disease, and 71 healthy controls aged 55.0 (9.4) years participated. Of those with metastatic disease, 27% had bone-only metastases, 35% visceral-only metastases and 38% bone and visceral metastases. Patient-reported outcomes and physical measures of muscle strength and aerobic fitness assessments were obtained. Participants wore a SenseWear® physical activity monitor over 7 days, and the average steps/day and the time spent in moderate-to-vigorous intensity physical activity were determined. Women with metastases were significantly (i) less aerobically fit than the control group (25.3 (5.4) vs. 31.9 (6.1) mL • kg(-1) • min(-1) P < 0.001) (ii) weaker (e.g. lower limb strength for the metastatic and control groups was 53.5 (23.7) vs. 76.0 (27.4) kg, respectively P < 0.001) (iii) less active, with the metastatic group attaining only 56% of the mean daily step counts of the healthy women and (iv) more symptomatic, reporting higher levels of fatigue and dyspnoea (P < 0.001). Women living in the community with metastatic breast cancer possessed lower aerobic fitness, reduced muscular strength and less daily physical activity compared to healthy counterparts. They also experienced poorer functioning and higher symptom burden. Women living with metastatic breast cancer may benefit from a physical activity programme to address their physical impairments.
Publisher: Mary Ann Liebert Inc
Date: 26-09-2022
Publisher: Springer Science and Business Media LLC
Date: 03-09-1998
Abstract: To determine whether proprioceptive acuity is the same at all digits, particularly when postured as in a 'grasp', we imposed 10 degrees movements at the distal joint of the thumb, index and ring finger, at three velocities 1.25 degrees/s, 2.5 degrees/s and 5 degrees/s. The test joint was initially flexed by 25 degrees and the joints proximal to the test joint were maintained in a standard posture for each study. When in a grasp posture that disengaged the extensor muscles at the distal joint of the finger, movement detection at the thumb was superior to that at the fingers for all velocities. However, when the fingers were positioned so that all proprioceptive inputs were able to contribute (i.e. cutaneous, joint and both flexor and extensor muscle afferents), proprioceptive acuity was similar for the three digits. Loss of local cutaneous (and joint) inputs by digital anaesthesia significantly impaired performance at all digits, suggesting a critical role for cutaneous input in normal proprioceptive sensibility at all distal joints of the digits. Anaesthesia of the extensor muscle afferents innervating the thumb did not affect its proprioceptive acuity. Thus, for the thumb, the extensor muscle afferents do not provide critical information. The greater change in muscle fascicle length for the thumb's long flexor muscle (3% per 10 degrees) compared with that in the finger flexor muscles (e.g. 0.1% per 10 degrees) could contribute to the thumb's performance. There appears to be less redundancy of muscle and non-muscle signals for the fingers than for the thumb, because a reduction in either cutaneous or muscle input significantly impaired acuity at the fingers. Overall, when the hand is in a grasping posture, irrespective of the contribution of local cutaneous inputs, the long flexor acting on the thumb may contribute more to its proprioceptive acuity than the long finger flexors contribute to acuity at the fingers.
Publisher: Mary Ann Liebert Inc
Date: 12-2012
Abstract: Upper limb lymphedema is a possible consequence of the treatment for breast cancer. Accurate detection of swelling is important in implementing appropriate treatment. Currently used diagnostic cut-offs for excess volume have been chosen for ease of use and are not based on normative differences. The aim of this study, therefore, was to determine the normal inter-limb variance for healthy older women and identify statistically-based diagnostic cut-offs for both circumference and volume. Two hundred and four healthy women, over the age of 40 years, with no history of treatment for breast cancer or lymphedema, underwent measurement of their upper limbs with a perometer. Using the associated software, the circumference of the limb was determined at a number of set points along the limb and the volume of the intervening segments recorded. Segment volumes were also calculated from the circumferential measurements using the formulae for a truncated cone and cylinder. The mean inter-limb difference found was small but a large range was seen for all of the circumference and volume measurements. Dominance was found to have a significant effect on the limb size. Regression analysis showed that an in idual's age was negatively related to their inter-limb difference. Diagnostic cut-offs, set at three standard deviations above the mean, were determined. New circumference and volume criteria based on normative data, taking arm dominance into consideration, will allow for more accurate diagnosis of changes in limb volume, allowing treatment to be started and monitored appropriately.
Publisher: Elsevier BV
Date: 2013
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.PTSP.2016.03.005
Abstract: To investigate the effect of rigid ankle tape on functional performance, self-efficacy and perceived stability, confidence and reassurance during functional tasks in participants with functional ankle instability. Clinical measurement, crossover design. Participants (n = 25) with functional ankle instability (Cumberland Ankle Instability Score < 25) were recruited from university students and sporting clubs. Participants performed five functional tests with and without the ankle taped. The tests were: figure-8 hopping test, hopping obstacle course, star excursion balance test (SEBT), single-leg stance and stair descent test. Secondary outcome measures were self-efficacy and perception measures. Rigid tape significantly decreased the stair descent time by 4% (p = 0.014), but had no effect on performance in the other tests. Self-efficacy increased significantly (p < 0.001). Perceived stability, confidence and reassurance also increased with the ankle taped (p < 0.05) during the stair and two hopping tasks, but not during the SEBT or single-leg stance test. Although taping the ankle did not affect performance, except to improve stair descent, it increased self-efficacy and perceived confidence in dynamic tasks. These findings suggest that taping may reduce apprehension without affecting functional performance in those with functional ankle instability and permit continued physical activity or sport participation.
Publisher: Springer Science and Business Media LLC
Date: 26-09-2007
DOI: 10.1007/S10549-007-9710-9
Abstract: The aim of this systematic review was to identify the prevalence and severity of upper limb problems following surgery and radiation for early breast cancer. Additionally, the independent prognostic contribution of radiation, type of breast surgery, type of axillary surgery, age and body mass index (BMI) was evaluated. Searches of electronic databases were conducted to identify articles that reported upper limb and quality of life outcomes after breast cancer surgery and external radiation. Eligible studies for prognosis were longitudinal in design, with > or =95% of patients treated by surgery and radiation that excluded the axilla. Cross-sectional studies were also included for identification of prognostic factors. Where possible, the contribution of independent prognostic factors was analyzed. The review identified 32 relevant studies. Shoulder restriction was reported in between <1% and 67% of participants, lymphedema was reported in between 0 and 34% of participants, shoulder/arm pain was reported in between 9 and 68% of participants and arm weakness was reported in between 9 and 28% of participants. Quality of life was high across studies. Irradiated patients had slightly increased odds of lymphedema (OR = 1.46, 95% CI 1.16-1.84) and shoulder restriction (OR = 1.67, 95% CI 0.98-2.86) compared with non-irradiated patients. For patients undergoing surgery and radiation for breast cancer, the prognosis is good in terms of the upper limb and quality of life. Radiation that excludes the axilla does not appear to be a strong prognostic indicator of adverse upper limb outcomes.
Publisher: Elsevier BV
Date: 11-2005
DOI: 10.1016/J.APMR.2005.05.015
Abstract: To determine the relation between 2 proprioceptive tests, movement detection and movement discrimination, at the ankle. A cross-sectional descriptive study. Research laboratory. Eighteen subjects with recurrent ankle inversion sprain. Not applicable. Threshold to detection of movement was tested for inversion and eversion movements at 3 velocities (0.1 degrees , 0.5 degrees , 2.5 degrees /s). Movement discrimination was tested for plantarflexion and inversion movements. The tests were performed in random order, and the velocity and movements were randomized within each test paradigm. Correlations (Pearson r) were calculated between movement detection and movement discrimination. Correlation within each proprioceptive paradigm was poor to moderate: for movement detection, correlations among movement directions at each velocity ranged from r equal to .53 to r equal to .54 for movement discrimination correlation was r equal to .49. There was poor correlation between the scores for the 2 tasks in 10 of the 12 comparisons (r range, -.02 to -.36). These findings show that performance in different proprioceptive tests is not well correlated and, therefore, that general proprioceptive status cannot be inferred from assessment of a single proprioceptive test.
Publisher: Springer Science and Business Media LLC
Date: 11-12-2009
DOI: 10.1007/S10549-008-0258-0
Abstract: The aim was to make bioimpedance spectroscopy (BIS) quantitative for assessment of lymphoedema. Apparent resistivity coefficients were determined for the intra- and extracellular water of arms in a control cohort of women (n = 66). These coefficients were used to predict water volumes in the arms of women with lymphoedema (n = 23) and a separate control group without lymphoedema (n = 13) and to compare these with total arm size measured by perometry. Total arm volume was highly correlated (r = 0.80-0.90) with arm fluid volumes predicted by BIS and the proportional increase in arm size predicted by BIS was not significantly different to that measured by perometry. BIS predicted that the increased volume in the women with lymphoedema was predominantly (60%) due to increase in extracellular fluid. BIS is capable of quantifying the volume increase in limb size seen in lymphoedema.
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.MATH.2012.03.007
Abstract: To assess inter-rater reliability of ankle manual tests. We also correlated the manual tests with the Cumberland Ankle Instability Tool (CAIT). One ankle from each of 60 participants was assessed using four different manual tests (anterior drawer in supine and crook lying, talar tilt, inversion tilt). Three different raters, varying in experience, tested each participant. The CAIT questionnaire was also administered. The study received ethics approval from the University of Sydney Human Research Ethics Committee. Intraclass correlation coefficients (ICC), standard error of the mean (SEM) and percent close agreement (PCA) were used to determine reliability of the four tests. Pearson's correlation coefficients were used to determine relationships between the manual tests and CAIT scores. Inter-rater reliability for the four manual tests was poor regardless of therapist's experience (ICC([1,1]) -0.12 to 0.33 SEM 0.93-1.69). Correlations between the CAIT and manual tests were also low varying between r = -0.12 and -0.42. Inter-rater reliability was poor for manual tests of ankle stability. Reliability may be improved by using a grading scale with fewer intervals. The CAIT scores and manual tests correlated poorly, potentially reflecting the variety of conditions leading to ankle instability.
Publisher: Springer Science and Business Media LLC
Date: 21-06-2017
DOI: 10.1007/S11764-017-0622-3
Abstract: The purpose of this study was to evaluate the efficacy of exercise, either alone or in combination with other interventions, compared to a control, for the preservation of bone mineral density (BMD) in early breast cancer (BC) patients. A systematic search was conducted to identify randomized or quasi-randomized trials which met inclusion criteria including prescribed exercise for ≥12 months. Ten publications from seven randomized controlled trials (RCTs), involving 1199 participants, were identified. Data on primary and secondary outcome measures related to BMD at the lumbar spine, total hip, femoral neck and greater trochanter were analysed. Meta-analyses were limited to subgroups by menopausal status as other data could not be pooled. Based on mean differences or mean percentage differences between groups at 1 year, exercise did not preserve BMD or bone mineral content at any site in post-menopausal women. In contrast, evidence from one RCT (n = 498) found that exercise reduced bone loss in pre-menopausal women at the femoral neck [% MD = 1.20 (95% CI 0.22-2.18) P = 0.02] but not at the lumbar spine. Although this review indicated that exercise may result in a clinically important preservation of bone health among pre-menopausal but not post-menopausal women, further studies are needed to confirm whether or not exercise is important in preservation of bone health in women diagnosed with early BC. Exercise alone may not be sufficient to prevent bone loss in post-menopausal women at high risk of osteoporosis. Further evidence is required to determine if it provides any benefit to pharmacological therapy.
Publisher: Mary Ann Liebert Inc
Date: 03-2011
Abstract: Secondary unilateral lymphedema in the leg may occur as a consequence of pelvic surgery and/or radiation therapy, which causes damage to the pelvic lymphatic system. To date, assessment has been typically by manual measurement of the volume excess of the affected leg compared to the contralateral leg. In contrast, the assessment of unilateral arm lymphedema is readily accomplished by the use of bioelectrical impedance spectroscopy (BIS) as an increased inter-arm impedance ratio due to the presence of excess lymph in the affected arm relative to that of the unaffected arm. The presence of lymphedema is defined by a value of this ratio greater than the mean ratio plus three standard deviations (SD) observed in a comparable healthy population. The aim of the present study was to determine the equivalent reference range of the impedance ratio for the legs. This would allow a cut-off value to be established as a criterion for the detection and assessment of lower limb lymphedema. The impedances of the legs of 172 healthy females and 150 healthy males, measured by BIS, were extracted from an accumulated database of impedance data. These data were used to determine the normal distribution of inter-leg impedance ratios and the reference range and threshold value (mean + 3 SD). The presence of lymphedema is indicated when the impedance ratio exceeds 1.167 in males and 1.136 in females. Unlike in the arms, the effect of limb dominance in the legs is minimal and it is suggested that no correction for limb dominance is warranted. The impedance ratio thresholds for lymphedema of the legs have been established, opening the way for BIS to become established clinically for the early detection and assessment of lower limb lymphedema.
Publisher: Elsevier BV
Date: 02-2008
Publisher: Springer Science and Business Media LLC
Date: 27-10-2023
DOI: 10.1007/S11764-022-01278-W
Abstract: Breast lymphoedema is a possible side effect of breast conserving surgery, but it is poorly understood. This is due, in part, to difficulty assessing the breast. This systematic review described outcome measures that quantify breast lymphoedema signs and symptoms and evaluated the measurement properties for these outcome measures. Seven databases were searched using terms in four categories: breast cancer, lymphoedema and oedema, clinician reported (ClinROM) and patient reported outcome measures (PROM) and psychometric and measurement properties. Two reviewers independently reviewed studies and completed quality assessments. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology was used for studies including measurement property evidence. Fifty-six papers were included with thirteen questionnaires, eight patient-reported rating scales, seven physical measures, seven clinician-rating scales and four imaging techniques used to quantify breast lymphoedema. Based on COSMIN methodology, one ClinROM had sufficient reliability, ultrasound measuring dermal thickness. Tissue dielectric constant (TDC) measuring local tissue water had promising reliability. Four questionnaires had sufficient content validity (BLYSS, BLSQ, BrEQ and LYMQOL-Breast). Ultrasound is recommended to reliably assess breast lymphoedema signs. No PROM can be recommended with confidence, but BLYSS, BLSQ, BrEQ and LYMQOL-Breast are promising. Further research is recommended to improve evidence of measurement properties for outcome measures. There are many approaches to assess breast lymphoedema, but currently, only ultrasound can be recommended for use, with others, such as TDC and questionnaires, showing promise. Further research is required for all approaches to improve evidence of measurement properties.
Publisher: IOP Publishing
Date: 04-2010
Publisher: Wiley
Date: 08-2002
DOI: 10.1113/JPHYSIOL.2002.023861
Abstract: In humans, the flexor digitorum profundus (FDP), which is a multi-tendoned muscle, produces forces that flex the four distal interphalangeal joints of the fingers. We determined whether the force associated with activity in a single motor unit in the FDP was confined to a single finger or distributed to more than one finger during a natural grasp. The discharge of single low-threshold motor units (n = 69) was recorded at sites across the muscle during weak voluntary grasping involving all fingers and spike-triggered averaging of the forces under each of the finger pads was used to assess the distribution pattern. Spike-triggered averaging revealed that time-locked changes in force occurred under the 'test' finger (that finger on which the unit principally acted) as well as under the 'non-test' fingers. However, for the index-, middle- and ring-finger units, the changes in force under non-test fingers were typically small ( 50 % of those under the test finger). The distribution of forces by little-finger units differed significantly from that for each of the other three fingers. Apart from increases in force under non-test fingers, there was occasional unloading of adjacent fingers (22/267 combinations), usually affecting the index finger. The increases in force under the test finger correlated significantly with the background force for units acting on the middle, ring and little fingers. During a functional grasp, the activity of single units in the FDP allows for a relatively selective control of forces at the tips of the index, middle and ring fingers, but this is limited for little-finger units.
Publisher: BMJ
Date: 16-11-2010
DOI: 10.1136/EBN1111
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.PHYSIO.2010.02.008
Abstract: To describe the maximal strength and endurance of the pelvic floor muscles in a cohort of women with no history of incontinence and to determine the effect of age, parity, hormonal status, previous gynaecological surgery and regular performance of pelvic floor muscle exercises on the strength and endurance of these muscles. Preliminary cross-sectional observational study. Faculty of Health Sciences, University of Sydney, Australia. Twenty-eight women aged 19 to 58 years, 16 of whom were under 40 years of age. Participants were excluded if they had a history of incontinence or were currently menstruating. Pelvic floor muscle strength assessed using a perineometer, and pelvic floor muscle endurance above 60% of maximal voluntary contraction. The effect of age, parity, hormonal status, previous gynaecological surgery and regular performance of pelvic floor muscle exercises on the strength and endurance of these muscles. Maximum strength of the pelvic floor muscles was not correlated with endurance (r=0.21, P=0.290) or age (r=-0.31, P=0.107) however, it was influenced by parity (r=-0.44, P=0.020). Endurance was significantly and positively correlated with age (r=0.38, P=0.048). This study provides preliminary data that age and parity may be important factors in pelvic floor muscle performance in women who are continent. A larger study that considers the variability associated with these variables will provide useful guidelines for prescription of exercise.
Publisher: Informa UK Limited
Date: 2008
DOI: 10.1080/09638280701809872
Abstract: To develop and psychometrically test a Brazilian-Portuguese version of the Cumberland Ankle Instability Tool (CAIT), the only questionnaire that provides a numeric measure for functional ankle instability. The CAIT was translated and adapted into Brazilian-Portuguese according to the Guidelines for the process of cross-cultural adaptation of self report measures. The Brazilian-Portuguese version of the CAIT was tested for internal consistency, test-retest reliability, ceiling and floor effects and responsiveness in 131 participants. Participants were recruited from the general community in Brazil (N = 101, community group) and from those seeking treatment for an ankle sprain from 2 clinics in Brazil (N = 30, treatment group). The Brazilian-Portuguese version of the CAIT had high internal consistency (Cronbach alpha = 0.86 for right ankles and 0.88 for left ankles), reliability (ICC = 0.95, 95% CI 0.93-0.97) and good responsiveness (ES = 0.75, 95% CI 0.49-1.00). No ceiling or floor effects were observed. The Brazilian-Portuguese version of the CAIT is as reliable as the English version of the questionnaire, has high internal consistency and good responsiveness. It thus provides the first tool that can be used to assess functional ankle instability by clinicians and researchers working among Brazilian-Portuguese speakers.
Publisher: Mary Ann Liebert Inc
Date: 04-2023
Publisher: Wiley
Date: 26-11-2013
DOI: 10.1111/ANS.12474
Abstract: Lymphoedema of the arm is a potentially serious consequence of any axillary procedure performed during the management of breast cancer. In an attempt to reduce its incidence and severity, patients are instructed to avoid venepunctures and blood pressure measurements on the treated arm. These precautions are not possible in some patients and attempts to adhere to them can cause discomfort, anxiety and stress for both patients and their health-care workers. The strength with which these recommendations are made is in contrast to the level of evidence underpinning them. This paper reviews this evidence regarding the safety, or lack thereof, of blood pressure monitoring and intravenous puncture in women who have had axillary surgery. With this evidence generally being anecdotal in nature, there appears to be no rigorous evidence-based support for the risk-reduction behaviours of avoiding blood pressure monitoring and venepuncture in the affected arm in the prevention of lymphoedema after axillary procedure. A clinical trial was proposed to investigate whether such avoidance measures were valuable, but failed during its inception. There remains a need for research from prospective trials on this controversial topic to determine the most appropriate patient recommendations that should be provided after axillary procedure regarding the risks for development of lymphoedema.
Publisher: BMJ
Date: 2011
DOI: 10.1097/IGC.0B013E31820866E1
Abstract: The aim of the present study was to determine if the ratio of extracellular fluid (ECF), including the lymph, to that of intracellular fluid (ICF), as measured by bioimpedance spectroscopy (BIS), could be used to assess bilateral lymphedema (LE). The presence of LE is commonly determined as an increase in tissue volume due to the presence of excess lymph relative to the volume of a comparable unaffected body region or to comparative normative data. However, in bilateral LE of the limbs, a comparable body region, the contralateral limb, is also affected, precluding normalization. An alternative is to normalize the increase in lymph volume, as ECF, to that of ICF volume. Extracellular/intracellular fluid ratios, expressed as the ratio of intracellular impedance ( R i ) to extracellular impedance ( R 0 ), for the limbs of 277 female and 224 male controls were determined from an accumulated database of impedance data. Equivalent data were obtained for an opportunistic cross-sectional s le of 37 female and 5 male participants with bilateral LE of the legs. The ratios of R i / R 0 in the lymphedematous legs of the affected participants were compared with the equivalent ratios in the unaffected arms of the same participants and with those of the controls using box plots and visualized as bivariate data using tolerance ellipses. Despite R i / R 0 ratios varying with age, sex, and limb dominance, comparison of the ratio for affected legs (normalized to the ratio in the unaffected arms) with equivalent ratios observed in a control population (as bivariate tolerance plots) was capable of discriminating between 70% and 89% of the participants with LE. Bioelectrical impedance spectroscopy and determination of R i /R 0 ratios as indices of ECF/ICF ratios holds promise for the semiquantitative assessment of bilateral LE.
Publisher: Mary Ann Liebert Inc
Date: 06-2011
Abstract: Arm lymphedema is routinely assessed by clinicians and researchers, using arm circumference measurements. A protocol was developed for measuring arm circumference independent of medically trained professionals. The aim of this project was to assess the protocol's inter-rater reliability and its coherence with perometry measures. Community-dwelling adults (n = 57), aged 60.2 ± 12.8 years, in good general health, were included in this study. Circumference of both arms were measured at the ulnar styloid of the wrist and at four 10 cm intervals up the arm by a friend of the participant, as well as the trained assessor using a tape measure. The same measures were also obtained with a perometer. The assessment tools had moderate to high concordance (r(c) = 0.84-0.94 for assessor vs. perometer and r(c) = 0.68-0.93 for assessor vs. participant). Limits of agreement analysis revealed that the mean difference between methods varied based on the measurement location the bias ranged from -5.5% to 1.5% for assessor-measured vs. perometer methods and from -2.4% to 4.0% for assessor-measured vs. participant-measured methods. The written instructions and cartoons are reliable tools that could be used by women at risk of lymphedema as well as those with lymphedema following treatment for breast cancer to measure their arm circumference reliably independent of medically trained personnel.
Publisher: SAGE Publications
Date: 10-2014
DOI: 10.1136/ACUPMED-2014-010593
Abstract: To determine the feasibility, acceptability and safety of using acupuncture to treat arm lymphoedema in women following treatment for breast cancer. We conducted a randomised controlled trial of acupuncture compared with treatment as usual. Twenty women with stable unilateral intransient lymphoedema present for at least 6 months were recruited from Sydney, Australia. The women received 12 acupuncture treatments administered to body and arm points on the non-lymphoedematous limb over 8 weeks, twice weekly for 4 weeks then once weekly for 4 weeks. Outcome measures included an assessment of interest to participate in the trial, identification of successful recruitment strategies, the appropriateness of eligibility criteria and compliance with treatment attendance. Clinical outcomes were assessed at baseline and 8 weeks and included extracellular fluid, lymphoedema symptoms, well-being and safety. Acupuncture was an acceptable intervention in women with upper limb lymphoedema. Compliance with the treatment protocol was high, with nine women completing all 12 treatments. Outcome forms were completed by 17 women at 8 weeks. No major adverse occurrences, as defined by the study protocol, were reported from the acupuncture group although one woman found the needling uncomfortable, and no study participant experienced an increase in swelling of %. There was no change in extracellular fluid or any patient-reported outcome measurement. Lymphoedema is a persistent symptom experienced by women recovering from breast cancer. Our study suggests that acupuncture may stabilise symptoms and no major safety concerns were identified, so further research is needed. Australian New Zealand Clinical Trials Registry, www.anzctr.org.au ACTRN12612000607875.
Publisher: SAGE Publications
Date: 03-2014
DOI: 10.1258/PHLEB.2012.012073
Abstract: To determine whether bioimpedance spectroscopy was suitable for detection of hand lymphoedema. The hands of 50 participants without a history of lymphoedema were measured with perometry and bioimpedance spectroscopy after positioning two ways for three minutes: (a) both hands rested at heart height and (b) the dominant hand at heart height and the non-dominant hand at head height. In addition, 10 women with secondary hand lymphoedema were also measured. Impedance and volume measurements were found to be strongly related (dominant hand r = −0.794). Both measurements were reliable (ICC 2,1 = 0.900–0.967 and 0.988–0.996, respectively). Impedance was more sensitive to small changes in hand volume due to the postural change (position × device interaction: F = 23.9, P 0.001). Finally, impedance measurements had better discrimination of women with lymphoedema than volume measurements. Bioimpedance spectroscopy is a promising tool for the detection of secondary hand lymphoedema.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 12-2008
Abstract: Controlled laboratory study using a cross-sectional design. To investigate the relationship between postural control and functional ankle instability during a hop-landing task, and to investigate whether postural control is altered in people with functional ankle instability. Sixty volunteers classified by the Cumberland Ankle Instability Tool (CAIT) scores formed the external control group (CAIT score, >or= 28, n = 31) and the instability group (CAIT score, .05) between the CAIT scores and the TTS for ankle inversion (r = -0.25), dorsiflexion (r = -0.04), summated EMG (r = -0.13) and proportion of movement in the frontal plane (r = 0.005). Participants in the instability group took longer to regain stability in inversion and displayed greater inversion variability prejump than the control group (P = .05 and .009, respectively). Ankle inversion control is affected in people with functional ankle instability in tasks of postural control after landing from a hop.
Publisher: Wiley
Date: 08-2005
Publisher: SAGE Publications
Date: 16-10-2008
Abstract: Taping is often used to counter the proprioceptive deficit after joint injury such as ankle sprain. However, the effect of taping on proprioceptive acuity at the ankle is unclear, with conflicting findings. Application of tape improves detection of inversion and eversion movements at the ankle. Controlled laboratory study. The 70% threshold for movement detection was measured in 16 participants with recurrent ankle sprain under 2 conditions: with the ankle taped or untaped. The threshold for movement detection was examined at 3 velocities (0.1 deg/s, 0.5 deg/s, and 2.5 deg/s) and in 2 directions (inversion and eversion). Application of tape significantly decreased the ability to detect movements at the ankle (P . 023). For ex le, at 0.5 deg/s, the 70% detection threshold was 3.40° ± 1.05° in inversion and 3.49° ± 1.15° in eversion at the untaped ankle, and 4.02° ± 0.86° in inversion and 4.04° ± 0.89° in eversion at the taped ankle. Taping the ankle decreased the ability to detect movement in the inversion-eversion plane in participants with recurrent ankle sprain. The findings suggest that the efficacy of taping is unlikely to be explained by an enhanced ability to detect inversion or eversion movements. However, because it has been found effective in reducing the incidence of ankle sprain, clinicians should continue taping to reduce the likelihood of resprain.
Publisher: Springer Science and Business Media LLC
Date: 18-06-2009
DOI: 10.1007/S10549-008-0090-6
Abstract: The aims were to determine (i) whether single frequency bioimpedance analysis (SFBIA) is as accurate as bioimpedance spectroscopy (BIS) in measurement of extracellular fluid and (ii) whether change in extracellular fluid was specific to only the limb directly affected by surgery. Arms of the control (n = 28) and arm lymphedema group (n = 28) and legs of the leg lymphedema group (n = 16) were assessed with SFBIA. All four limbs in all participants were assessed with BIS. All measurements occurred in a single session. BIS-measured ratios were highly concordant with those obtained with SFBIA (r (c) = 0.99, P < 0.001). Repeated measures ANOVA revealed that the ratio involving the lymphedema limb was different to the ratio of the non-oedematous limbs which was not significantly different to the arm or leg ratios of the control group. SFBIA is a simple accurate alternative to BIS for the clinical assessment of unilateral lymphedema. BIS discriminates those with clinical diagnosis of unilateral lymhoedema from those without the diagnosis.
Publisher: Springer Science and Business Media LLC
Date: 29-01-2012
DOI: 10.1007/S10549-012-1964-1
Abstract: The aim of this study was to determine whether an exercise program, commencing 4-6 weeks post-operatively, reduces upper limb impairments in women treated for early breast cancer. Women (n = 160) were randomized to either an 8-week exercise program (n = 81) or to a control group (n = 79) following stratification for axillary surgery. The exercise program comprised a weekly session and home program of passive stretching and progressive resistance training for shoulder muscles. The control group attended fortnightly assessments but no exercises were provided. The primary outcome was self-reported arm symptoms derived from the EORTC breast cancer-specific questionnaire (BR23), scored out of 100 with a low score indicative of fewer symptoms. The secondary outcomes included physical measures of shoulder range of motion, strength, and swelling (i.e., lymphedema). Women were assessed immediately following the intervention and at 6 months post-intervention. The change in symptoms from baseline was not significantly different between groups immediately following the intervention or at 6 m post-intervention. The between group difference immediately following the intervention was 4 (95% CI -1 to 9) and 6 months post-intervention was 4 (-2 to 10). However, the change in range of motion for flexion and abduction was significantly greater in the exercise group immediately following the intervention, as was change in shoulder abductor strength. In conclusion, a supervised exercise program provided some, albeit small, additional benefit at 6 months post-intervention to women who had been provided with written information and reminders to use their arm. Both the groups reported few impairments including swelling immediately following the intervention and 6 months post-intervention. Notably, resistance training in the post-operative period did not precipitate lymphedema.
Publisher: Mary Ann Liebert Inc
Date: 03-2011
Abstract: Breast cancer-related lymphedema in the arm is commonly detected by bioelectrical impedance spectroscopy as an increased inter-arm impedance ratio due to the presence of excess lymph in the at-risk arm relative to that of the unaffected arm. The presence of lymphedema is determined by a value of this ratio greater than the mean ratio, plus three standard deviations observed in a comparable healthy population. This threshold value has not been established using the measurement protocols in current practice. The aim of the present study was to determine the reference range of the inter-arm impedance ratio to allow a cut-off value to be established as a criterion for the detection of breast cancer-related lymphedema. The mean and variation (3 SD) of the inter-arm impedance ratio for the arms of 172 healthy female control participants were determined from an accumulated database of impedance data obtained using present generation impedance instrumentation and methodology. This reference range and threshold value was compared to the original threshold ratio determined a decade ago but still in current use. The presence of lymphedema is indicated when the impedance ratio exceeded 1.106 when the nondominant limb is at risk, and 1.134 when the dominant limb is at risk compared with the currently used values of 1.066 and 1.139, respectively. Although the difference in these values was statistically significant, this difference was determined to be of minor importance to clinical practice. The impedance ratio thresholds for early detection of lymphedema remain suitable for clinical use with present day bioimpedance spectroscopy analyzers and measurement protocols.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-06-2022
DOI: 10.1200/JCO.21.02567
Abstract: To determine whether prophylactic use of compression sleeves prevents arm swelling in women who had undergone axillary lymph node dissection for breast cancer surgery. Women (n = 307) were randomly assigned to either a compression or control group. In addition to usual postoperative care, the compression group received two compression sleeves to wear postoperatively until 3 months after completing adjuvant treatments. Arm swelling was determined using bioimpedance spectroscopy (BIS) thresholds and relative arm volume increase (RAVI). Incidence and time free from arm swelling were compared using Kaplan-Meier analyses. Hazard ratios (HRs) were estimated from Cox regression models for BIS and RAVI thresholds independently. In addition, time to documentation of the first minimally important difference (MID) in four scales of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the breast cancer–specific (BR23) questionnaire was analyzed. The HR for developing arm swelling in the compression group relative to the control group was 0.61 (95% CI, 0.43 to 0.85 P = .004) on the basis of BIS and 0.56 (95% CI, 0.33 to 0.96 P = .034) on the basis of RAVI. The estimated cumulative incidence of arm swelling at 1 year was lower in the compression group than the control group on the basis of BIS (42% v 52%) and RAVI (14% v 25%). HRs for time from baseline to the first change of the minimally important difference were not statistically significant for any of the four scales of EORTC QLQ-30 and BR23 questionnaires. Prophylactic use of compression sleeves compared with the control group reduced and delayed the occurrence of arm swelling in women at high risk for lymphedema in the first year after surgery for breast cancer.
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.CCT.2011.04.012
Abstract: Aromatase inhibitors (AIs) have improved the prognosis for breast cancer survivors and are now standard of care for postmenopausal women with hormone receptor positive early stage breast cancer. One side-effect, however, is a decrease in bone mineral density (BMD) and increased fracture risk. Since hormone replacement therapy (HRT) is contraindicated in these women, one prevention option is exercise combined with vitamin D and calcium. The effect of this intervention on drug-induced osteoporosis is unknown. A single-blind randomized controlled trial will be undertaken to test the hypothesis that exercise combined with vitamin D and calcium can prevent the decrease in BMD associated with the use of AIs. Sixty postmenopausal women prescribed an AI for the treatment of breast cancer will be randomized into either an exercise or control group. Participants randomized to the exercise group will undertake a 12-month gym-based exercise program, 3 times per week involving resistance and impact training. Participants in the control group will be advised on the benefits of exercise for preventing osteoporosis, but not prescribed exercise. Both groups will receive vitamin D and calcium supplements. The primary outcome will be total hip bone mineral density measured via dual energy X-ray absorptiometry (DXA). Study outcomes will be compared between groups at baseline, 6months and 12months. This study will investigate the effect of exercise in combination with vitamin D and calcium on prevention of drug-induced osteoporosis in postmenopausal women prescribed AIs for the treatment of breast cancer.
Publisher: Mary Ann Liebert Inc
Date: 09-2015
Publisher: Informa UK Limited
Date: 14-09-2018
DOI: 10.1080/07357907.2018.1517362
Abstract: To ascertain how change in upper body lymphedema is assessed and understand how clinically significant change is determined. A systematic search of the literature resulted in 55 eligible studies for analysis. A range of assessment methods, measurement protocols, and outcomes were used in the literature. Of the 21 studies in which thresholds for change were set a priori, 20 different thresholds were reported. How data was measured, analysed and reported was inconsistent across studies. Consensus on a core outcome set with standardised assessment protocols and reporting and investigation into empirically based minimum important differences (MID) is needed.
Publisher: Springer Science and Business Media LLC
Date: 11-1992
DOI: 10.1007/BF00227850
Publisher: Informa UK Limited
Date: 21-01-2021
Publisher: Springer Science and Business Media LLC
Date: 22-10-2020
DOI: 10.1007/S00520-019-05083-7
Abstract: In the absence of monitoring programs, those at risk of developing breast cancer-related lymphoedema (BCRL) must detect its development. However, the efficacy of self-assessment for BCRL has not been widely investigated. This study will determine if symptoms and signs of BCRL are associated with lymphoedema detected by bioimpedance spectroscopy (BIS) and whether those with and without BCRL can accurately assess the signs of its presence. Participants with a history of breast cancer (n = 100) reported the presence/absence of symptoms associated with upper limb BCRL and underwent assessment for pitting oedema and differences in tissue texture between their arms (pinch). BIS detected BCRL in 48 women. Women were more likely to have BIS-detected BCRL if they reported swelling (odds ratio (OR), 58.8 95% CI, 4.9 to 709.4 p = 0.001) or had inter-limb tissue texture differences in their forearm (OR, 73.5 95% CI, 7.3 to 736.9 p = < 0.001) or upper arm (OR, 23.9 95% CI, 2.8 to 201.7 p = 0.003). Agreement between therapist and self-assessment of signs of BCRL was almost perfect (kappa, 0.819 to 0.940). A combination of self-reported swelling and/or self-assessed forearm tissue texture difference identified all cases of BIS-detected BCRL. Participants accurately identified the presence or absence of physical signs of BCRL in their arm. Perceived swelling and differences in tissue texture in the affected arm were associated with, and sensitive to, BIS-detected BCRL. These findings support the use of self-assessment to determine if BCRL is developing, indicating the need for professional assessment.
Publisher: IOP Publishing
Date: 18-04-2013
Publisher: Springer Science and Business Media LLC
Date: 15-03-2013
DOI: 10.1007/S00520-013-1770-2
Abstract: The aim was to better understand the incidence, time course and risk factors for swelling in the arm on the side of surgery over the first year following surgery for breast cancer. Women (n = 160) were assessed 1 month following surgery and then randomised to the exercise or control group. Reassessment occurred 3, 9 and 15 months following surgery. Potential risk factors for swelling included age, body mass index, side of surgery and surgical and medical treatments for their breast cancer, physical measures of shoulder range of motion and strength, inter-limb arm circumference difference and the group to which they were randomised. Swelling was determined using bioimpedance spectroscopy with reference to previously established cut-offs for lymphoedema. The number of women with swelling at 3, 9 and 15 months was 15, 15 and 13, respectively however, at 15 months only 5/13 presented with swelling in either of the preceding assessments. The risk of swelling increased at 3, 9 and 15 months for each centimetre increase in the baseline inter-limb difference in sum of arm circumferences by 1.30, 1.17 and 1.14. In addition, risk of swelling at 3 months was 2.6 times greater for women in the control group at 9 months, 7 times greater for women who had taxane-based chemotherapy and at 15 months, the risk increased 1.16 times for each day the drain was in situ. Swelling in the first year is likely to be transient, and factors including exercise and taxane chemotherapy affect the risk of developing swelling.
Publisher: Springer Science and Business Media LLC
Date: 24-02-2010
DOI: 10.1007/S10549-010-0793-3
Abstract: To assess the impact of air travel on swelling of the 'at risk' arm of women treated for breast cancer. Women treated for breast cancer from Canada (n = 60) and from within Australia (n = 12) attending a dragon boat regatta in Queensland, Australia participated. Women were measured within 2 weeks prior to their flight, on arrival in Queensland and, for 40 women travelling from Canada, measured again 6 weeks following return to Canada. Changes to extracellular fluid were measured using a single-frequency bioimpedance device (BIA). Each arm was measured separately using a standardized protocol to obtain the inter-limb impedance ratio. An increase in the ratio indicates accumulated fluid. Information regarding medical management of participants' breast cancer, use of compression garment and history of exercise were also obtained. For most women (95%), air travel did not adversely affect the impedance ratio. The BIA ratio of long-haul travellers was 1.007 +/- 0.065 prior to the flight and 1.006 +/- 0.087 following the flight. The ratio of short-haul travellers was 0.994 +/- 0.033 and following the flight was 1.001 +/- 0.038. Air travel did not cause significant change in BIA ratio in the 'at-risk' arm for the majority of breast cancer survivors who participated in dragon boat racing. Further research is required to determine whether these findings are generalizable to the population of women who have been treated for breast cancer.
Publisher: Wiley
Date: 09-2007
Publisher: Wiley
Date: 18-04-2008
DOI: 10.1111/J.1532-5415.2008.01707.X
Abstract: To determine whether changes in strength or cardiorespiratory fitness after exercise training improve walking ability in in iduals who have had a stroke. A sham exercise-controlled, randomized two-by-two factorial design, in which the two factors investigated were cycle training (AEROBIC) and resistance training (STRENGTH). University exercise laboratory. Fifty-two in iduals with a history of stroke (aged 63+/-9 time since stroke, 57+/-54 months). Participants undertook 30 exercise sessions over 10 to 12 weeks. Depending on group allocation, in iduals underwent aerobic cycling plus sham progressive resistance training (PRT) (n=13), sham cycling plus PRT (n=13), aerobic cycling plus PRT (n=14), or sham cycling plus sham PRT (n=12). Primary outcomes were 6-minute walk distance, habitual and fast gait velocities, and stair climbing power. Secondary outcomes included measures of cardiorespiratory fitness muscle strength, power, and endurance and psychosocial attributes. Neither AEROBIC nor STRENGTH improved walking distance or gait velocity significantly more than sham exercise, although STRENGTH significantly improved participants' stair climbing power by 17% (P=.009), as well as their muscle strength, power, and endurance cycling peak power output and self-efficacy. Conversely, AEROBIC improved indicators of cardiorespiratory fitness only. Cycling plus PRT produced larger effects than either single modality for mobility and impairment outcomes. Single-modality exercises targeted at existing impairments do not optimally address the functional deficits of walking but do ameliorate the underlying impairments. The underlying cardiovascular and musculoskeletal impairments are significantly modifiable years after stroke with targeted robust exercise.
Publisher: Elsevier
Date: 1994
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2007
Publisher: Springer Science and Business Media LLC
Date: 08-05-2007
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.ACRA.2013.01.018
Abstract: Lymphoscintigraphy may be used for diagnosing secondary lymphedema. Dermal backflow, the presence of radiotracer in dermal lymphatics, is a key clinical feature. Although often reported as present or absent, a scale that assesses the severity of dermal backflow has been previously developed. The aim of this study was to determine the reliability of these two methods of assessment. Sixteen experienced nuclear medicine physicians assessed the quantity of dermal backflow of 57 lymphoscintigraphy scans using a 4-point descriptive scale that was dichotomized for secondary analysis. Each scan included images from four time points for women previously diagnosed with secondary lymphedema (n = 47) and controls (n = 5) five scans were presented twice to examine intraobserver reliability. This was further investigated as 13 physicians viewed the scans again on an Apple iPad2. The physicians rated their confidence in their scoring. Readers were blinded to clinical history. Although both the 2- and 4-point scale had moderate interobserver reliability, the reliability of the 2-point scale was slightly higher (4-point: Fleiss κ = .418, standard error [SE] = .008) 2-point: Fleiss κ = .574, SE = .013). Low interobserver reliability was found when only control subjects were considered (Fleiss κ = 0.055, SE = 0.034). Intraobserver reliability of the five repeated images varied from poor to perfect (Cohen κ = .063 to 1.00), whereas moderate to substantial intraobserver reliability (Cohen's κ = .342 to .752) was found when comparing devices. The readers were highly confident of their scores. Overall, moderate intraobserver and interobserver reliability was found for quantifying dermal backflow with both the 2- and 4-point scale.
Publisher: Springer Science and Business Media LLC
Date: 28-07-2006
Abstract: Active inversion and eversion ankle range of motion (ROM) is widely used to evaluate treatment effect, however the error associated with the available measurement protocols is unknown. This study aimed to establish the reliability of goniometry as used in clinical practice. 30 subjects (60 ankles) with a wide variety of ankle conditions participated in this study. Three observers, with different skill levels, measured active inversion and eversion ankle ROM three times on each of two days. Measurements were performed with subjects positioned (a) sitting and (b) prone. Intra-class correlation coefficients (ICC [2,1] ) were calculated to determine intra- and inter-observer reliability. Within session intra-observer reliability ranged from ICC [2,1] 0.82 to 0.96 and between session intra-observer reliability ranged from ICC [2,1] 0.42 to 0.80. Reliability was similar for the sitting and the prone positions, however, between sessions, inversion measurements were more reliable than eversion measurements. Within session inter-observer measurements in sitting were more reliable than in prone and inversion measurements were more reliable than eversion measurements. Our findings show that ankle inversion and eversion ROM can be measured with high to very high reliability by the same observer within sessions and with low to moderate reliability by different observers within a session. The reliability of measures made by the same observer between sessions varies depending on the direction, being low to moderate for eversion measurements and moderate to high for inversion measurements in both positions.
Publisher: Springer Science and Business Media LLC
Date: 12-2006
Publisher: IOP Publishing
Date: 18-04-2013
Publisher: Springer Science and Business Media LLC
Date: 02-12-2006
DOI: 10.1007/S10549-006-9339-0
Abstract: Surgery and radiotherapy commonly cause adverse musculoskeletal problems, particularly loss of strength and range of motion, in the upper quadrant of breast cancer patients. Few well-designed studies have investigated whether these impairments can be prevented. Stretching is an effective technique for increasing range of motion, hence the aim of this study was to investigate whether a stretching program reduced acute musculoskeletal impairments in patients undergoing radiotherapy for breast cancer. Sixty-four women were recruited prior to commencement of radiotherapy following breast cancer surgery. Participants were randomised to either a control or stretch group. Participants in both groups were reviewed by the physical therapist on a weekly basis for approximately 6 weeks, and were given general information about skin care and lymphedema. The control group received no advice about exercise. The stretch group received instruction on low-load, prolonged pectoral stretches, which were to be performed daily and were checked at weekly visits. Shoulder range of motion, strength, arm circumference, and quality of life measurements were taken prior to, and at completion of radiotherapy, and at 7 months after radiotherapy. There was no difference in any outcome between groups. Breast symptoms increased for both groups during radiotherapy, without loss of strength or range of movement. The incidence of lymphedema during the study was low for both groups and did not differ between groups. The pectoral stretching program did not influence the outcomes measured because the symptoms reported by patients were not a consequence of contracture.
Publisher: Mary Ann Liebert Inc
Date: 03-2011
Abstract: Lymphedema of hand after breast cancer treatment causes significant loss of hand function. Although there are several ways of assessing limb volume, measuring hand volume has been problematic due to technical difficulties associated with assessment of finger volumes. The aim of this study was to investigate the criterion validity and reliability of Perometer™ for measuring hand volume in woman with and without lymphedema. Hand volume of forty women with (n = 20) and without lymphedema (n = 20) was assessed twice by one rater and once by another rater using the Perometer, and once by one rater using the water volumetry method. Intra- and inter-rater reliability was determined from the intraclass correlation coefficients and Percent Close Agreement. Agreement between the Perometer and water volumetry was determined using a limit of agreement and Lin's concordance correlation. The Perometer had high intra [ICC(2,1) = 0.989 (95% CI: 0.98-0.99)] and inter-rater reliability [ICC(2,1) = 0.993 (95% CI: 0.99-1.0)]. Percent close agreement revealed that 80% of the measures were within 9 ml for inter-rater reliability and within 15 ml for intra-rater reliability. In addition, there was high concordance between hand volumes obtained with the Perometer and water volumetry method (R(c) = 0.88). However, the Perometer overestimated the volume of hand compared to water volumetry method (bias: 7.5%). The Perometer can be used with high reliability to measure hand volume but caution should be exercised when data are compared with measures derived from the water volumetry method.
Publisher: Oxford University Press (OUP)
Date: 20-10-2013
DOI: 10.1634/THEONCOLOGIST.2013-0238
Abstract: This letter concerns the recent article by O'Toole et al. on the need to standardize the screening and diagnosis of lymphedema. Perometry and bioimpedance spectroscopy, the potential of combining new technologies and available clinical tools, and the need for evidence are discussed.
Publisher: Informa UK Limited
Date: 16-11-2010
DOI: 10.3109/07357900902918494
Abstract: To determine the relationship between physical methods of measuring lymphedema and self-reported swelling, their reliability, and standard error of measurement. Lymphedema in each arm of women with (n = 33) and without (n = 18) unilateral arm lymphedema, secondary to breast cancer was measured by self-report, bioimpedance spectroscopy (BIS), perometer, and the truncated cone method. The physical measurement tools were highly reliable (ICC((2,1)): 0.94 to 1.00) with high concordance (r(c): 0.89 to 0.99). Self-report correlated moderately with physical measurements (r = 0.65 to 0.71) and was moderately reliable (ICC((2,1)): 0.70). Lymphedema assessment methods are concordant and reliable but not interchangeable.
Publisher: Mary Ann Liebert Inc
Date: 06-2013
Abstract: To explore what factors affect volume of extracellular fluid (ECF) in the arm on the side of surgery pre- and postoperatively and to determine the value of knowing preoperative ECF volume for diagnosis of lymphedema postoperatively. Women (N=516) with early breast cancer were assessed preoperatively and within 4 weeks postoperatively. Baseline measures included inter-arm ECF ratio, side of cancer, number of nodes involved, and other in idual characteristics. Postoperative assessment included inter-limb ECF ratio and details from surgery. The postoperative ECF ratio was categorized as to whether it exceeded previously established thresholds, and the change in ECF was categorized as to whether it exceeded 0.1. Linear regression identified which factors explained the variance for preoperative ECF ratio and the change in ratio. Chi square analysis compared whether women categorized using thresholds were the same as those whose ratio increased >0.1 postoperatively. Postoperative ECF ratio was significantly higher than the preoperative ratio (p 0.1 postoperatively (p<0.001). Only the side of surgery explained the preoperative ECF measure extent of surgery and actual weight explained the change in ECF ratio. The ECF ratio preoperatively is not affected by nodal involvement. The change in ECF ratio is affected by the extent of surgery and body mass. Change from preoperative ECF ratio did identify more women at risk for lymphedema than reliance postoperatively on thresholds, supporting preoperative measures.
Publisher: Springer Science and Business Media LLC
Date: 18-01-2022
DOI: 10.1007/S00520-021-06751-3
Abstract: (1) To determine, in women with breast cancer-related lymphedema (BCRL), the frequency, intensity and distress of body image and sexuality concerns. (2) To examine relationships between body image and sexuality concerns, and lymphedema, personal and cancer treatment factors. Women with BCRL (n = 64) completed the Lymphedema Symptom Intensity and Distress Scale - Arm (LSIDS-A), which focuses on the intensity and distress of a range of lymphedema symptoms. They also underwent a lymphedema assessment. Responses to eight questions from the LSIDS-A regarding sexuality, body image and intimate relationships were considered. Frequency of responses was tabulated. Multiple linear regressions were used to determine if specific factors were related to higher intensity and distress scores associated with body image and sexuality issues. Body image and sexuality concerns were common (48%, 23% respectively). Participants reported a range (0-10) of intensity and distress related to body image and sexuality symptoms. Univariate linear regression revealed greater intensity of sexuality concerns was associated with younger age, whilst distress related to sexuality concerns was associated with higher inter-arm bioimpedance ratio and shorter duration of lymphedema. Body image concerns were not related to any considered factors. Body image and sexuality concerns are common, intense and distressing for patients with breast cancer lymphedema. Assessment of both the intensity and distressed caused by these symptoms is necessary to understand the impact of lymphedema.
Publisher: Elsevier BV
Date: 2006
DOI: 10.1016/S0004-9514(06)70062-9
Abstract: The aim of this study was to determine whether gluteal taping on the affected side improved hip extension during stance phase of walking for persons following stroke. Fifteen subjects who had suffered a stroke months to years previously resulting in mild to moderate gait impairments participated in the study. Their gait was measured under control, sham, and gluteal taping conditions, in random order. For each condition, subjects walked at a self-selected and a fast speed. Hip angle relative to that obtained during quiet standing, step length, stride length and walking velocity were measured. Hip extension increased significantly with gluteal taping (p < 0.05) for both walking speeds at late stance phase of walk compared to sham taping and control. The mean absolute difference between gluteal and control conditions for self-selected velocity was 14.2 degrees (95% CI 8.6 to 19.8) whereas the difference between sham and control conditions was 2.0 degrees (95% CI -2.0 to 6.0). Also, for both speeds, step length on the unaffected side increased significantly with gluteal taping compared with either the control or placebo conditions. The absolute difference between gluteal taping and control conditions at self-selected velocity was 3.3 cm (95% CI 2.2 to 4.3) and between sham and control conditions was 0.6 cm (95% CI -0.8 to 1.9). Affected step length and walking velocity, however, remained unchanged. Lastly, there was no significant difference between the control and sham taping condition for any of the measured variables. Gluteal taping may be a useful adjunct to current rehabilitation gait training strategies.
Publisher: Elsevier BV
Date: 2005
DOI: 10.1016/S0004-9514(05)70040-4
Abstract: The aim of this study was to describe the type and frequency of hand use in healthy older adults. Observational studies were conducted involving structured observations at five-minute intervals on 15 healthy older adults as they went about their normal daily routine between 10.00 am and 2.00 pm. Overall, the dominant hand was used more frequently than the non-dominant hand. Subjects used their hands predominantly to hold and manipulate objects, and not for balance. There was no significant difference between the frequency of manipulating objects with the fingers and the frequency of use of the whole hand. Subjects used their hands significantly more often in bimanual activities than in unimanual activities or in no activity. Although subjects usually stood while they held or manipulated objects, they also sat or walked while manipulating them. The present study provides insights into how healthy older adults naturally use their hands in performing everyday activities. While the dominant hand is used more than the non-dominant hand, the hands are used predominantly together to perform bimanual tasks.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2007
Publisher: Oncology Nursing Society (ONS)
Date: 28-05-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2010
Publisher: Elsevier BV
Date: 12-2003
DOI: 10.1016/S0003-9993(03)00376-9
Abstract: To evaluate the cardiorespiratory fitness of subacute stroke patients and to determine whether reduced fitness is associated with gait performance. Descriptive, cross-sectional study. Rehabilitation hospital. Seventeen patients in an inpatient rehabilitation unit who had mild to moderate gait impairments after a recent (< or =7wk) stroke. All subjects could walk at least 3m alone or with an aid but with no standby assistance. Not applicable. Peak and submaximal cardiorespiratory responses were measured during semirecumbent leg cycling exercise. Walking velocity and endurance were assessed with 10-m and 6-minute walk tests, respectively. Peak oxygen uptake (Vo(2)peak) was 1.15+/-0.36L/min, which was only 50% of the Vo(2)peak reported in the literature for a healthy, age-matched group. Maximal walking velocity (1.02+/-0.28m/s) and endurance (294.1+/-120.2m) were also approximately 50% of an aged-matched healthy group. Pearson product-moment correlations revealed that 6-minute walking endurance was strongly associated with self-selected walking velocity (R=.91) and measures of peak cardiorespiratory fitness (R=.84). Cardiorespiratory fitness was markedly impaired within 7 weeks after a stroke. Although muscle weakness and loss of coordination are the primary impairments that affect gait after a stroke, impaired cardiorespiratory fitness may secondarily affect gait performance by limiting walking endurance. To address this secondary impairment, current rehabilitation interventions can incorporate assessment of cardiorespiratory fitness status and aerobic exercise training for persons after stroke.
Publisher: Oxford University Press (OUP)
Date: 05-2010
DOI: 10.2522/PTJ.20090104
Abstract: Shoulder movement impairment is a commonly reported consequence of surgery for breast cancer. The aim of this study was to determine whether shoulder girdle kinematics, including those of the scapula, spine, and upper limb, in women who have undergone a unilateral mastectomy for breast cancer are different from those demonstrated by an age-matched control group. An observational study using 3-dimensional kinematic analysis was performed. Women who had a unilateral mastectomy on their dominant-arm side (n=29, mean [±SD] age=62.4±8.9 years) or nondominant-arm side (n=24, mean [±SD] age=59.8±9.9 years), as well as a control group of age-matched women without upper-limb, shoulder, or spinal problems (n=22, mean [±SD] age=58.1±11.5 years), were measured while performing bilateral arm movements in the sagittal, scapular, and coronal planes. All of the women were free of shoulder pain at the time of testing. Data were collected from the glenohumeral joint, the scapulothoracic articulation, and the spine (upper and lower thoracic and lumbar regions) using an electromagnetic tracking system. Women following mastectomy displayed altered patterns of scapular rotation compared with controls in all planes of movement. In particular, the scapula on the mastectomy side rotated upward to a markedly greater extent than that on the nonmastectomy side, and women following mastectomy displayed greater scapular excursion than controls. The findings suggest that altered motor patterns of the scapula are associated with mastectomy on the same side. Whether these changes are harmful or not is unclear. Investigation of interventions designed to restore normal scapulohumeral relationships on the affected side following unilateral mastectomy for breast cancer is warranted.
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.BREAST.2016.04.011
Abstract: A prospective study was conducted to identify women at increased risk for lymphoedema (LE) based on axillary surgery. Assessment occurred prior to surgery, within 4 weeks, and at 6, 12 and 18 months following surgery. Following post-surgery assessment, women were asked to complete weekly diaries regarding events that occurred in the previous week. Risk factors were grouped into demographic, lifestyle, breast cancer treatment-related, arm swelling-related, and post-surgical activities. Bioimpedance spectroscopy thresholds were used to determine presence of LE. At 18-months, 241 women with <5 nodes removed and 209 women with ≥5 nodes removed were assessed. For those with <5 nodes removed, LE was present in 3.3% compared with 18.2% for those with ≥5 nodes removed. There were insufficient events to identify risk factors for those with 5 nodes removed, independent risk factors included presence of arm swelling at 12-months (Odds Ratio (OR): 13.5, 95% CI 4.8, 38.1 P < 0.01), at 6-months (5.6 (2.0, 16.9) P 5 nodes removed and who maintained weekly diaries, only blood drawn from the 'at-risk' arm was identified as a potential risk (OR 2.0 0.8, 5.2). For women with ≥5 nodes removed, arm swelling in the first year poses a very strong risk for presence of LE at 18-months.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2008
Publisher: Wiley
Date: 29-08-2022
DOI: 10.1111/SRT.13100
Abstract: The current study assessed the level of reliability of ultrasound to assess dermal thickness, a clinical feature of breast lymphedema. Additionally, the relationship of dermal thickness to patient‐reported outcomes was investigated. Women ( n = 82) with unilateral breast edema secondary to treatment of breast cancer were randomized to an exercise or control group. Ultrasound measurements of the unaffected and affected breasts were taken at baseline and 12 weeks later at 3–4 cm superior, medial, inferior, and lateral to the nipple. Additionally, women completed breast‐related questions from the European Organization Research and Treatment Committee Quality of Life breast cancer module (EORTC‐BR23) and Lymphedema Symptom Intensity and Distress Questionnaire (LSIDS). Reliability of ultrasound measurements was determined on the unaffected breast. Intraclass correlation coefficients (2,1) ranged from 0.66 (95% CI: 0.52–0.77) for the lateral location to 0.84 (0.77–0.90) for the superior location. Percent close agreement (80%) on the unaffected breast ranged from 0.20 to 0.27 mm compared to 0.57 to 0.93 mm on the affected breast. The standard error of measurement (%) on the unaffected breast varied from 9% to 13% with smallest real difference 0.34–0.41 mm. Dermal thickness of the affected breast was not‐to‐poorly associated with EORTC BR23 and LSIDS scores. Reliability of dermal thickness measurements of the breast was excellent for the superior, medial, and inferior locations, and fair to good for the lateral location. However, these measurements were not related to the symptom's women perceive and measured with the EORTC BR23 or LSIDS.
Publisher: Elsevier
Date: 2005
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.JBIOMECH.2010.01.024
Abstract: Simultaneous motion of the scapula and humerus is widely accepted as a feature of normal upper limb movement, however this has usually been investigated under conditions in which purposeful, functional tasks were not considered. The aim of this study was to investigate the synchrony and coordination of the constituent 3D movements of the shoulder girdle and trunk, during a functional activity. 45 healthy women, aged between 20 and 80 years, performed a simple lifting task, moving a loaded box from a shelf at waist level to one at shoulder level and then reversed the movement, during which the linear and angular motions of the scapulae, upper and lower thoracic spine and upper limbs were monitored and analysed using cross-correlation techniques. Results indicated a close and consistent set of coordinated movement patterns, which suggest biomechanical invariance in the responses of the structures adjacent to the upper limb during such a lifting task. These scapulohumeral relationships were, however, more constant and phase-locked when there was a specific purpose to the movement than during periods in which the arm was lowered without load. There were no age-related differences in any movement responses.
Publisher: Informa UK Limited
Date: 2008
DOI: 10.1080/09638280701478512
Abstract: To assess whether muscle strength, power and endurance at the affected shoulder were reduced in women treated for breast cancer. Secondly, we assessed whether muscle performance was explained by management or other symptoms. Participants were 40 women (mean +/- SD: 56.7 +/- 11.6 yr) who had completed all treatments for breast cancer at least 6 m previously. We measured dynamic concentric strength at one repetition maximum (1RM), endurance at 90% 1RM, and power through a range of 40-100% 1RM for shoulder protractors, extensors and retractors. Strength and endurance, but not power, were measured for shoulder flexors. Additionally, maximal grip strength, passive shoulder range of motion and arm circumference were measured. Self-reported symptoms were recorded using a questionnaire. Shoulder protractors (p = 0.011), retractors (p = 0.007), and extensors (p = 0.009), but not flexors, were significantly weaker on the affected side compared to the unaffected side. Muscle power and endurance at the shoulder and grip strength were not impaired. Inter-limb differences in muscle strength were not explained by the surgical and medical management of the cancer. Self-reported weakness correlated poorly with our measures of muscle strength. Long-term weakness occurs about the shoulder secondary to treatment for breast cancer. Strategies to prevent weakness need to be considered.
Publisher: Springer Science and Business Media LLC
Date: 15-05-2011
DOI: 10.1007/S00520-010-0896-8
Abstract: To determine if bioimpedance spectroscopy (BIS) could detect localised lymphoedema of the arm and to compare BIS measurements with equivalent measures of limb volume by perometry. Women with mild to severe upper limb lymphoedema (n = 29) and women with no history of lymphoedema (n = 11) participated. Commencing at the ulnar styloid of the wrist, 4 × 10 cm segment measurements were made of each arm using both BIS and perometry. Average BIS inter-limb ratios for the total arm and each arm segment were higher than comparable perometry measures in women with lymphoedema, but similar to perometry measures for women without lymphoedema. Limits of agreement analysis showed that the mean difference between methods varied according to segment measured, ranging from 8.5% for the uppermost segment of the arm to 16.6% for the forearm segment just below the elbow. For all limb segments, there was a positive bias towards BIS measurements, which increased as lymphoedema severity increased. BIS can be used for localised measurement of lymphoedema. Because it is specific to extracellular fluid, BIS is more sensitive to localised lymphoedema than perometry.
Publisher: Springer Science and Business Media LLC
Date: 13-03-2012
DOI: 10.1007/S00520-012-1433-8
Abstract: This study evaluated the acute effect of massage and compression components of lymphoedema treatment in women with and without arm lymphoedema secondary to breast cancer from a single treatment session. Women with (n = 15) and without (n = 15) lymphoedema underwent a single session of lymphatic massage. Following the session, women were randomised to receive or not receive a compression sleeve. Measurements were taken prior to, during, and following the massage as well as 30 min after completion of the massage. Bioimpedance spectrometry (BIS) was used to measure changes in extracellular fluid volume of all limbs as well as 10-cm segments within the upper limbs perometry was used to measure changes in total upper limb volume as well as 10-cm segments within the limb. There were no significant changes after massage with or without compression. The median (and interquartile range) BIS ratios (unaffected:affected) for the whole upper limb for women with lymphoedema changed from 1.152 (1.053 to 1.422) to 1.192 (1.045 to 1.410) after massage, while the control group changed from 1.024 (0.998 to 1.047) to 1.041 (0.982 to 1.07). The median change in both the BIS ratio and the total arm volume measured with perometry from prior to the massage to following 30-min rest changed <2%, irrespective of whether women used a compression garment and whether women presented with or without lymphoedema. Examination of 10-cm segments within the arm also revealed no significant change in BIS ratio from one segment to the next. Massage alone or the application of compression after a single session of lymphatic massage was ineffective for reducing lymphoedema.
Publisher: Elsevier BV
Date: 09-2006
DOI: 10.1016/J.APMR.2006.05.022
Abstract: To test the Cumberland Ankle Instability Tool (CAIT), a 9-item 30-point scale, for measuring severity of functional ankle instability. Cross-sectional study. General community. Volunteer s le of 236 subjects. Not applicable. Concurrent validity by comparison with the Lower Extremity Functional Scale (LEFS) and a visual analog scale (VAS) of global perception of ankle instability by using the Spearman rho. Construct validity and internal reliability with Rasch analysis using goodness-of-fit statistics for items and subjects, separation of subjects, correlation of items to the total scale, and a Cronbach alpha equivalent. Discrimination score for functional ankle instability by maximizing the Youden index and tested for sensitivity and specificity. Test-retest reliability by intraclass correlation coefficient, model 2,1 (ICC(2,1)). There were significant correlations between the CAIT and LEFS (rho=.50, P<.01) and VAS (rho=.76, P 0.5 item reliability index, .99). The threshold CAIT score was 27.5 (Youden index, 68.1) sensitivity was 82.9% and specificity was 74.7%. Test-retest reliability was excellent (ICC(2,1)=.96). CAIT is a simple, valid, and reliable tool to measure severity of functional ankle instability.
Publisher: Springer Science and Business Media LLC
Date: 18-09-2007
DOI: 10.1007/S00520-007-0328-6
Abstract: Radiotherapy is routinely used in the treatment of early breast cancer, particularly in women who have undergone lumpectomy. Its impact on the quality of life of patients is important and is taken into consideration when making informed choices about treatment from both a patient's and health professional's point of view. This study reports on the quality of life of women at baseline, the completion of radiotherapy and 7 months after the completion of radiotherapy. European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C-30 and BR-23 questionnaires were used to evaluate quality of life of 61 women treated with radiotherapy for breast cancer. Additionally, demographic and treatment variables were analysed in relation to quality of life outcomes to determine if there were any significant predictors of quality of life. There was no difference in quality of life of women at baseline, completion and 7 months after completion of radiotherapy. Fatigue and breast symptoms increased during radiotherapy but returned to baseline levels at 7 months. Fatigue was the strongest predictor of poor quality of life in women after radiotherapy. Women retain a high quality of life and return to baseline function by 7 months after radiotherapy. Treatment may best be targeted to alleviate fatigue and breast symptoms during radiotherapy.
Publisher: Mary Ann Liebert Inc
Date: 06-2009
Abstract: The aim was to assess the agreement between bioimpedance indices and inter-limb volume differences, as assessed by perometry, for assessment of unilateral arm lymphedema. Impedance was measured in the arms of 45 women with lymphedema and a separate control group without lymphedema (n = 21). Arm volume was measured at the same time by perometry. The impedance indices, (ratio of impedances between limbs and the L-dex scores) were compared to the inter-limb volume differences using concordance correlation analysis. Impedance indices were highly correlated (r = 0.926) with the difference in arm volume measured by perometry. Bioelectrical impedance analysis, although not providing a quantitative volume measurement of lymphedema, provides a measurement index that is highly correlated with quantitative measurements of the volume increase in limb size seen in lymphedema. The speed and ease of the impedance technique renders it a suitable alternative to perometry for the assessment of lymphedema.
Publisher: Springer Science and Business Media LLC
Date: 18-08-2020
Start Date: 2014
End Date: 2015
Funder: National Health and Medical Research Council
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