Date Presented 04/21/2023
This study investigated how OTs who were certified lymphedema therapists addressed quality-of-life (QOL) issues for clients with lymphedema. Participants tended to administer occupation-based interventions but not QOL assessments despite how important they rated addressing client QOL. Because lymphedema affects QOL, it is important to understand practice trends to improve client care and justify the need for OT in this specialty area of practice.
Primary Author and Speaker: Mackenzie Feldhacker
Contributing Authors: Keri B. Kamphoff
Despite effective interventions to mitigate symptoms of lymphedema, clients report long-term functional impairments that correlate with decreased quality of life (QOL) (Bojinović-Rodić et al., 2016; Hikosaka et al., 2014; Pusic et al., 2013). Occupational therapists (OTs) address QOL with a variety of evaluation tools and intervention strategies, but there is a lack of evidence regarding therapist extent of use and preferences. This study aimed to identify what assessments and interventions Certified Lymphedema Therapists (CLTs) who are OTs in the United States (U.S.) use to measure and address QOL issues through the following questions: 1) To what extent do OTs in the U.S. administer QOL assessments? 2) Are some QOL assessments used more frequently than others? 3) To what extent do OTs in the U.S. use interventions to address QOL issues? 4) Which interventions do OTs use most frequently in practice? 5) How important is it for OTs to address QOL issues among clients with lymphedema? A descriptive, cross-sectional survey design was used to obtain information on current practice trends from participants across the country. An online questionnaire was created and distributed via email listservs of CLT certification and professional organizations. Inclusion criteria consisted of any licensed OT who was a CLT, had worked with clients with lymphedema within the past year, worked in the U.S., and spoke English. A nine-item questionnaire was developed after conducting an extensive literature review to identify assessments and interventions used when working with clients with lymphedema and referencing a published study by Ikiugu (2012). Participants rated the extent to which they administered QOL assessments and interventions, as well as their perception of the importance of addressing QOL issues for clients with lymphedema using five-point Likert-type scales. Analysis consisted of Friedman’s ANOVA for extent of QOL assessment and intervention use, one sample t-tests to compare preparatory and occupation-based interventions, and Kolmogorov-Smirnov test for perceived importance of addressing QOL issues. OTs in this study (n = 26) did not typically administer QOL assessments (t(14)= -20.76, p = 0.00). In addition, there was a significant difference in the extent to which OTs use various QOL assessments (χ2(16,10)= 62.23, p=0.00) most often using the Lymphedema Life Impact Scale, Short Form 36-Item Health Survey, and ‘other’. There was no significant difference in how OTs utilize various preparatory methods in practice, t(20)= 0.19, p= 0.85; however, the extent to which OTs use occupation-based interventions when treating clients with lymphedema was statistically significant, t(22)= 6.04, p= 0.00. There was a significant difference in the extent to which OTs use various QOL interventions, χ2(23,19)= 307.60, p= 0.00. Finally, 92.3% of participants perceived addressing QOL issues as important or very important, D(24)= 0.52, p= 0.00. Although OTs in this study agree assessing QOL in this population is of great importance, they did not tend to administer QOL assessments in practice. However, this project revealed occupation-based interventions are commonly used when treating those with lymphedema. This research is important to practice as it demonstrates the significance of occupational therapy in working with clients with lymphedema through highlighting current trends in clinical practice. Because OTs indicated they preferred to use occupation-based interventions when treating these clients, occupational therapy’s role in providing client-centered and occupation-based intervention was emphasized. Additionally, understanding the need to include QOL assessments in OT evaluation of these clients will also be important to the profession.
Bojinović-Rodić, D., Popović-Petrović, S., Tomić, S., Markez, S., & Živanić, D. (2016). Upper extremity function and quality of life in patients with breast cancer related lymphedema. Vojnosanitetski Pregled: Military Medical & Pharmaceutical Journal of Serbia, 73(9), 825-830. https://doi.org/10.2298/VSP150208075B
Hikosaka, M., Onishi, F., Takayama, M., Konno, E., & Kishi, K. (2015). QOL of the patients with lymph edema: Evaluation of Japanese patients using SF-36. International Journal of Surgery Research and Practice, 2(1). https://doi.org/10.23937/2378-3397/1410018
Ikiugu, M. N. (2012). Use of theoretical conceptual practice models by occupational therapists in the US: A pilot survey. International Journal of Rehabilitation, 19(11), 629-639. https://doi.org/10.12968/ijtr.2012.19.11.629
Pusic, A. L., Cemal, Y., Albornoz, C., Klassen, A., Cano, S., Sulimanoff, I., Hernandez, M., Massey, M., Cordeiro, P., Morrow, M., & Mehrara, B. (2013). Quality of life among breast cancer patients with lymphedema: A systematic review of patient-reported outcome instruments and outcomes. Journal of Cancer Survivorship, 7(1), 83-92. https://doi.org/10.1007/s11764-012-0247-5