| dc.description | Secondary hand lymphoedema is a multifaceted condition that can impact on the daily functions of the individuals affected; however, currently, this impact is not well understood. One reason for our poor understanding of the impact of secondary hand lymphoedema may be that the hand is infrequently considered separately from the rest of the upper limb. Clinical guidelines for upper limb lymphoedema management, including the hand, recommend both objective and subjective assessments for appraisal of lymphoedema. Objective assessments of the size or volume of the hand may present specific challenges due to the irregular shape of the hand. Various physical assessment tools and measurement methods are currently available to quantify hand size and volume. There is no agreement, however, on what are the most appropriate tools or methods to quantify hand swelling in hand lymphoedema.
Reliable and valid assessment tools and measurement methods, with known measurement error, that can accurately quantify small changes occurring in hand swelling are essential to understand the effects of treatments for secondary hand lymphoedema. However, the reliability and validity of physical assessment tools and measurement methods quantifying hand swelling have not been compared across all adult population, with and without hand swelling. The aim of Chapter 2 was, therefore, to assess the reliability, validity, and measurement error of physical assessment tools and measurement methods to quantify hand volume or size in all adult population that may or may not have hand swelling. A systematic review was conducted searching the databases of MEDLINE, CINAHL, EMBASE, Web of Science and Scopus using key terms related to oedema, swelling, volume, size, hand, measures, reliability and validity. Cross-sectional or longitudinal studies that assessed the reliability and/or validity of physical assessment tools or measurement methods to quantify hand swelling were included. Two examiners independently extracted data from the included articles and appraised the articles’ quality using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Data extracted were grouped by type of assessment tool and measurement method. Tape measures, water volumeters, BIS, and ring gauge, and three-dimensional techniques were identified to be reliable and valid to quantify the size or volume, or volume of extracellular fluid (ECF) of the hand. All measurement methods using these tools had good to excellent reliability, and moderate to high validity, supporting the recommendation of their use in clinical practice and research contexts. Among measurement methods, the figure of eight, which uses a tape measure, had the most robust evidence.
Treatment for secondary hand lymphoedema may also be challenging. The main treatment for secondary hand lymphoedema is compression but it may not be appropriate for use in all contexts, particularly where the compression garment or glove could get wet or dirty. An alternative treatment, which has shown promise in other body regions with lymphoedema, is kinesiotape. This tape is applied to the skin and purports to manage lymphoedema through improving lymph drainage. However, whether it can be used in the hand, without compression, has not been studied. The safety and feasibility of the use of kinesiotape therefore, requires investigation. The aim of Chapter 3 was, therefore, to determine whether a single application of kinesiotape on the dorsum of the hand of females with secondary hand lymphoedema is safe and feasible to maintain the size or volume of the hand and digits. Kinesiotape was applied to the dorsum of the hand in six participants with secondary hand lymphoedema and left in site for 48 hours. The primary outcome was change in the size of the hand and digits, secondarily to ECF volume, upper limb function, symptoms and quality of life. The smallest detectable change (SDC) was used to interpret the changes after kinesiotape application. No changes were found outside the SDC value for hand size nor for ECF volume of the whole limb. No adverse events were reported, and participants were generally satisfied with the treatment. Six out of 60 finger circumferences were outside the SDC values; however, three of them occurred in the non-treated side. Changes outside the SDC were found in the ECF volume of the dorsum of the hand, which increased in one participant and decrease in another participant. The ECF volume of the forearm decreased in two participants. There were also no changes in upper limb function nor in quality of life outside the SDC values. SDC values for interpretation of symptoms were not available; however, no clear pattern of improvement nor deterioration was found.
In conclusion, while there are many reliable and valid assessment tools and measurement methods for assessing hand and digit volume and size, there is a critical lack of information about the measurement error for most tools and measurement methods, limiting their use. Measurement error is particularly important in determining the effect of treatments for hand lymphoedema. Using assessment tools, with at least basic previously determined measurement error results, it was found that for almost all participants kinesiotape for hand lymphoedema appeared to be safe in maintaining the size of the hand and the digits. However, whether this is a treatment of interest for individuals with secondary hand lymphoedema to use in place of their compression garment or glove, requires further investigation. | |
