WHAT IS THE PRINCIPAL DIFFERENCE BETWEEN COMPLETE DECONGESTIVE PHYSIOTHERAPY (CDT) AND DECONGESTIVE LYMPHATIC THERAPY (DLT)? - Precaution with the Modified Low-Cost Treatment Options - Pediatric and Primary Lymphedema - Secondary Lymphedema

Due to new terminologies and abbreviations that are emerging in the field of lymphedema treatment, it is necessary to take note of the terms and vocabulary being used by some health and lymphedema-related organizations to denominate the "Low-Cost" treatment options for lymphedema. 

Whilst the International Society of Lymphology and specialized societies use the term and abbreviation "Complete Decongestive Therapy (CDT)" to designate the (Gold Standard) conservative treatment, some health and lymphedema organizations are now using a modified term “Decongestive Lymphatic Therapy (DLT)" to describe the treatment.

It should be noted that there is a big difference between the two terms and treatment options, as they are not the same and they are not substitutive. Whilst the traditional term "Complete Decongestive Therapy (CDT)" refers to treatment that includes all the components that form part of conservative treatment, the new term "Decongestive Lymphatic Therapy (DLT", refers to treatment in a very broad sense and, without the strict need for the use of all the components that form part of conservative treatment.  The treatment focus and term designated as "Decongestive Lymphatic Therapy (DLT)" was developed as a cost-saving non-investment strategy, in order to exclude Manual Lymphatic Drainage (MLD) conducted by therapists at the specialist level.

When the term "Decongestive Lymphatic Therapy (DLT)" is used, it represents or designates many variations of treatment, including the treatment options made up of one single component, such as the use of compression pump devices (IPC) or multi-layer bandaging alone. The term Decongestive Lymphatic Therapy (DLT) appears therefore as a "Low-Cost" alternative treatment option to replace the conservative treatment.

WHAT TERMS AND ABBREVIATIONS ARE USED BY SCIENTIFIC SOCIETIES TO DESCRIBE LYMPHEDEMA TREATMENT?

The term and abbreviation used by the ISL (International Society of Lymphology) are:

• Complete Decongestive Therapy (CDT) 

The term and abbreviation NOT USED by the ISL (International Society of Lymphology) are:

• Decongestive Lymphatic Therapy (DLT) 

WHAT DOES THE INTENSIVE PHASE I OF THE CONSERVATIVE TREATMENT "COMPLETE DECONGESTIVE THERAPY(CDT)" INCLUDE?

• Skincare.

• Decongestive Exercises.

• Manual Lymphatic Drainage (MLD) (conducted by therapists at the specialist level).

• Multi-layered Bandage Wrapping (conducted by therapists at the specialist level)).

• Custom-made low-stretch Compression Garments (Flat knit).

• Patient Education (for the Maintenance Phase).

• Compression Pumps (this is an optional adjuvant, and must be accompanied by Manual Lymph Drainage (MLD) conducted by therapists at the specialist level)).  

According to the German Scientific Society Guidelines, isolated application of single components is not recommended, and Complex Decongestive Therapy (CDT) should be used in its entirety. Isolated compression therapy of the extremities may increase swelling at the root of the extremity and may even lead to genital lymphoedema.

Read more about what is the best treatment option for lymphedema HERE. 

WHAT DOES THE NEW MODIFIED TREATMENT OPTION "DECONGESTIVE LYMPHATIC THERAPY (TDL)" REPRESENT?

1.   It can represent treatment consisting of the use of one single component for Phase        1(intensive or reduction phase), such as the use of pneumatic pumps (IPC) or multi-layer bandaging isolatedly, without the inclusion of Manual lymphatic drainage (MLD) conducted by therapists at the specialist level. (This can cause serious complications for patients).

2.    It can represent treatment for Phase 1(intensive or reduction phase) which suppresses multilayer bandaging conducted by a therapist at a specialist level, and replaced by patient-self-applied multi-layer bandaging. (This can cause severe complications for patients according to the ISL). 

3.    It can represent treatment that suppresses Manual Lymphatic Drainage (MLD) conducted by therapists at the specialist level for Phase 1(intensive or reduction phase), and replace it with self-drainage, a simplified version of drainage applied by the patient. (The efficacy of simple lymphatic drainage (SLD) as a treatment option for the reduction phase does not have sufficient scientific evidence). 

     (Read more about strategies to discredit Manual Lymphatic Drainage HERE)

Patients should be especially careful when choosing a Lymphedema Multidisciplinary Expert Center of Reference, as not all countries and centers provide the same treatment options. The best choice is a reference center that provides Complete Decongestive Therapy (CDT), which is recognized as the "Gold Standard" treatment for Lymphedema. Read more about which country has the best public healthcare coverage of lymphedema HERE.

References:

GERMAN SCIENTIFIC SOCIETY GUIDELINE

THE INTERNATIONAL SOCIETY OF LYMPHOLOGY

EFFECTIVENESS AND SAFETY OF COMPLETE DECONGESTIVE THERAPY OF PHASE I

THERAPEUTIC EFFICACY OF COMPLEX DECONGESTIVE THERAPY IN THE TREATMENT OF THE LOWER EXTREMITIES

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