domingo, 14 de mayo de 2017

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 lymphedema organizations and practitioners to denominate the "Low-Cost" treatment options for lymphedema. Read more about what is the best treatment option for lymphedema HERE.

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 backed by long experience, some organizations and practitioners 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 and abbreviation "CDT" refers to treatment that includes all the components that form part of Conservative Treatment, the new term and abbreviation "DLT", refers to treatment in a very broad sense and, without the strict need for the use of all the components that are 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, and a final policy tool for the reduction in lymphedema-related healthcare costs.


When the term "Decongestive Lymphatic Therapy (DLT)" is used, it represents or designates many variations of treatment, including the treatment option made up of a 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 TERM AND ABBREVIATION ARE USED BY SCIENTIFIC SOCIETIES TO DESCRIBE LYMPHEDEMA TREATMENT?

The term and abbreviation used by the ISL (International Society of Lymphology):
  • Complete Decongestive Therapy (CDT) 

The term and abbreviation NOT USED by the ISL (International Society of Lymphology):
  • Decongestive Lymphatic Therapy (DLT) 


WHAT DOES THE INTENSIVE PHASE OF CONSERVATIVE TREATMENT (CDT) INCLUDE?

     1.   Skincare.

2.   Decongestive Exercises.

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

4.   Compression Pumps (it is optional, and must be accompanied by Manual Lymph Drainage (MLD) conducted by therapists at the specialist level)).

5.   Multi-layered Bandage wrapping (conducted by therapists at the specialist level)).

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

7. Patient education for the Maintenance Phase. 

(According to the German Scientific Society Guidelines, isolated application of single components is not recommended; 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). 



WHAT DOES THE NEW MODIFIED TREATMENT (TDL) REPRESENT?

1.   It can represent treatment consisting of the use of a single component for initial phase edema reduction, such as the application of pneumatic pumps (IPC) or multi-layer bandaging used alone, 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 initial phase edema reduction 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 the edema initial 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 lymphedema does not have sufficient scientific evidence). 


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


References:


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