domingo, 14 de mayo de 2017

PRECAUTION WITH NEW LOW-COST MODIFIED LYMPHEDEMA TREATMENT OPTIONS - Definition of Terminologies and abbreviations - Lympedema Expert Centres of Reference/Excellence - 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 new 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 uses the term and abbreviation "Complete Decongestive Therapy (CDT)" to designate the first-line (Gold Standard) Conservative Treatment backed by long experience, some organizations and practitioners are now using the 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 are not substitutive. Whilst the traditional term and abbreviation "CDT" refers to treatment that includes all the components that are 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 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 physiotherapists at 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) therefore appears as a "Low-Cost" alternative treatment option to replace the Conservative Treatment.

TERMS AND ABBREVIATIONS 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 Conservative "Golf  Standard" Treatment include?

     1.   Skincare.

2.   Decongestive Exercises.

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

4.   Compression Pumps (optional, can only be used if accompanied by Manual Lymph Drainage (MLD) conducted by physiotherapists at specialist level)).

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

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


What does the new modified term “Decongestive Lymphatic Therapy (DLT)” represent?

1.   It can represent treatment consisting of the use of a single component for edema reduction, such as the application of Pneumatic Pumps (IPC) or Multi-layer Bandaging in isolation, without the inclusion of Manual lymph drainage (MLD) conducted by physiotherapists at specialist level(This can cause serious complications for patients).

2.    It can represent treatment for edema reduction which suppresses Multilayer Bandaging conducted by a physiotherapist at 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 physiotherapists at specialist level for edema reduction, 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 Centre of Reference/Excellence, as not all countries and centers offer or provide the same treatment options. The best choice is the Expert Reference Centre of Excellence which 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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