domingo, 14 de mayo de 2017

WHICH ARE THE TWO MAIN LYMPHEDEMA TREATMENT PROTOCOLS? - WHAT IS THE PRINCIPAL DIFFERENCE BETWEEN COMPLETE DECONGESTIVE PHYSIOTHERAPY (CDT) AND DECONGESTIVE LYMPHATIC THERAPY (DLT)? - Pediatric and Primary Lymphedema - Secondary Lymphedema - Organic Lymphatic Vascular Disease - Best Practices Management Guidelines / Treatment Protocol / Patient Care Pathways / Preventive Medicine / Rehabilitation Stratagies



In the wake of terminologies and abbreviations that are emerging in the medical field, it is necessary to take note of the new term that is being used to designate the (low-cost) treatment for lymphedema


Whilst the International Society of Lymphology (ISL) and most scientific societies use the term and initialism "Complete Decongestive Therapy (CDT)" to designate the (Gold Standard) conservative treatment, some health and lymphedema organizations are now replacing and 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 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 broader 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 with the primary purpose of limiting or excluding Manual Lymphatic Drainage (MLD) conducted by therapists at the specialist level.


When the term "Decongestive Lymphatic Therapy (DLT)" is usedit 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 thus as a "Low-Cost" alternative treatment option to replace the conservative treatment.




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

The term and initialism used by the International Society of Lymphology (ISL) and the German Scientific Society (Lymphedema STK Guideline) are:

COMPLETE DECONGESTIVE THERAPY - (CDT)



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 Guidelineisolated application of single components is not recommended, and Complex Decongestive Therapy (CDT) should be used in its entirety. Isolated compression therapy of the extremities without Manual Lymphatic Drainage (MLD) may increase swelling at the root of the extremity and may even lead to genital lymphoedema.





WHAT TERMS AND INITIALISMS ARE NOT USED BY SCIENTIFIC SOCIETIES TO DESCRIBE LYMPHEDEMA TREATMENT?

The term and initialism not used by the International Society of Lymphology (ISL) and the German Scientific Society (Lymphedema STK Guideline) are:

DECONGESTIVE LYMPHATIC THERAPY (TDL)



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 isolatedlywithout 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 scientific societies. Bandaging for edema reduction is not the same as maintenance bandaging.).
 

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).


4. It may represent treatment protocols where Manual Lymphatic Drainage (MLD) conducted by a specialized therapist is indicated only for very severe lymphedema (Elephantiasis Stage) and complicated cases (head, neck, and genitalia), excluding treatment for severe, moderate, and mild lymphedema. (Preventive medicine is not considered here).






IMPORTANT NOTICE 

Lymphedema is a serious chronic and progressive disease due to lymphatic dysfunction (Organic Lymphatic Vascular Disease). The clinical treatment of lymphedema is neither a cosmetic nor an aesthetic treatment. The treatment of lymphedema is to control its progression and alleviate the symptoms related to dysfunction of the lymphatic circulatory system. To prevent and avoid serious complications associated with treatment, such as the possible displacement of edema to previously unaffected areas when compression therapy is applied for volume reduction, patients should use highly specialized and experienced therapists. 

Professional qualification and instruction delivered remotely online are not the same as live hands-on practical instruction in the clinical training and certification of lymphedema therapists, similar to all other rehabilitation, medical, and surgical training programs, and especially for developing the necessary manual skills to treat a disease as complex as lymphedema. 

Patients should also take special care when choosing a "Multidisciplinary Center of Reference for Lymphedema", as not all countries and centers provide the same treatment options. The best choice is a center of reference that provides “Complete Decongestive Therapy - (CDT)”, which is recognized as the “Gold Standard” treatment for lymphedema. 

  • Read more about what is the best treatment option for Lymphedema HERE.
  • Read about what are the principal functions of Manual Lymphatic Drainage HERE.
  • Read about what are the strategies for the implementation of low-cost treatment options for Lymphedema HERE.

REFERENCES

(Click on the texts to read the research articles)

SCIENTIFIC SOCIETIES

PATHOPHYSIOLOGY

CUTANEOUS COMPLICATIONS
INFECTIOUS COMPLICATIONS
CELLULITIS / DERMATOLYMPHANGIOADENITIS
TUMOURS

TREATMENT

COMPRESSION GARMENTS

DISABILITY

DISFIGUREMENT

PSYCHOSOCIAL IMPACT

PEDIATRIC LYMPHEDEMA

LYMPHATIC FILARIASIS / PODOCONIOSIS



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  • WHAT KIND OF DOCTOR TREATS LYMPHEDEMA/LYMPHOEDEMA - WHAT TYPE OF DOCTOR IS SPECIALIZED IN LYMPHATIC DYSFUNCTION - WHICH MEDICAL SPECIALITIES ARE RELATED TO LYMPHEDEMA













CLICK ON THE TEXTS 
TO SEE  LYHMPHEDEMA INCIDENCE 
AND PREVALENCE






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