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Article

Addition of Lymphatic Stimulating Self-Care Practices Reduces Acute Attacks among People Affected by Moderate and Severe Lower-Limb Lymphedema in Ethiopia, a Cluster Randomized Controlled Trial

1
Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
2
National Podoconiosis Action Network, Addis Ababa 1000, Ethiopia
3
Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK
4
Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia
5
College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(12), 4077; https://doi.org/10.3390/jcm9124077
Received: 2 December 2020 / Revised: 11 December 2020 / Accepted: 14 December 2020 / Published: 17 December 2020
(This article belongs to the Special Issue Self-Management and Health Promotion in Chronic Disease)
Lymphedema causes disability and exacerbates poverty in many countries. The management of lymphatic filariasis (LF) and podoconiosis-related lymphedema involves daily hygiene to reduce secondary infections, but self-massage and deep-breathing, which have proven beneficial in cancer-related lymphedema, are not included. A cluster randomized trial in northern Ethiopia investigated the effects of lymphatic stimulation for people affected by moderate to severe lymphedema. Participants were allocated to either standard (control n = 59) or enhanced (intervention n = 67) self-care groups. Primary outcomes were lymphedema stage, mid-calf circumference, and tissue compressibility. Secondary outcomes were the frequency and duration of acute attacks. After 24 weeks, fewer patients were assessed as severe (control −37.8%, intervention −42.4%, p = 0.15) and there were clinically relevant changes in mid-calf tissue compressibility but not circumference. There was a significant between-group difference in patients who reported any acute attacks over the study period (control n = 22 (38%), intervention n = 7 (12%), p = 0.014). Daily lymphedema self-care resulted in meaningful benefits for all participants with a greater reduction in acute episodes among people performing lymphatic stimulation. Observations of a change in lymphedema status support earlier findings in Bangladesh and extend the demonstrated benefits of enhanced self-care to people affected by podoconiosis. View Full-Text
Keywords: lymphedema; lower limb; filariasis; podoconiosis; self-care; breathing; exercise; skin mobilisation; lymphatic massage lymphedema; lower limb; filariasis; podoconiosis; self-care; breathing; exercise; skin mobilisation; lymphatic massage
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MDPI and ACS Style

Douglass, J.; Hailekiros, F.; Martindale, S.; Mableson, H.; Seife, F.; Bishaw, T.; Nigussie, M.; Meribo, K.; Tamiru, M.; Agidew, G.; Kim, S.; Betts, H.; Taylor, M.; Kelly-Hope, L. Addition of Lymphatic Stimulating Self-Care Practices Reduces Acute Attacks among People Affected by Moderate and Severe Lower-Limb Lymphedema in Ethiopia, a Cluster Randomized Controlled Trial. J. Clin. Med. 2020, 9, 4077. https://doi.org/10.3390/jcm9124077

AMA Style

Douglass J, Hailekiros F, Martindale S, Mableson H, Seife F, Bishaw T, Nigussie M, Meribo K, Tamiru M, Agidew G, Kim S, Betts H, Taylor M, Kelly-Hope L. Addition of Lymphatic Stimulating Self-Care Practices Reduces Acute Attacks among People Affected by Moderate and Severe Lower-Limb Lymphedema in Ethiopia, a Cluster Randomized Controlled Trial. Journal of Clinical Medicine. 2020; 9(12):4077. https://doi.org/10.3390/jcm9124077

Chicago/Turabian Style

Douglass, Jan, Fikre Hailekiros, Sarah Martindale, Hayley Mableson, Fikre Seife, Tesfahun Bishaw, Mekdes Nigussie, Kadu Meribo, Mossie Tamiru, Getnet Agidew, Susan Kim, Hannah Betts, Mark Taylor, and Louise Kelly-Hope. 2020. "Addition of Lymphatic Stimulating Self-Care Practices Reduces Acute Attacks among People Affected by Moderate and Severe Lower-Limb Lymphedema in Ethiopia, a Cluster Randomized Controlled Trial" Journal of Clinical Medicine 9, no. 12: 4077. https://doi.org/10.3390/jcm9124077

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