Relationship Between Balance and Body Awareness in Lymphedema Patients

Overview

Lymphedema (LE) is a chronic condition caused by the accumulation of protein-rich fluid in the subcutaneous tissue as a result of insufficiency of the lymphatic system . Primary LE occurs due to an anomaly in the development of the lymphatic system, while secondary LE occurs as a result of subsequent damage to the lymph vessels or lymph nodes. The incidence of LE in the literature varies. It is thought that there are approximately 140-250 million patients with LE worldwide. While the incidence of LE is 1.4 in every 1000 people, primary LE accounts for one-fourth of this. Chronic inflammation, cellulitis, pain, fatigue, deformity, difficulty in movement, and difficulty in functional use of the affected extremity may occur due to untreated LE (5-6). Loss of joint mobility and developing asymmetry affect the individual's balance (7-9). To our knowledge, there are a limited number of studies evaluating lymphedema and balance (10-11). This study will evaluate individuals with unilateral edema in the lower extremity. We think that balance will be affected due to the increase in volume in the extremity, feeling the extremity heavy and feeling fullness. Body awareness is defined in physical therapy texts as a type of treatment aimed at awareness of how the body is used in terms of function, behavior and interaction with self-other (12-13). Body awareness includes attention directed to the body both in motion and motionless. It refers to awareness of both sensory inputs and motor control related to the integration of breath and movements, coordination and balance (14). Studies on body image in LE patients are also insufficient. As far as we can see, there is no study in the literature examining the relationship between balance and body awareness in lower extremity lymphedema patients with different lymphedema levels (mild, moderate, severe) according to objective assessment criteria in Turkish patients. In this study, our hypothesis is that balance and body awareness are more affected in patients with severe lymphedema compared to patients with mild and moderate lymphedema associated with secondary unilateral lower extremity lymphedema. Therefore, we aimed to compare female individuals with secondary unilateral lymphedema with healthy volunteer female individuals. Our study will include 28 female individuals with unilateral secondary lower extremity lymphedema who applied to Kayseri City Hospital, Physical Therapy and Rehabilitation Hospital between March 2023 and June 2023 and who meet the study criteria, and 28 healthy female individuals in the same age group. The sample group consisted of patients who had undergone lymphoscintigraphy in the past and were diagnosed with lymphedema as a result of scintigraphy and applied to Kayseri City Hospital, Physical Therapy and Rehabilitation Hospital for LE treatment. The "G\*Power 3.1" package program was used in the computer environment to evaluate the power and sample size of our study. As a result of the analysis, when the power is targeted as minimum 85% and the error amount is 0.05, the minimum sample size required to find a significant difference between the means has been determined as 28 individuals for each group (15). Individuals will be evaluated once. 1\. Maclellan RA, Couto RA, Sullivan JE, Grant FD, Slavin SA, Greene AK. Management of Primary and Secondary Lymphedema: Analysis of 225 Referrals to a Center. Ann Plast Surg. 2014; Aug;75(2):197-00. 2. Földi M, Földi E. Földi's textbook of lymphoLÖgy for physicians and lymphedema therapists (2nd ed.)Elsevier, Munich. 2006. 3. NLN Medical Advisory Committee. The diagnosis and treatment of lymphedema 2011. 4\. Rockson SG, Rivera KK. Estimating the population burden of lymphedema. Ann N Y Acad Sci. 2008;1131:147-54. 5. Andersen L, Hojris I, Erlandsen M, Andersen J. Treatment of breast-cancer-related lymphedema with or without manual lymphatic drainage--a randomized study. Acta Oncol. 2000;39(3):399-05. 6.Johansson K, Ingvar C, Albertsson M, Ekdahl C. Arm Lymphoedema, Shoulder Mobility and Muscle Strength after Breast Cancer Treatment ? A Prospective 2-year Study. Adv Physiother. 2001;3(2):55-66. 7\. Özkal Ö, Topuz S, Konan A, Kısmet K. Alt Ekstremite Yanık Yaralanması Olan Bireylerde Ağrı, Kinezyofobi, Denge Ve Fonksiyonellik Arasındaki İlişkinin İncelenmesi. Ankara Eğt. Arş. Hast. Derg. 2017;50(3):122-8. 8\. Truszczyńska A, Dobrzyńska M, Trzaskoma Z, Drzał-Grabiec J, Tarnowski A. Assessment of postural stability in patients with lumbar spine chronic disc disease. Acta of bioengineering and biomechanics. 2016;18(4):71-77. 9. Hassan B, Mockett S, Doherty M. Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis 68 and normal control subjects. Annals of the rheumatic diseases. 2011;60(6): 612-618. 10. Orhan C, et al. Meme Kanseri Tedavisiyle İlişkili Lenfödemi Olan Hastalarda Lenfödem Şiddetinin Yaşam Kalitesi, Üst Ekstremite Fonksiyon