Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Brix, B.
Effects of Physical Therapy on Fluid Mobilization, Hemodynamic Responses and Vascular Function in Lower Limb Lymphedema Patients
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Graz Medical University; 2021. pp. 135
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- Autor*innen der Med Uni Graz:
- Steuber Bianca
- Betreuer*innen:
- Goswami Nandu
- Rössler Andreas
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- Abstract:
- Purpose: Lymphedema is characterized by massive tissue swelling due to lymphatic system dysfunction. Complete decongestive therapy (CDT), a three-week physical therapy, consists of manual lymphatic drainage (MLD) and tissue compression. It aims at mobilizing lymphatic fluid and at volume reduction. Although lymphatic fluid is known to be returned into the blood stream, it is not yet known how the body copes with the excess fluid mobilized during physical therapy. Therefore, this thesis aimed at investigating the effect of CDT on fluid shifts, hemodynamic responses as well as vascular function systematically over three weeks of CDT and due to MLD. Methodology: Measurements were conducted on day 1, 2, 7, 14 and 21 of CDT, before - and after - MLD in 13 patients with primary and secondary stage II lower lymphedema. Perometry and bioelectrical impedance spectroscopy were used to investigate limb volume, segmental and whole-body fluid composition (total body water (limbTBW, %TBW), extracellular (limbECF, %ECF) and intracellular (limbICF, %ICF fluid), as well as ECF/ICF & limbECF/limbICF). Blood samples were collected to assess plasma hyaluronic acid levels (pHA), plasma volume changes (PVC) and plasma component concentrations. Hemodynamic responses were evaluated continuously during a sit-to-stand test, consisting of seated baseline, standing and a recovery phase. Plasma asymmetric dimethylarginine (ADMA) levels, carotid-femoral pulse wave velocity (PWVcf), brachial flow mediated dilatation (FMD) and retinal microvasculature analysis were assessed to determine endothelial/vascular (dys-)function. Results: Leg volume, limbECF, limbICF, limbECF/limbICF, %TBW and %ECF significantly decreased over three weeks of CDT. The greatest reductions occurred within the first week of CDT. MLD led to significant increases in limbICF, %TBW and %ICF, whereas ECF/ICF reduced due to MLD. Plasma volume, albumin and albumin to globulin ratio increased significantly post-MLD. MLD further led to the increase in white blood cell and neutrophils as well as a decrease in eosinophils. pHA levels did not change due to lymphedema therapy. Three weeks of CDT led to a significant reduction in resting diastolic blood pressure. Results further showed significantly lower heart rate during orthostatic loading post-MLD on day 14 and day 21 of CDT. Although lymphedema patients did not show elevated levels at baseline, ADMA reduced significantly due to MLD. Conclusion: Complete decongestive therapy leads to fluid shifts in lymphedema patients. The major fluid shift effects occur within the first week of therapy. Fluid shifts due to lymphedema therapy were reflected in plasma volume and protein concentration increases as well as cell counts changes. Plasma hyaluronic acid levels might not be a suitable biomarker for lymphatic flow in lymphedema patients undergoing therapy. Lymphedema patients do not seem to be at a higher risk for orthostatic intolerance and falls. Although, lymphedema patients do not seem to show signs of endothelial function at baseline, manual lymphatic drainage seems to have a beneficial effect, as it led to reductions in AMDA levels.