Decongestive Physiotherapy Helps Patients with Painful Leg Swelling

Combination Approach Benefits Patients with Chronic Venous Insufficiency or Lymphedema, Reports Topics in Geriatric Rehabilitation

Newswise — For patients with painful swelling of the legs caused by chronic venous insufficiency (CVI), a combination treatment approach called "complete decongestive physiotherapy" improves symptoms, walking ability, and quality of life, reports a study in Topics in Geriatric Rehabilitation. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

Complete (or "complex") decongestive physiotherapy (CDP) can greatly reduce leg swelling and pain in patients with CVI, according to the new study, led by Yesim Bakar, Ph.D., P.T., of Abant Izzet Baysal University in Bolu, Turkey. Another paper in the same issue of TGR shows similar benefits of CDP in a patient with lymphatic obstruction (lymphedema) related to the skin condition psoriasis.

Complete Decongestive Physiotherapy Brings Good ResultsDr Bakar and coauthors evaluated the effects of CDP in 62 older adults (average age 65 years) with CVI. Patients with CVI have poor blood flow in the veins of the leg, leading to fluid buildup. This results in painful swelling, making it difficult for patients to walk and perform other activities. Usually only one leg is affected.

All patients were treated using the CDP approach, which combines four types of physical therapy treatments:• Manual lymph drainage—massage to promote drainage of the lymph nodes.• Skin care—moisturizers and other treatments for skin changes caused by poor circulation.• Compression—bandages are applied to prevent fluid from reaccumulating.• Exercise—simple leg exercises to improve blood flow and leg motion.

For the first month, patients met with a physical therapist five days a week for treatment. They also received education in performing each of the four types of therapy for themselves. The goal was to keep fluid buildup under control through lifelong, daily self-care.

The CDP treatment program dramatically reduced leg swelling—on average, fluid buildup in the affected leg decreased by the equivalent of nearly half a liter. Pain was also decreased, from an average score of 67 to 18 on a 100-point scale. Patients had improved walking ability, less pain when walking, and improved ability to perform daily activities. The authors believe that including exercise in the treatment program was a key factor in improving walking ability.

Dr. Bakar is also a co-author of the other paper, which reports on the use of CDP in a woman with lymphedema related to the chronic skin condition psoriasis. In patients with lymphedema, obstruction of the lymph nodes causes similar symptoms of leg pain and swelling. In both the short and long term, CDP brought significant improvement in pain, swelling, and activity.

In recent years, CDP has become an accepted approach to treatment for lymphedema. Although not a cure, CDP incorporates several physical therapy techniques that can help keep fluid buildup, leg swelling, and pain under control.

The new studies are the first to evaluate the fully integrated CDP approach—including daily home maintenance therapy—in patients with CVI and psoriasis-related lymphedema. "CDP is a time-consuming process for patients and physiotherapists," Dr. Bakar and colleagues write. "However, it is widely used and an effective treatment for patients with lymphedema." The new results suggest that this combination physical therapy approach could also be very helpful for patients with leg pain and swelling caused by CVI.

About Topics in Geriatric RehabilitationTopics in Geriatric Rehabilitation is a peer-reviewed quarterly publication that presents clinical, basic, and applied research, as well as theoretic information, consolidated into a clinically relevant form. TGR is a leading resource for the healthcare professional practicing in the area of geriatric rehabilitation. TGR provides useful treatment information written by and for specialists in all aspects of geriatric care. Each issue focuses on a specific topic, providing best practices and dependable hands-on tips and techniques.

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