domingo, 14 de mayo de 2017

BEWARE WITH NEW MODIFIED TERMINOLOGY AND ABRIVIATIONS DISCRIBING LYMPHEDEMA TREATMENT. MEDICAL DEFINITION, TERMINOLOGY AND ABBREVIATIONS. LYMPHEDEMA-LYMPHOEDEMA GLOSSARY OF TERMS


Due to new terminologies and abbreviations that are emerging in the field of lymphedema treatment, it is necessary to take note of the new vocabulary used by some international organizations to denominate the treatment for lymphedema. Whilst the International Society of Lymphology and Specialized Societies use the following terms and abbreviations to designate treatment: Combined physical therapy (CPT), Complete Decongestive Therapy (CDT) or Complex Decongestive Physiotherapy (CDP), which all describe the same Gold Standard treatment backed by long-standing experience, some organizations are now using the following modified term to describe treatment: “Decongestive Lymphatic Therapy (DLT)

It should be noted that there is a big difference between these descriptions, for they are not the same and they are not substitutive. While the traditional abbreviations and terms (CPT, CDT or CDP) refer to the need for a combination of all elements that are part of the Conservative Treatment, the new modified abbreviation and term DLT, refers to treatment in a general way, without strictly specifying the need of all the elements included in the traditional Conservative Therapy. 

The new abbreviation and term “Decongestive Lymphatic Therapy (DLT)”, totally excludes the words Combined, Complete or Complex. Therefore it can mean or represents many variations of therapies, including treatment formed by one single element, such as the use of compression pump devices (IPC) alone. The abbreviation and term DLT, appears as an alternative to define and substitute Conservative Lymphedema Treatment, so as to include more economical treatment options, such as self-treatments or the omission of Manual Lymph Drainage (DLM) therapy, conducted by specialized physiotherapists.


A SUMMARY OF TERMINOLOGY AND ABBREVIATIONS USED TO DESCRIBE LYMPHEDEMA TREATMENT


Terminology used by the ISL (International Society of Lymphology):
  • CPT -  Combined physical therapy
  • CDT - Complete or Complex Decongestive Therapy
  • CDP - Complex Decongestive Physiotherapy
  • MLD - Manual Lymph Drainage
  • IPC  - Intermittent Pneumatic Compression

New terminology not used by the ISL (International Lymphology Society):
  • DLT - Decongestive Lymphatic Therapy
  • SLD - Simple Lympahtic Drainage (Self applied Lymph Drainage)
  • MLLB - Multi-layer Lymphedema Bandaging
  • MODIFIED MLLB - Modified Multi-layer Bandaging (Self applied Multi-layer bandaging)
  • MODIFIED CDT - Modified Complete Decongestive Therapy

What does the Conservative Gold Standard Treatment include:


     1.   Skin care.

2.   Motion exercises.

3.   Manual lymph drainage-MLD ( conducted by specialized physiotherapists).

4.   Compression Pumps (it´s optional and can only be used if accompanied by MLD conducted by specialized physiotherapists).

5.   Multi-layered bandage wrapping (conducted by specialized physiotherapists).

6.   Low-stretch compression garments (custom made and specific for lymphedema).


What does the new modified term “Decongestive Lymphatic Therapy (DLT)” include, or exclude:

1.   It excludes the keywords: Combined, Complete or Complex.

2.   It can represent treatment consisting of one sole element, as the use of Pneumatic Pumps (IPC) alone, without MLD conducted by specialized physiotherapists. This can have serious side-effects for patients.

3.    It can represent treatment consisting of simple or modified versions of treatments. These havn´t  sufficient scientific evidence, and can lead to irreversible problems on the long run.

4.    It can represent treatment that suppress for the reduction of edemas, bandaging conducted by specialized physiotherapists, and incorporate patient self-administrated Multi-layer Bandaging (MODIFIED MLLB). This can cause severe complications for patients.

5.    It can represent treatment that suppress Manual lymphatic drainage (MLD) conducted by specialized physiotherapists, and incorporate Simple Lymphatic Drainage (SLD), a patient serf-administrated version of MLD. Although some say that SLD is said to be of psychological and symptomatic value to some patients, its efficacy as treatment for lymphedema does not have sufficient scientific evidence, and remains to be proven. 

References:

Consensus Document of the IDL- International Society of Lymphology
http://www.u.arizona.edu/~witte/2013consensus.pdf
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