Asociacion Galega de Linfedema: BEWARE WITH NEW MODIFIED TERMINOLOGY AND ABRIVIATIONS DISCRIBING LYMPHEDEMA TREATMENT

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 the Intensive Treatment: Combined physical therapy (CPT), Complete Decongestive Therapy (CDT) or Complex Decongestive Physiotherapy (CDP, which describes Gold Standard treatment backed by long-standing experience, some organizations are using the following new and modified term to describe treatment: “Decongestive Lymphatic Therapy (DLT)”

It should be noted that there is a big difference between these descriptions, they are not the same and they are not substitutive. While the traditional terms (CPT, CDT or CDP) refer to the need for a combination of all elements that are part of the Conservative Treatment, the new term DLT refers only to treatment in general without specifying the need Of the incorporation of all elements included in conservative therapy. The term “Decongestive Lymphatic Therapy (DLT)” totally excludes the words: Combined, Complete and Complex. Therefore it can mean or represent many variations of therapies, including treatment formed by one single element, such as the use of compression pump devices (IPC) alone. The term DLT appears as an alternative to define lymphedema therapy as opposed to conservative 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.

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, conducted by specialized physiotherapists 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 (they are specific for lymphedema)

What does the new term “Decongestive Lymphatic Therapy (DLT)” include, and what does it not include:

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 incorporate simple or modified versions of treatments. These can lead to irreversible problems on the long run.

4. It can 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 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 remains to be proven.

References:

Consensus Document of the IDL- International Society of Lymphology

http://www.u.arizona.edu/~witte/2013consensus.pdf

(consulted 30/05/2017)

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