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A needs assessment of Lymphoedema services in Fife: an exploration of Physiotherapy and District Nursing Management.

By Catherine Bulley and R Mcphee


Introduction: The physical and psychosocial effects of lymphoedema have\ud profound effects on function and quality of life. While the disease is incurable,\ud specific management is used to minimise and control symptoms. Strategies include\ud compression garments and bandaging, specialised massage, skin care, and exercise1.\ud A needs assessment of lymphoedema services in Fife was commissioned by\ud the Core Cancer Review Group in Fife and supervised by Queen Margaret Hospital.\ud An early finding indicated that many General Practitioners refer individuals with\ud lymphoedema to local Physiotherapy and District Nursing (DN) services. However,\ud the capability of these services in providing the required management was unknown.\ud Therefore, a postal survey was conducted to explore the levels of experience,\ud confidence and knowledge of Physiotherapy and DN staff in relation to the treatment\ud of lymphoedema.\ud Method: A postal questionnaire was sent to all Physiotherapy and DN\ud services (n=36 and 53) in Fife. This strategy was used to obtain a broad overview of\ud specific issues. The local ethics committee did not require a submission for ethical\ud approval. Descriptive analysis of responses to both open and closed questions was\ud carried out in relation to the number of clinicians represented by each response.\ud Results: Response rates from local Physiotherapy and DN units were 58% and\ud 53%, respectively. Findings are summarised below:\ud Clinicians represented: Physiotherapists (n=60) District Nurses (n=91)\ud % of clinicians with experience of\ud lymphoedema management\ud 26.67\ud 56.04\ud Mean number of patients treated\ud by each clinician\ud 2.94 1.27\ud % of clinicans with experience\ud who expressed confidence in\ud lymphoedema management\ud 25.00 27.45\ud Most frequently mentioned\ud management options (frequency\ud count)\ud Limb elevation (4);\ud massage (3); exercise\ud (3)\ud Compression garments\ud / bandaging (5); skin\ud care advice (3)\ud Fewer Physiotherapists than DNs had experience of lymphoedema\ud management, but those few had treated more patients. However, clinicians with\ud experience frequently lacked confidence in treating lymphoedema and the suggested\ud management strategies reflected incomplete knowledge regarding recommended\ud practice.\ud Conclusions: These findings represent a localised pilot investigation. The\ud issue requires further study to a greater depth and in different geographical regions.\ud Non-specialist Physiotherapists and DNs appear to lack experience, confidence and\ud knowledge of lymphoedema management. Therefore, specialist lymphoedema\ud services are recommended and increased awareness of management services and\ud strategies should be promoted.\ud References: 1. Badger, C. and Jeffs, E. (1997) “Macmillan Lymphoedema\ud Project.” London, Macmillan Cancer Relief

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