Are fewer circumference measurements reliable to determine volume measurements in lower limb lymphedema compared to every 4th cm?

Objective: In lymphedema management, lower limb volume is commonly assessed by circumference measurementevery 4th cm which is however time-consuming. The aim of this study is to evaluate the agreement between volumemeasurements derived from circumference measurements every 4th cm (V4) with every 8th cm (V8) and every 12th cm(V12) in patients with lower limb lymphedema (LLL) and to determine the test-retest reliability of these methods.Material-Method: Thirty women with unilateral or bilateral LLL were measured twice, two weeks apart usingcircumference measurements every 4th cm. Inclusion criteria: (i) primary or secondary LLL; (ii) persistent lymphedemafor the past 6 months; (iii) daily treatment with compression stockings. Exclusion criteria: (i) ongoing LE treatment; (ii)comorbidity affecting lower limb volume. Volume was calculated using the truncated cone formulae. Statistics: Intraclasscorrelation coefficient (ICC), Bland-Altman plots with limits of agreement, standard error of measurement (SEM%) and thesmallest real difference (SRD%).Results (preliminary): Overall, there are high agreement between the V4 and the V8 and V12 methods (ICCs 0.99).Also, the test-retest reliability is high for all three methods (ICC 0.99 for V4, V8 and V12, respectively) and the measurementerror low both for a group of subjects (SEM%: 1.2%-1.5%) and a single subject (SRD%: 3.4%-4.1%).Conclusions: The V8 and V12 methods agree sufficiently with the V4 gold standard method. All three methods are reliablewith small measurement errors indicating that real clinical changes can be detected over time. Fewer circumferencemeasurements can therefore be recommended in the management of LL

Sense of Coherence and the association with sociodemographics and disability related factors in persons with late effects of polio

BACKGROUND: Sense of Coherence (SOC) is important for successful adaptation in persons with life-long disabilities. A previous study has shown that persons with Late Effects of Polio (LEoP) have a level of SOC indicating that they generally have the ability to understand, handle and being motivated when dealing with stressful events and problems arising in their lives. However, no study has explored the associations between SOC, sociodemographics and disability related factors in persons with LEoP.OBJECTIVE: To explore the associations between SOC, sociodemographics and disability related factors in persons with LEoP.DESIGN: A cross-sectional design.SETTING: University hospital outpatient clinic.STUDY PARTICIPANTS: Ninety-three persons (mean age 74 years, 52% women) with LEoP.MAIN OUTCOME MEASUREMENTS: Swedish versions of the Sense of Coherence scale (SOC-13), Self-reported Impairments in Persons with late effects of Polio (SIPP) scale, Reintegration to Normal Living Index (RNL-I) (subscales "Daily functioning" and "Perceptions of Self") and Satisfaction With Life Scale (SWLS).METHODS: The participants responded to a postal survey with background information and the four rating scales. To determine factors associated with SOC, a hierarchical regression analysis was performed with SOC as the dependent variable.RESULTS: Higher age, less bothered by symptoms of LEoP, better perceptions of self and higher life satisfaction were significantly associated with a greater SOC score. The final model explained 60% of the variance in the SOC (R2 Adj= 0.60, p<.001).CONCLUSION: The strong association between SOC, higher age and disability related factors is important to consider in the rehabilitation of persons with LEoP. This knowledge can assist rehabilitation professionals to plan interventions that enable people with LEoP to develop strategies to better manage their daily life. This article is protected by copyright. All rights reserved

Test-Retest Reliability of the Reintegration to Normal Living Index (RNL-I) to Assess Perceived Participation in Adults With Late Effects of Polio

BACKGROUND: Many individuals with late effects of polio have difficulties participating in daily activities. The Reintegration to Normal Living Index (RNL-I) is a self-report questionnaire that evaluates perceived participation, but knowledge of the test-retest reliability and measurement errors in this population is lacking.OBJECTIVE: To evaluate the test-retest reliability of the RNL-I in adults with late effects of polio.DESIGN: A postal survey with a test-retest design.SETTING: University hospital outpatient clinic.PARTICIPANTS: Fifty-one adults (20 women and 31 men; mean age 72 years) with late effects of polio.MAIN OUTCOME MEASUREMENTS: The Reintegration to Normal Living Index (RNL-I).METHODS: The participants responded to the RNL-I twice, 3 weeks apart. Data were analyzed with the following statistical methods: percentage agreement (PA), quadratic kappa coefficients, the intraclass correlation coefficient (ICC), mean difference, standard error of measurement (SEM/SEM%), and the smallest real difference (SRD/SRD%).RESULTS: The PA (ie, the same scoring at both test occasions) was >70% for 10 of 11 items. The kappa coefficients showed good test-retest agreement (>0.61) for 7 items. The ICC was 0.88 and the mean difference was -0.74. The SEM (SEM%) was 7.4 (9.7%) and the SRD (SRD%) was 20.5 (27.0%).CONCLUSION: The RNL-I can be considered reliable for adults with mild to moderate late effects of polio. It can thereby be used to assess changes in perceived participation over time or after rehabilitation interventions, both for a group of individuals and a single individual.LEVEL OF EVIDENCE: III