Dolan, Gina

Williams, Edgar Mark

English

University of South Wales Research Explorer

PUBLIC / CYHOEDDUSIntermittent Pneumatic Compression for the Treatment of Lower Limb Lymphoedema:A pilot trial of Sequencing to Mimic Manual Lymphatic Drainage Versus Traditional Graduated Sequential Compression#Nyree Dunn1, Michelle Fishbourne2, E Mark Williams1, Gina Dolan1 and Jane H Davies31Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK 2Dewi Sant Hospital, CTMUHB, Pontypridd, UK  , 3Huntleigh Healthcare, Cardiff, UKRESEARCH & DEVELOPMENT CONFERENCE    Wednesday 23rd November 2022#With some insights and thoughts about conducting research in the NHS.  PUBLIC / CYHOEDDUSIntroduction: People with swollen legs due to inadequate lymph drainage can reduce the accumulation of excess fluid in the limbs by massage of the affected area. Recent advances in technology have allowed intermittent pneumatic compression (IPC) devices to develop so that their function mimics the process and principals of manual lymphatic drainage (MLD); however, research into the effectiveness of such devices is lacking.PUBLIC / CYHOEDDUSAim: These studies aimed to investigate the effectiveness of a IPC technique designed to mimic MLD (LymphAssistTM) (Panel A), compared with a typical sequential IPC regimen (Panel B).ABRQ.  Is the new technique better or worse than the established technique?Who is asking the question (the aims)  and interested in the answer (outcomes)?1. Patients:     Relief from swollen limbs, better QOL?2. Healthcare:   Better treatment and care. Cost effective?3. Scientist:  Understanding lymph drainage, improved knowledge? 4. Manufacturer:   More sales/improved technology?“Research questions aren't formulated by researchers in isolation, and research questions can only be answered if the research is funded. How the research is done can fundamentally affect its impact and value to different groups”The BMJ Research Forum teamCreatingthe Research ProjectStudy Design Questions1. Outcome measure:  Leg Volume?2. How to measure:  Tape or Perometer?3. Control versus Intervention?4. How long to treat?5. Sample size?6. Where to recruit participants and setting ?Study 1Study 2VsStudy 1Pilot Feasibility Stud 5, 113 (2019). https://doi.org/10.1186/s40814-019-0496-4Study 2PUBLIC / CYHOEDDUSStudy 3Results: The LymphAssistTM IPC regimen was significantly more effective in reducing distal leg volume than thesequential mode (mean volume reduction: 230 ± 135 ml vs 140 ± 84 ml, respectively, p = 0.01).Improvements in leg volume were transient as both groups demonstrated a rebound increase in volume during thewashout period (LymphAssist: 238 ±168 ml; Sequential 276 ± 158 ml, regimens, p = 0.3).SequentialIPC regimenConclusions: IPC (LymphAssistTM ) is effective in reducing limb volume in patients with lower limb lymphoedema. IPC that mimics the MLD process has been shown to be more effective in reducing leg volume compared with traditional sequential IPC in the distal leg. The subsequent increase in leg volume observed after withdrawal of IPC suggests that regular treatment is required to maintain its associated effects. IPC regimen SequentialStudy 4Accessory dataLessons Learnt1) Participant expectations.2) Participation availability and recruitment.3) Practical design.4) Collaboration between academia, healthcare and industry very productive.5) Educational component for all.6) Working with Health Professionals and their Networks7) Home use difficult to test. 8) Commercial drivers and research9) Further ResearchQuestion answered?1. Patient :     Reduces limb volume, continuous use required.2. Healthcare:   Cost effective, worthwhile?3. Scientist:  Technology assists lymph drainage. 4. Manufacturer:   The instrument reduces limb volume (clinically proven).Thank you:   This work was completed by Nyree Dunn and submitted successfully for her  PhDThe programme of research was overseen and supervised by:Professor E Mark WilliamsDr Gina DolanDr Jane DaviesClinical support was provided by:Michelle Fishbourne, Lymphoedema Clinic, Dewi Sant Hospital, CTMUHBLinda Jenkins, Lymphoedeama Clinic and CRIC,  St Woolos Hospital, ABUHB.Cheryl PikeTechnical Support (Supply of devices, garments and maintainance) was provided by:Dr Jon Evans and Wayne Harris.  Huntleigh HealthcareStudy governance and ethics overseen by University of South Wales and R&D CTMUHB.Funding was provided by the KESS 2 programme via Huntleigh Healthcare and awarded to EMW.

Intermittent Pneumatic Compression for the Treatment of Lower Limb Lymphoedema: A pilot trial (IMPRESS II Study) of Sequencing to Mimic Lymphatic Drainage Versus Traditional Graduated Sequential Compression

https://pure.southwales.ac.uk/ws/files/16710037/Intermittent_Pneumatic_Compression_for_the_Treatment_of_Lower_draft.pdf

Intermittent Pneumatic Compression for the Treatment of Lower Limb Lymphoedema: A pilot trial (IMPRESS II Study) of Sequencing to Mimic Lymphatic Drainage Versus Traditional Graduated Sequential Compression

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