Practice Patterns of Physical Therapists and Physical Therapist Assistants Treating Patients with Breast Cancer Related Lymphedema

Overview

Journal Support Care Cancer

Specialties Critical Care
Oncology

Date 2023 Jan 26

PMID 36701027

Authors

Meredith Wampler

Elizabeth Campione

Charlotte A Bolch

Affiliations

Soon will be listed here.

Abstract

Purpose: The purpose of this study is to describe practice patterns of physical therapists (PT) and physical therapist assistants (PTA) who treat patients with breast cancer-related lymphedema and determine if they are adherent to best evidence recommendations for lymphedema diagnosis and intervention.

Methods: An electronic survey to collect practice pattern data of PTs and PTAs who treat patients with BCRL was distributed. A descriptive and quantitative statistical analysis was performed.

Results: Twenty-six percent of respondents read the American Physical Therapy Association sponsored lymphedema diagnosis clinical practice guideline (CPG) and 20% read the lymphedema intervention CPG. Lymphoscintigraphy was the only diagnosis or intervention tool with a significant difference in use between therapists who read versus did not read the CPGs. Adherence to "should do" recommendations was variable: bioimpedance (18.2%), volume calculation (49.3%), ultrasound (0%), patient reported outcome tools (64.9%), compression garments (43.9%), exercise (87.2%), and compression bandaging (56.8%).

Conclusions: There is variability in adherence to recommendations for both the lymphedema diagnosis and intervention CPGs. Interventions to improve implementation and adherence to CPG recommendations are warranted.

Citing Articles

Barriers and facilitators to implementation of APTA's breast cancer-related lymphedema diagnosis and intervention clinical practice guidelines.

Campione E, Wampler M, Bolch C, Krzak J J Cancer Surviv. 2023; 19(1):397-406.

PMID: 37853271 DOI: 10.1007/s11764-023-01475-1.

References

Jeffs E, Ream E, Taylor C, Bick D . Clinical effectiveness of decongestive treatments on excess arm volume and patient-centered outcomes in women with early breast cancer-related arm lymphedema: a systematic review. JBI Database System Rev Implement Rep. 2018; 16(2):453-506. PMC: 5828398. DOI: 10.11124/JBISRIR-2016-003185. View

Levenhagen K, Davies C, Perdomo M, Ryans K, Gilchrist L . Diagnosis of Upper Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of the American Physical Therapy Association. Phys Ther. 2017; 97(7):729-745. PMC: 5803775. DOI: 10.1093/ptj/pzx050. View

Davies C, Levenhagen K, Ryans K, Perdomo M, Gilchrist L . Interventions for Breast Cancer-Related Lymphedema: Clinical Practice Guideline From the Academy of Oncologic Physical Therapy of APTA. Phys Ther. 2020; 100(7):1163-1179. PMC: 7412854. DOI: 10.1093/ptj/pzaa087. View

Armer J, Ostby P, Ginex P, Beck M, Deng J, Fu M . ONS Guidelines™ for Cancer Treatment-Related Lymphedema. Oncol Nurs Forum. 2020; 47(5):518-538. DOI: 10.1188/20.ONF.518-538. View

Bundred N, Stockton C, Keeley V, Riches K, Ashcroft L, Evans A . Comparison of multi-frequency bioimpedance with perometry for the early detection and intervention of lymphoedema after axillary node clearance for breast cancer. Breast Cancer Res Treat. 2015; 151(1):121-9. DOI: 10.1007/s10549-015-3357-8. View

Woolf S, Grol R, Hutchinson A, Eccles M, Grimshaw J . Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999; 318(7182):527-30. PMC: 1114973. DOI: 10.1136/bmj.318.7182.527. View

Cabana M, Rand C, Powe N, Wu A, Wilson M, Abboud P . Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999; 282(15):1458-65. DOI: 10.1001/jama.282.15.1458. View

Sackett D, Rosenberg W, Gray J, Haynes R, Richardson W . Evidence based medicine: what it is and what it isn't. BMJ. 1996; 312(7023):71-2. PMC: 2349778. DOI: 10.1136/bmj.312.7023.71. View

Grimshaw J, Eccles M, Tetroe J . Implementing clinical guidelines: current evidence and future implications. J Contin Educ Health Prof. 2005; 24 Suppl 1:S31-7. DOI: 10.1002/chp.1340240506. View

10.

Zadro J, OKeeffe M, Maher C . Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? Systematic review. BMJ Open. 2019; 9(10):e032329. PMC: 6797428. DOI: 10.1136/bmjopen-2019-032329. View

11.

Zadro J, OKeeffe M, Allison J, Lembke K, Forbes J, Maher C . Effectiveness of Implementation Strategies to Improve Adherence of Physical Therapist Treatment Choices to Clinical Practice Guidelines for Musculoskeletal Conditions: Systematic Review. Phys Ther. 2020; 100(9):1516-1541. DOI: 10.1093/ptj/pzaa101. View

12.

Ryans K, Perdomo M, Davies C, Levenhagen K, Gilchrist L . Rehabilitation interventions for the management of breast cancer-related lymphedema: developing a patient-centered, evidence-based plan of care throughout survivorship. J Cancer Surviv. 2021; 17(1):237-245. DOI: 10.1007/s11764-021-00991-2. View

13.

Delitto A, George S, Van Dillen L, Whitman J, Sowa G, Shekelle P . Low back pain. J Orthop Sports Phys Ther. 2012; 42(4):A1-57. PMC: 4893951. DOI: 10.2519/jospt.2012.42.4.A1. View

14.

Kaplan S, Coulter C, Fetters L . Developing evidence-based physical therapy clinical practice guidelines. Pediatr Phys Ther. 2013; 25(3):257-70. DOI: 10.1097/PEP.0b013e31829491c5. View

15.

Rutten G, Degen S, Hendriks E, Braspenning J, Harting J, Oostendorp R . Adherence to clinical practice guidelines for low back pain in physical therapy: do patients benefit?. Phys Ther. 2010; 90(8):1111-22. DOI: 10.2522/ptj.20090173. View

16.

Corkery M, Edgar K, Smith C . A survey of physical therapists' clinical practice patterns and adherence to clinical guidelines in the management of patients with whiplash associated disorders (WAD). J Man Manip Ther. 2014; 22(2):75-89. PMC: 4017798. DOI: 10.1179/2042618613Y.0000000048. View

17.

Greenberg E, Greenberg E, Albaugh J, Storey E, Ganley T . Rehabilitation Practice Patterns Following Anterior Cruciate Ligament Reconstruction: A Survey of Physical Therapists. J Orthop Sports Phys Ther. 2018; 48(10):801-811. DOI: 10.2519/jospt.2018.8264. View

18.

Niihata K, Nishiwaki H, Kurita N, Okada H, Maruyama S, Narita I . Variations in actual practice patterns and their deviations from the clinical practice guidelines for nephrotic syndrome in Japan: certified nephrologists' questionnaire survey. Clin Exp Nephrol. 2019; 23(11):1288-1297. DOI: 10.1007/s10157-019-01772-z. View

19.

Willy R, Hoglund L, Glaviano N, Bolgla L, Bazett-Jones D . Survey of confidence and knowledge to manage patellofemoral pain in readers versus nonreaders of the physical therapy clinical practice guideline. Phys Ther Sport. 2022; 55:218-228. DOI: 10.1016/j.ptsp.2022.04.009. View

20.

Lang C, Macdonald J, Reisman D, Boyd L, Kimberley T, Schindler-Ivens S . Observation of amounts of movement practice provided during stroke rehabilitation. Arch Phys Med Rehabil. 2009; 90(10):1692-8. PMC: 3008558. DOI: 10.1016/j.apmr.2009.04.005. View