best practice for the management of lymphoedema ... - EWMA

ASSESSMENT
Psychosocial assessment
C Patients
with lymphoedema should
receive psychological screening to
identify those who require help to
cope with the condition and those who
require specialist psychological
intervention.
Lymphoedema can result in functional
impairment, reduced self esteem, distorted
body image, depression, anxiety, and
problems with sexual, family and social
relationships 7,10,47 . Psychosocial assessment
will highlight areas that require referral for
specialist intervention and factors that may
have an impact on management and
concordance with treatment.
Psychological evaluation should include
asking the patient how their swelling makes
them feel about themselves alongside
assessment for:
■ depression – eg low mood, loss of
interest, low energy, changes in weight,
appetite or sleep patterns, poor
concentration, feelings of guilt or
worthlessness, suicidal thoughts (Box 13)
■ anxiety – eg apprehension, panic attacks,
irritability, poor sleeping, situation
avoidance, poor concentration
■ cognitive impairment – may contribute to
lack of motivation and inability to be
independent
■ lack of motivation
■ ability to cope
■ understanding of disease and
concordance with treatment.
BOX 13 Screening for depression48 NICE recommends that screening for depression
should include the use of at least two questions
concerning mood and interest, eg:
■ During the last month, have you often
been bothered by feeling down, depressed
or hopeless?
■ During the last month, have you often
been bothered by having little interest or
pleasure in doing things?
Social factors that should be assessed
include:
■ accommodation – accessibility, general
living standards, heating/cooling
■ support – involvement of carers, effect of
lymphoedema on personal relationships,
social isolation
■ employment – ability to work, effect of
work on lymphoedema
■ education – ability to attend educational
establishment and study
■ financial status – benefit entitlement,
medical insurance
■ recreational activities, exercise, sport.
Mobility and functional assessment
Assessment of a patient's mobility and
functional status (Box 14) will contribute
to the formulation of a management plan
and determine whether referral for further
assessment is necessary. Functional
assessment of lymphoedema affecting
the head, neck, trunk or genitalia should
be undertaken by a lymphoedema
specialist.
The World Health Organization has
produced a standardised, cross-cultural,
non-disease specific tool for functional
assessment – the WHO Disability
Assessment Scale, available at:
www.who.int/icidh/whodas.
Patients with functional, joint or mobility
problems should be referred as appropriate
for physiotherapy and/or occupational
therapy assessment.
ASSESSMENT
BOX 14 Functional assessment of limbs affected by lymphoedema
Arm:
■ range of joint movement
■ ability to use fastenings, eg buttons, bra fastenings
■ ability to put on or remove underwear/compression garments or bandaging
■ hand grip and pincer movement (opposition of thumb and index finger)
■ effect of lymphoedema on activities of daily living
■ use of any aids
Leg:
■ range of joint movement
■ ability to get up from sitting or lying
■ ability to walk; gait analysis
■ ability to lift individual legs
■ posture when sitting and standing
■ ability to put on and take off footwear/compression garments or bandaging
■ suitability of footwear
■ effect of lymphoedema on activities of daily living
■ use of any aids
14 BEST PRACTICE FOR THE MANAGEMENT OF LYMPHOEDEMA