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

Introduction
Lymphoedema is a progressive chronic
condition that affects a significant number
of people and can have deleterious effects on
patients' physical and psychosocial health.
Even though it may be greatly ameliorated by
appropriate management, many patients
receive inadequate treatment, are unaware
that treatment is available or do not know
where to seek help. Several recent systematic
reviews have highlighted the distinct lack of
evidence for the optimal management of
lymphoedema 1-3 . By presenting a model for
best practice in lymphoedema in adults, this
document aims to raise the profile of the
condition and improve the care that patients
receive.
ABOUT THIS DOCUMENT
The guidance provided here was derived
from a UK national consensus on standards
of practice for people who are at risk of or
who have lymphoedema (Box 1). The
consensus process (Box 2) was launched in
2002 and was driven by the Lymphoedema
Framework with input from national patient
support groups, patients with
lymphoedema, national professional
lymphoedema groups, clinical experts and
industry (Appendix 1). Production of this
document included review by an
international panel of experts and
endorsement by key national lymphoedema
organisations.
The recommendations resulting from the
consensus approach are included where
relevant. Each recommendation has been
classified according to the UK NHS Health
BOX 2 Consensus process
The recommendations made in this document
are the result of a highly rigorous, systematic
process based on an explicit methodology of
consultation and consensus4 that involved:
■ developing multidisciplinary, nationally
representative groups
■ identifying and critically appraising the best
available information
■ linking recommendations to supporting
evidence
Technology Assessment model for guideline
development (Box 3) 4 .
This document will be reviewed and
updated after five years. Key references
have been included; a complete list of the
references used in the preparation of the
text can be found at: www.lf.cricp.org.
ABBREVIATIONS
ABPI: ankle-brachial pressure index
IPC: intermittent pneumatic compression
MLD: manual lymphatic drainage
MLLB: multi-layer inelastic lymphoedema
bandaging
SLD: simple lymphatic drainage (self massage)
TBPI: toe-brachial pressure index
Standard 1: Identification of people at
risk of or with lymphoedema
Systems to identify people at risk of or
with lymphoedema, regardless of cause,
will be implemented and monitored to
ensure that patients receive high quality
education and lifelong care
Standard 2: Empowerment of people at
risk of or with lymphoedema
Individual plans of care that foster selfmanagement
will be developed in
partnership with patients at risk of or
with lymphoedema (involving relatives
and carers where appropriate), in an
agreed format and language
Standard 3: Provision of lymphoedema
services that deliver high quality clinical
care that is subject to continuous
improvement and integrates
community, hospital and hospice based
services
All people at risk of or with
lymphoedema will have access to trained
healthcare professionals, including
lymphoedema specialists, who will work
to agreed standards for comprehensive
ongoing assessment, planning,
education, advice, treatment and
monitoring. Care will be of a high
standard and subject to continuous
quality improvement
INTRODUCTION
BOX 3 Classification of
recommendations4 A
Clear research
evidence
B
Limited supporting
research evidence
C
Experienced common
sense judgement
BOX 1 Standards of practice for lymphoedema services, adapted from 5
Standard 4: Provision of high quality
clinical care for people with
cellulitis/erysipelas
Agreed protocols for the rapid and
effective treatment of cellulitis/
erysipelas, including prevention of
recurrent episodes, will be
implemented and monitored by
healthcare professionals who have
completed recognised training in this
subject
Standard 5: Provision of compression
garments for people with
lymphoedema
Agreed protocols for assessment for
and the provision of compression
garments for people with
lymphoedema, or where warranted,
those at risk of lymphoedema, will be
implemented and monitored
Standard 6: Provision of multi-agency
health and social care
Following comprehensive assessment,
any patient at risk of or with
lymphoedema who requires multiagency
support will have access to and
receive care appropriate to their needs
from health and social services
BEST PRACTICE FOR THE MANAGEMENT OF LYMPHOEDEMA 1