診療と新薬・第 51 巻

第 11 号（2014 年 11 月）

31（1053）

EFFECTIVENESS OF COMPLEX PHYSICAL THERAPY (CPT) OF
LYMPHEDEMA IN A PROSPECTIVE BASELINE-CONTROLLED STUDY
IN ELEVEN DOMESTIC FACILITIESYoshikazu ASHINO, MD1), Yoshihiro OGAWA, MD2), Tsunenori ARAI, PhD3),
Kayoko SATO, CLT3), Lymphedema Multicenter Study Group
1）Aomori Prefectural Central Hospital, 2）Limbs Tokushima Clinic, 3）Goto College Lymphedema Institute

ABSTRACT
Objective: In a domestic prospective multicenter study, the effectiveness of complex
physical therapy（CPT）of lymphedema was evaluated.
Materials and Methods: Adult outpatients who required lymphedema therapy aftercancer surgery were registered in eleven lymphedema outpatient facilities. CPT was
conducted according to the study protocol, and data（body measurements to calculate theedema volume, quality of life（QOL）questionnaire）on the eﬀectiveness of the therapy wererecorded.
Results: Two hundred and thirty-three cases were analyzed. Signiﬁcant decrease in edemavolume was achieved in the intensive decongestion phase. No significant change in limb
volume was seen in the maintenance phase. The signiﬁcant improvement of QOL over thecourse of treatment was observed in the QOL assessment using the health survey SF-36（Medical Outcomes Study 36-Item Short-Form Health Survey: SF-36）and the questionnaire
regarding skin condition（Skindex 29）.
Conclusion: CPT's eﬀectiveness in decreasing edema volume in the intensive decongestion
phase was shown, and the maintenance of limb volume was conﬁrmed in the maintenancephase. Moreover, it was shown that QOL was improved after CPT as compared topretreatment scores.
Key words: lymphedema, complex physical therapy, multicenter study, edema volume,
quality-of-life assessment

Introduction
Complex physical therapy（CPT）was introduced toJapan from Germany in 1995 as a conservative medical
treatment for lymphedema. Full-scale implementation of
CPT began in 2000. CPT is recognized as standard
therapy by the International Society of Lymphology, 1,2
and a large number of theses on its effectiveness andsafety have been released in Europe and North
America.3-8 In Japan, despite the research on CPT has
been publicized thus far 9,10 its eﬀectiveness has only been
evaluated in single facilities. Therefore, in order to verify
the eﬀectiveness of CPT in multiple domestic facilities, aprospective multicenter study was performed.

Materials and Methods
This study was conducted as a prospective multicenter
epidemiological study （prospective open study）
pertaining to the effectiveness of complex physicaltherapy of lymphedema, using as its study subjects theoutpatients who visited the lymphedema departments of
the lymphedema multicenter study group during a period
from February 2009 through March 2010. The study was
based on the standard diagnostic and treatment methods
for lymphedema speciﬁed in the protocol, as devised by
the lymphedema multicenter study group（see 1. and 2.）.
The subjects of the study were adult patients who
required lymphedema therapy after cancer surgery. Of
those patients, the ones who satisfied the following
selection/exclusion criteria and signed the informed
consent, were registered in this study.
Subject Selection Criteria:
・Patients who received cancer surgery; and・Patients who had been diagnosed with upper- or lowerlimb lymphedema based on the results of interview andvisual examinations, palpation and ultrasound imaging,
and who required lymphedema treatment
・male or female of at least 20 years old or older upon

Corresponding author: Yoshikazu Ashino, MD Executive Medical Advisor
Department of Palliative Medicine, Aomori Prefectural Central Hospital
Address: 2-1-1 Higashi Tsukurimichi, Aomori City, Aomori Prefecture 030-8553 Japan
Tel: 017-726-8111 Fax: 017-726-8325 ashino52@giga.ocn.ne.jp32 （1054）

診療と新薬・第 51 巻

None

Slight

第 11 号（2014 年 11 月）

MildModerate

SevereFig. 1 Ultrasound imaging of EFS

registration.
Subject Exclusion Criteria:
・Primary lymphedema patients;
・Patients in whom edema developed during theproliferation of cancer cells in the lymphoreticular system（e.g., edema caused by lymph-node metastasis）;
・Patients whose life expectancy was a year or less;・Patients who were/were going to be participating inclinical trials of pharmaceuticals and/or medical
equipment pertaining to lymphedema;・Venous edema accompanied by acute phase thrombus,
generalized edema such as cardiac and renal edemas, ormixed edema caused by multiple factors;
・Patients whose lymphedema treatment wascontraindicated due to their pathological conditions orother reasons; and・Patients whose physicians had determined that thecontinuous data collection would be diﬃcult due to their
physical/mental conditions and/or living environments.
Additionally, it was determined that initiation of thestudy must be approved by the Ethics Committee of eachparticipating hospital.
1. Diagnostic Method of Lymphedema
The diagnostic method and the staging speciﬁed in the
protocol of this study were as follows:
1.1. Diagnosis Based on Ultrasound Imaging
Using the linear probe（center frequency of 7.5 MHz
and maximum depth of ﬁeld of 4 cm as the standard）, the
subcutaneous adipose tissue structure of the limbs was
examined in order to confirm the presence of thedestruction of the layer structure（decrease in tissue
contrast, increase in echogenicity）and increase inadipose tissue as well as the Echo-Free Space（EFS）in
the subcutaneous adipose tissue. Eight points, generally
used as measuring points of the circumference of thelimbs, were used as observation points for the respective
upper and lower limbs. The level of free water in the
subcutaneous adipose tissue was evaluated using the EFS
as an index with the following five-grade scale（Figure1）:

None: No EFS is observed in the subcutaneous adipose
tissue.
Slight: EFS is observed in the form of dots or lines.
Mild: The EFS lines further expanded and show an
obvious belt-like shape.
Moderate: Several lines of belt-like EFS are observed,
and those belts begin to align in the vertical direction.
Severe: It can be observed that the subcutaneous
adipose tissue is floating in a cobblestone-like state in
EFS.
1.2. Staging in combination with UltrasoundFindings
This study conformed to the staging determined by theInternational Society of Lymphology. 1,2 Additionally, aclearer staging was achieved by adding the evaluation
criteria based on the ultrasound imaging, aiming for moreobjective evaluation.
Stage 0: Although no obvious edema is observed during
the interview and visual examinations and palpation, aslight tension is present on the surface of skin. The
decrease in the tissue contrast within the subcutaneous
adipose tissue（increased echogenicity）is observed on
the echo. No increase is observed either in the adipose
tissue or in the EFS in the adipose tissue.（EFS = None）
Stage 1: Although a slight degree of skin tension canbe seen during interview and visual examinations andpalpation, no hardness is present on the skin. A slightincrease in adipose tissue is observed, as well as thedecrease in tissue contrast in the subcutaneous adipose
tissue on the echo. No EFS can be seen.（EFS = None）
Stage 2: The edema is evident during interview andvisual examinations and palpation, and it is partially
accompanied by skin hardness. The structural destruction
on the subcutaneous adipose tissue and the increase in
the adipose tissue are evident on the echo. EFS can or
cannot be observed.（EFS = None ‒ Moderate / Severe）
Stage 3: This stage can be determined by the fact thatan obvious lymphedema is accompanied by skincomplications. The obvious structural destruction of the
subcutaneous adipose tissue, the increase in the adipose
tissue and belt-like or cobblestone-like EFS can be診療と新薬・第 51 巻

observed on the echo as well.（EFS = Moderate ‒Severe）
2. Treatment Methods
The following four programs were conducted ascomplex physical therapy（CPT）:（1）skincare;（2）manual lymphatic drainage（MLD）;（3）compression
therapy using elastic bandages（Bdg.）or elastic
compression garments; and（4）kinesitherapy undercompression. The treatment period was divided into twophases: the intensive decongestion phase and themaintenance phase. However, in Japan lymphedema is
treated mostly in the outpatient setting. Because it wasdifficult to conduct intensive care on a daily basis asrecommended in the guidelines of overseas countries,11, 12
the definitions of intensive decongestion and themaintenance phases were determined speciﬁcally for thisstudy and are described below. Treatment wasadministered by nurses, physiotherapists, occupational
therapists and massage therapists with expert knowledge
in lymphedema treatment and under the supervision of aphysician.
2.1. Intensive Decongestion Phase
MLD at least for 60 minutes, skincare, compression
therapy and kinesitherapy were given by a single
practitioner to stage 2 patients with moderate to severe
EFS and/or signiﬁcant skin hardness and stage 3 patients.
This treatment was repeated at least once a week basedon the standard of three days a week. During theintensive decongestion phase the QOL evaluation form
was ﬁlled out at two occasions.
2.2. Maintenance Phase
MLD for at least 40 minutes and Bdg.（as required）
were conducted by a single practitioner to stage 0, 1 andstage 2 patients with none to mild EFS and no signiﬁcantskin hardness. These procedures were performed at least
twice a month when introducing treatment to a newpatient. For all other occasions the above procedures
were performed once in a period of one month to threemonths. The QOL evaluation form was ﬁlled out once amonth.（However, if the treatment interval was longer
than one month, the form was filled out upon eachtreatment.）In addition to the treatment self-careguidance was given to the patients at the outpatient
department.
Regarding the intensive decongestion ‒ maintenancephase transition, after giving treatment several times, atherapist of each facility conﬁrmed that the conditions of
the affected limbs had changed through visual
examination and palpation. Subsequently, a physician
performed ultrasound diagnosis in order to determine
whether or not there was a shift to the maintenancephase. When the condition of the ultrasound observation
points had been recognized as Mild or less the intensive
decongestion phase changed to maintenance phase.

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3. Evaluation of Treatment Eﬀects
The lymphedema treatment eﬀects were evaluated bymeasuring the limb circumferences. The limb volume
was calculated as an approximate volume of a circular
truncated cone, and the volume change caused by thetreatment was evaluated. The volumes were calculatedusing the equation V = h（C2+Cc+c2）/ 12π, which
was reported by Casley-Smith.13 Furthermore, for theevaluation of treatment eﬀects on QOL, SF-36 was used
to evaluate health-related QOL and Skindex 29 was used
to evaluate skin-condition-related QOL.
4. Statistical Analysis Method
4.1. Upper and Lower Limb Volumes
Investigation in multiple facilities concerning theeﬀectiveness of lymphedema treatment in terms of edemavolume involves various kinds of patient data. Due tosuch diversity, a random-effects linear regression
analysis14 was conducted using Stata SE（Release 11.2）,
considering the upper- and lower-limb volume values（including the unaffected control limbs）of the patient
who received treatment at least once as dependent
variables.
As the factors that may possibly aﬀect the volumes, six
independent variables of the regression model were
determined as: 1）Upper or lower limbs, 2）Left andright, 3）Staging of lymphedema before treatment, 4）
Elapsed period since the ﬁrst measurement, 5）The ﬁrst
treatment phase classification and 6）The interaction（reciprocal action）between the treatment type×elapsed
periodThe ﬁrst three items of the list were speciﬁed as the
major items, of which eﬀects to the volume values werealready known or could be predicted. Chronologicalcomparison between before and after treatment served as
the most important index of effectiveness. Because theeffectiveness of treatment in each treatment phase is acombination of treatment phase and the elapsed period, it
can be shown as an item of interaction of treatment phase× elapsed period. The patient functioned as randomeﬀects.
4.2．QOL Evaluation
QOL data were obtained from answers to the SF-36
and Skindex 29 questionnaires, which were comprised ofeight and four subscales, respectively. The subscalescores of the ﬁrst and last surveys for each patient were
calculated, including mean values and SD. Calculations
for the SF-36 subscales were based on the norm-based
scoring method. For the statistical analysis, theWilcoxon signed-rank test was conducted on each scalefor each questionnaire separately.

Results
1. Outline of Subject Patients
At eleven facilities 233 cases of adult patients, who34 （1056）

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Table 1

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Eﬀect of the factors on the volumes（liters）of upper and lower limbs（random-eﬀect linear regression of limb volumes in 233 patients）
Regression
Factor（Variable）

coeﬃcient andp-valuestandard error（L）
Stages（initial edema volume compared to unaﬀected limbs）
Stage 0Stage 1
Stage 2
Stage 3

− 0.20 ± 0.12
− 0.26 ± 0.13
0.16 ± 0.14
1.33 ± 0.15

0.1
0.05
0.2
< 0.0005

1.04 ± 0.15
0.32 ± 0.13

< 0.0005
0.01− 0.14 ± 0.13

0.3

Phases（initial edema volume compared to unaﬀected limbs）
Intensive decongestion phase（Phase I）
Maintenance phase（Phase II）
Elapsed period（rate of limb volume change of not-treatedunaﬀected limbs, liters per year）

Interaction: treatment phase × elapsed period（compared to unaﬀected limbs）
Phase I × elapsed period（rate of limb volume change withintensive phase, liters per year）− 0.52 ± 0.19

0.007

Phase II × elapsed period（rate of limb volume change withmaintenance phase, liters per year）− 0.09 ± 0.18

0.6

Random-eﬀect linear regression intercept: volume of unaﬀected left arm

required lymphedema treatment after cancer surgery,were eligible for this study. Out of the 233 cases, 229
were female and four were males. The average age was
59.5 years old（29 - 88）. The major cancer types thatcaused lymphedema were 103 cases（44%）of uterine
cancer（including one case with ovarian cancer）; 86 cases（37%）of breast cancer; and 31 cases（13%）of ovariancancer（including one case with uterine cancer）.
2. Effectiveness of Lymphedema Treatment in
Terms of Edema Volume
Volume changes were calculated on the basis of 233
cases. Stage 2 was most frequently seen, accounting for
more than 70% of all cases. Neither the upper limbs nor
the lower limbs showed laterality in the distribution
tendency. With respect to the patients treatment-phase
distribution, patients with the maintenance phase alone
accounted for more than half of the subjects. Of thepatients who were in the intensive decongestion phase,more than half transitioned to the maintenance phase,because their conditions had improved during the courseof treatment.
The average treatment period was 93 ± 74 days,
ranging from one day to 304 days. The number oftreatments for each aﬀected limb was widely spread fromonce to 20 times in both treatment phases. However,patients who received treatment ten times or lessaccounted for 91% in the maintenance phase, while it was
80% in the intensive decongestion phase.

Table 1 shows the results of the random-eﬀects linear
regression analysis. At the time of the ﬁrst circumference
measurement the initial edema volumes of the affected
limbs were compared to those of the unaﬀected limbs anddivided into each stage and each treatment phase. Resultsfor each stage were as follows: − 0.20 ± 0.12 L（p = 0.1）
in stage 0; − 0.26 ± 0.13 L（p = 0.05）in stage 1; 0.16
± 0.14 L（p = 0.2）in stage 2; and 1.33 ± 0.15 L（p =0.0005）in stage 3. Here, only the aﬀected limbs in stage
3 showed a signiﬁcant increase in volume. The diﬀerent
treatment phases showed both a significant increase involumes with 1.04 ± 0.15 L（p < 0.0005）for theintensive decongestion phase and 0.32 ± 0.13 L（p =0.01）for the maintenance phase.
Volume changes during the study period have been
converted to an annual basis showing no significant
chronological change of the non-treated unaﬀected limbs（− 0.14 ± 0.13 L, p = 0.3）
. As a result of CPT, asigniﬁcant chronological decrease of − 0.52 ± 0.19 L（p= 0.007）was observed in the volumes of the affected
limbs that received treatment for the intensive
decongestion phase. No signiﬁcant chronological change
was observed in the volumes of the affected limbs thatreceived treatment for the maintenance phase（− 0.09 ±0.18 L, p = 0.6）.
Figure 2 depicts the actual volume change in eachtreatment phase for each of the upper and lower limbs.
The x-axis indicates the volume of each limb upon theinitial measurement, and the y-axis indicates the volume

診療と新薬・第 51 巻

第 11 号（2014 年 11 月）

Arms

.2
0

r ＝ − 0.2560（p ＝ 0.008）

2
1
0

−1

−.2

−2

−.4

Intensive Phase
Volume Change（liters）

Volume Change（liters）.4

r ＝ − 0.1352（p ＝ 0.468）.50Volume Change（liters）

Maintenance Phase
Volume Change（liters）

Legs
r ＝ − 0.2255（p ＝ 0.101）.635（1057）

r ＝ − 0.5635（p ＜ 0.00005）

1
0

−1
−2

−.5

−3
−4

−.1
1.5

Fig. 2

2.5
Initial Volume（liters）

3.5

4

8
12
Initial Volume（liters）

16

Correlation between initial volume (x-axis) and volume change at the last visit(last - initial, y-axis)change upon the final measurement. Generally, fromthese results it was observed that the volume change hada correlation with the volume at the initial measurement.
Particularly, during the intensive decongestion phase thelower limbs showed a signiﬁcantly high correlation with
the initially measured volume（r = − 0.5635, p <0.00005）.
3. Eﬀectiveness of Lymphedema Treatment on QOL
181 out of 233 possible answers to the questionnaires
could be obtained and evaluated, accounting for 78% of
all cases. Regarding the changes in the SF-36 norm-based
scores between the first and last visits all the subscale
items showed an increase after treatment. According toWilcoxon signed-rank test significant differences wereobserved in all items except for physical functioning,
PF （p = 0.065）, role（physical）, RP （p = 0.199）and
general health, GH （p = 0.313）. The scores±SD forthe remaining subscales before treatment were for bodypain, BP 46.2±10.1, vitality, VT 46.4±9.7, social
functioning, SF 42.5±12.6, role（emotional）, RE 40.3± 13.7 and mental health, MH 46.3±10.3. Thosescores increased after treatment to BP 47.8±9.5（p =0.022）, VT 49.0±9.1（p = 0.000）, SF 46.0±11.9（p=0.000）, RE 42.9±12.8（p = 0.017）and MH 48.4±9.9（p = 0.002）. Furthermore, regarding the changes of theSkindex 29 scores between the first and last visits,
according to Wilcoxon signed-rank test, all the subscale
items demonstrated a significant decrease after
treatment, thus indicating a significant improvement in

QOL related to skin condition. Scores±SD before
treatment were symptoms 22.3±16.5; functioning
23.8±18.5; emotions 34.8±19.4 and overall score 27.0
± 16.2. Those decreased after treatment to symptoms
19.0±14.2（p = 0.001）; functioning 19.2±16.4（p =0.000）; emotions 24.3±18.0（p = 0.000）and overall
score 20.7±14.7（p = 0.000）.

Discussion
The prospective multicenter study conducted in elevendomestic facilities reported in this paper was planned
because no report had been made about a multicenter
study on effects of treatment using a standardized
lymphedema diagnosis method and CPT. This study was
conducted in order to investigate the effectiveness of
CPT, focusing not only on the decrease in the edemavolume but also on the improvement in patients QOL interms of their overall health and skin condition.
Regarding the decrease in lymphedema using CPT, it isdifficult to directly compare absolute volume deduction
values and rates of decrease from diﬀerent publications to
the results of this study, because the results can differ
between upper and lower limbs, stages of the disease andtreatment phases, as well as the diﬀerence between the
CPT standards of foreign countries and those of Japan（where such treatment is mainly conducted in outpatient
departments）. Furthermore, this study did not evaluate aparticular treatment method employed by a single facility
for a certain period of time but instead included data
pertaining to various pathological conditions or situations

36 （1058）

診療と新薬・第 51 巻

of various types of patients in multiple facilities withdifferent treatment phases. In order to investigate theeﬀectiveness of CPT in terms of limb volumes using suchdiverse data, it is necessary to use an evaluation method
for the eﬀects of major factors that might possibly aﬀect
the limb volumes. Therefore, it was necessary to analyze
the influential factors using a random-effects linear
regression model. This analysis can also show thediversity in patients treatment phases as thestandardized annual base volume change rate of eachtreatment phase. The analysis results showed thefollowing facts: Lymphedema volume can be signiﬁcantly
reduced by the intensive decongestion phase of CPT andthrough further treatment in the maintenance phase, theupper and lower limb volumes can be maintained without
any change for a long period of time. It can be concluded
that the results of this study show the more universal
clinical eﬀectiveness of CPT treatment in Japan because,
despite diverse patient conditions, different therapists
and treatment phases in multiple facilities, the datacollected has clearly demonstrated that the goals of CPT
treatment（i.e. reducing lymphedema during theintensive congestion phase and maintaining limb volume
during the maintenance period）have been achieved.
Regarding SF-36, as used in this study to evaluate the
QOL related to lymphedema patients, improvement wasrecognized in all the subscales with statisticallysigniﬁcant diﬀerence in ﬁve of the subscales. It therefore
indicates that the improvement in health-related QOL has
been observed over a broad range. Moreover, in Skindex
29, which indicates skin-condition-related QOL,
significant improvement was recognized in all subscale
items（emotions, functions, symptoms and overall
scores）. It can therefore be surmised that CPT improves
QOL in various aspects by improving not only limb
volumes but also the patientʼs overall health and skincondition.

Conclusion
The prospective multicenter study conducted in elevendomestic facilities showed the eﬀectiveness of CPT in theintensive decongestion phase in terms of lymphedema
reduction. It also conﬁrmed the maintenance of the upperand lower limb volumes in the maintenance phase.
Moreover, the patients QOL evaluation using SF-36（QOL related to overall health）and Skindex 29（QOL
related to skin condition）showed that patients QOL wassignificantly improved after CPT, as compared to their
QOL before treatment.

第 11 号（2014 年 11 月）

Acknowledgement
The authors would like to sincerely thank Dr. Takako
Hamamoto（Tokyo Vascular Clinic）for her suggestions
and support as well as all following facilities for theircooperation and valuable contribution to this study:
Towada Municipal Central Hospital, Iwate Prefectural
Miyako Hospital, Meiwakai Nakadori Central Hospital,
Akita City Hospital, Japanese Red Cross Ishinomaki
Hospital, Saiseikai Chuwa Hospital, University of
Yamanashi Hospital, Limbs Tokushima Clinic, Nishibeppu
National Hospital, Sanshu Hospital, Goto College ClinicalCenter.

Disclosure Statement
None of the authors have any conflict of interest to
disclose.
References
1）International Society of Lymphology Executive Committee. The
Diagnosis and Treatment of Peripheral Lymphedema. Lymphology
1995; 28: 113-7.
2）International Society of Lymphology Executive Committee. The
Diagnosis and Treatment of Peripheral Lymphedema. Lymphology
2003; 36: 84-91.
3）Boris M, Weindorf S, Lasinski B et al. Lymphedema reduction by
noninvasive complex lymphedema therapy. Oncology 1994; 8: 95106.
4）Boris M, Weindorf S, Lasinski S. Persistence of lymphedema
reduction after noninvasive complex lymphedema therapy. Oncology
1997; 11: 99-109.
5）Ko DS, Lerner R, Klose G et al. Eﬀective treatment of lymphedemaof the extremities. Arch Surg. 1998; 133: 452-8.
6）Hamner JB, Fleming MD. Lymphedema therapy reduces the volumeof edema and pain in patients with breast cancer. Ann Surg Oncol
2007; 14: 1904-8.
7）Didem K, Ufuk YS, Serdar S et al. The comparison of two diﬀerent
physiotherapy methods in treatment of lymphedema after breast
surgery. Breast Cancer Res Treat 2005; 93: 49-54.
8）Pinell XA, Kirkpatrick SH, Hawkins K et al. Manipulative therapy ofsecondary lymphedema in the presence of locoregional tumors.
Cancer 2008; 112: 950-4.
9）Yamamoto R, Yamamoto T. Eﬀectiveness of the treatment-phase of
two-phase complex decongestive physiotherapy for the treatment of
extremity lymphedema. Int J Clin Oncol. 2007; 12: 463-8.
10）Yamamoto T, Todo Y, Kaneuchi M et al. Study of edema reduction
patterns during the treatment phase of complex decongestive
physiotherapy for extremity lymphedema. Lymphology 2008; 41: 806.
11）AWMF Leitlinien der Gesellschaft Deutschsprachiger Lymphologen:Diagnostik und Therapie der Lymphödeme. AWMF online 2009.
（Society of German-speaking Lymphologists, Diagnosis andTreatment of Lymphedema Guideline）
12）Lymphoedema Framework: Best Practice for the Management of
Lymphoedema. International Consensus. London: MEP Ltd, 2006.
13）Casley-Smith JR. Measuring and representing peripheral oedema andits alterations. Lymphology 1994; 27: 56-70.
14）Rabe-Hesketh S, Skrondal A. Multilevel and Longitudinal Modeling
Using Stata, Third Edition Volume I: Continuous Responses.（College
Station, Texas, U.S.A.: Stata Press）2012.

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リンパ浮腫の複合的理学療法の有効性に関する
国内 11 施設の前向きベースライン試験

蘆野吉和，MD1）

小川佳宏，MD2）

新井恒紀，PhD3） 佐藤佳代子，CLT3）

リンパ浮腫多施設研究グループ
1）青森県立中央病院
2）医療法人リムズ徳島クリニック
3）学校法人後藤学園附属リンパ浮腫研究所

要旨【目的】国内多施設研究において，リンパ浮腫の複合的理学療法（Complex Physical Therapy：CPT）の有効性を確認する。
【方法】11 施設のリンパ浮腫外来において，悪性腫瘍術後にリンパ浮腫治療を必要とする成人患者が登録された。実施計画書に基づき CPT を実施し，治療の有効性に関するデータ〔浮腫容積の計算に必要な身体計測値，生活の質（Quality of Life: QOL）質問票〕を記録した。
【結果】233 例を解析した。集中排液期の患者では，浮腫容積の有意な減少がみられた。維持治療期の患者では，上下肢容積の有意な変化はみられなかった。SF-36 健康調査（Medical Outcomes Study 36-Item
Short-Form Health Survey: SF-36）および皮膚の状態についてのアンケート（Skindex 29）を用いた
QOL 評価では，治療による有意な改善が認められた。
【結論】CPT により集中排液期では浮腫容積が有意に減少した。また，維持治療期においては，上下肢容積の維持が確認された。さらに，治療前と比較して，CPT 後の患者の QOL が有意に改善されている
ことが示された。