Treatment Response to Different Lymphoedema Compression Programs Using a Pneumatic Compression Device

Study Overview
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Brief Summary
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Proof of principle study in order to determine if there is a difference in treatment effect across the 3 study groups when treating lower extremity lymphoedema using a pneumatic compression device.

Detailed Description
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This is a single center, 3 arm, prospective, randomized, clinical trial to assess the difference between 3 treatment options for achieving a measurable physiologic effect on lower extremity lymphedema with pneumatic compression device. Each intervention arm will include 10 completed subjects for a total of 30 completed subjects.

Official Title
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Physiologic Response to Varying Lymphoedema Compression Programs With the Flexitouch System

Conditions
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Lower Extremity Lymphoedema, Leg Lymphoedema

Intervention / Treatment
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* Device: pneumatic compression - 1 hour per day
* Device: pneumatic compression - 2 hours per day
* Device: pneumatic compression - 4 hours per day


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjects must be ≥ 18 years old Subjects must have a diagnosis of primary or secondary Stage 2 unilateral or bilateral lower extremity lymphoedema Must currently be using adequate compression garment(s) as determined by the clinician: (Garments must be at least 20mmHg and no more than 3 months old and must be worn upon rising and removed at bedtime) Subjects must have clinically relevant excess limb swelling as determined by clinician pitting test Must be able to attend all required in-clinic treatment visits Exclusion Criteria: Diagnosis of active or recurrent cancer, or less than 3 months at the time of initial evaluation from the completion of chemotherapy, radiation therapy, or primary surgery for the treatment of cancer Active infection or inflammation Active thrombophlebitis (within the last 2 months) History of pulmonary embolism (within the last 2 months) Documented history of deep chronic venous insufficiency or deep venous obstruction with a reflux duration of > 2 second in the deep system or any history of deep vein thrombosis (DVT) History of pulmonary edema History of congestive heart failure History of chronic kidney disease with a glomerular filtration rate (GFR) of less than 30 mls per minute Poorly controlled asthma Symptomatic or severe peripheral artery disease (defined by current lifestyle-limiting claudication or critical limb ischemia) Presence of an open wound or ulcer of any etiology Diagnosis of lipoedema and lipolymphoedema Currently using an in-home pneumatic compression device Metal implant(s) that would interfere with bioimpedance equipment Pacemaker or other implanted electronic device(s) Unable or unwilling to remove bandaging from treatment regimen while participating in the study Pregnant Any condition where increased venous and lymphatic return is undesirable Unable or unwilling to participate in all aspects of the study protocol and/or unable to provide informed consent Currently participating in another clinical trial Currently using diuretics BMI > 40

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: pneumatic compression - 1 hour per day<br>Pneumatic compression device - 12 consecutive days undergoing a 1 hour treatment regimen. | Device: pneumatic compression - 1 hour per day<br>* Pneumatic compression treatment once per day (1 hour)<br>* Other names: Flexitouch device;|
| Experimental: pneumatic compression - 2 hours per day<br>Pneumatic compression device - 5 consecutive days undergoing 1 hour treatment in the am and 1 hour of treatment in the pm. | Device: pneumatic compression - 2 hours per day<br>* pneumatic compression treatment twice per day in the AM & PM (2 hours)<br>* Other names: Flexitouch device;|
| Experimental: pneumatic compression - 4 hours per day<br>Pneumatic compression device - 5 consecutive days undergoing treatment twice per day consisting of 2 consecutive 1 hour treatments in the am and the pm (4 hours total) | Device: pneumatic compression - 4 hours per day<br>* pneumatic compression treatment twice per day consisting of 2 consecutive 1 hour treatments in the AM & PM (4 hours)<br>* Other names: Flexitouch device;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Limb Volume (ml) | Limb volume changes measured via perometry reported in change of ml of fluid. A negative value is associated with the clinically-desirable decrease in fluid. | Change baseline to final day (day 12 for Group A and day 5 for Groups B and C) | 
| Limb Volume (% Change) | Limb volume changes measured via perometry reported in percent reduction. A negative value is associated with the clinically-desirable decrease in fluid. | Change baseline to final day (day 12 for Group A and day 5 for Groups B and C) | 
| Change in Skin Tone | Change in skin tone (fibrosis) measured via tonometry. The tonometer is a mechanical device that gives an indication of the resistance of tissue to compression. It is used in lymphedema to give an estimate of the extent of pitting and fibrotic induration. Tonometry measures were collected at 5 anatomical locations. A negative value is associated with a clinically desirable decrease in tone. | Change baseline to final day (day 12 for Group A and day 5 for Groups B and C) | 
| Patient Reported Outcomes - MYMOP | Changes in patient-determined symptoms* and change in affect the symptoms had on the subject. Measured via MYMOP (Measure Yourself Medical Outcome Profile) questionnaire. A low score indicates a good outcome. Scores range from 0 (as good as can be) to 6 (as bad as can be). *Recorded symptoms were: Gr A, 1st symptom: none, abdominal pain and discomfort, swelling, physical, and worrying about granddaughters Gr B, 1st symptom: arthritis, hayfever, look of fat foot, right hand area of neck and shoulder, stairs, and swelling Gr C, 1st symptom: none, energy during dancing and gardening, frustration of not going out on own, swelling, mild longstanding depression, and MPT joint at base of small toe Gr A, 2nd symptom: fatigue, heaviness of leg, mental, and pain under knee Gr B, 2nd symptom: narrowed choice of footwear, shower in bath, and swollen left foot Gr C, 2nd symptom: being tired and aching all over, and shoes and clothing | Change baseline to final day (day 12 for Group A and day 5 for Groups B and C) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cellular Fluid Changes (Ohms) | Changes in extra cellular fluid (ECF) on treated leg measured by bioimpedance. A negative number is indicative of a clinically desirable reduction in ECF. | Change after initial treatment on day 1 and change baseline to end of day 5 for all groups | 
| Cellular Fluid Changes (% Change) | Changes in extra cellular fluid (ECF) on treated leg measured by bioimpedance. A negative number is indicative of a clinically desirable reduction in ECF. | Change after initial treatment on day 1 and change baseline to end of day 5 for all groups | 
| Incidence of Complications | Number of complications experienced. Incidence based on clinician assessment. | Change baseline to final day (day 12 for Group A and day 5 for Groups B and C) | 
| Activity Level | Change in number of steps as accumulated each day monitored through use of a pedometer. A positive number indicates an increase in step count (activity) while a negative number indicates a decrease in step count. | Day 1 compared to final treatment day (day 12 for Group A and day 5 for Groups B and C) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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lymphedema, lymphoedema, leg lymphoedema, lower extremity lymphoedema, pneumatic compression device