Alternative assessment and measurement tools

The stage and status of any lymphedematous limb (or other part of the body) and the impact of treatment on it can be measured objectively and accurately, yet, very few health professionals (and even fewer patients) ever make any attempt to undertake even the most basic measurements to obtain a complete assessment of the limb, few bother to compare the at-risk or affected limb with the contralateral one or consider the impact of limb dominance, and even fewer have the opportunity to determine risk and measure a high-risk limb prior to an intervention. The measurements need not always involve high-tech equipment; in fact many studies have shown low-tech information correlates well with our high-technology ones. What we need to do though is to undertake any assessment in an orderly and sequenced manner using a consistent technique ideally from presurgical intervention (or the first time a patient presents) through postsurgical recovery through their treatment and management programs. Once we do this, we should be able to look forward not only to a greater awareness of the presenting condition but also the information will point to strategies for sequencing and targeting of the treatment/management program and will indicate the impact of our treatment interventions on the presenting condition. The result we hope will be a good outcome for those with or at risk of lymphedema. Why do we have the above-described problem? Time is certainly an issue, but is not an excuse because a good understanding of the limb and its current presentation should help target and sequence treatment and thus gain a better outcome for the patient (and a better reputation for the treating clinician or therapist). The lack of enthusiasm for measuring is also another issue. This is often perceived as another chore, which can be bad news for the practitioner. Accurate information will certainly help the patient, but it can also help protect the practitioner should a legal claim be made against him or her. I strongly believe that we must all make every attempt to detect lymphedema before it manifests clinically; this means easier treatment, a greater chance of patient involvement, compliance and adherence to management suggestions, better outcomes, and, from the perspective of the health-care system, a better cost-benefit analysis. The alternative tools and techniques that are available to help us better understand and react to changes in limb structure (fibrotic tissue buildup) and function (shown as changes in levels of extracellular fluids) will be described.