Efficacy and Feasibility of Short-stretch Compression Garments Enabled by Three-dimensional Infrared Imaging for Lymphedema

Introduction, Objectives, and/or Purpose: Complete decongestive therapy (CDT) for lymphedema requires initial intensive volume reduction through daily lymphedema therapist directed short-stretch compression bandaging, followed by maintenance through static compression garment use. The vast majority of people suffering from limb lymphedema, including those living in low-and middle-income countries (LMIC), do not have access to CDT. We sought to determine whether two technical advances in lymphedema care, (1) adjustable, inelastic, short-stretch compression garments (SSCG) and (2) portable 3D infrared imaging (3DII) used to measure limb volume and circumference, could make CDT more accessible to patients living with limb lymphedema.

Methods: We conducted a six-week, interventional, single group, open-label, pilot study in nine adults (five female) with Dreyer stage 3 filarial lymphedema in Sri Lanka. A four-week lead in period of hygiene (daily washing, drying, and elevation) was followed by a two-week intervention SSCG period. Limb volume and circumference measurements were collected using 3DII, which provided baseline measurements for garment fitting, as well as tracked volume and circumference changes over time. Quality of life scores were measured via the WHO-Disability Assessment Schedule 2.0 (WHO-DAS 2.0) survey, acceptability via a de novo garment acceptability survey, and adherence via self-reported hygiene compliance and hourly compression garment use per day.

Results: Subjects were a median age of 74 years with affected mean leg volumes of 3052 mL (SD 454). Adherence to hygiene measures alone resulted in a small but significant lower limb volume reduction (mean reduction 189 mL, SD 128, p=0.02), while SSCG resulted in a marked additional reduction (mean reduction 296 mL, SD 241, p=0.006). Median time from compression introduction to volume reduction plateau was 8 days (range 3-10). Only 2/9 participants achieved average goal usage of SSCG for ≥23 hours/day, however 9/9 reported >21 hours/day of average use. There was a non-significant reduction in WHO-DAS 2.0 scores between enrollment and study end (18.7, SD=9.5 vs. 17.5, SD=8.1, p=0.30). There was marked person-to-person compression response variability in terms of overall limb volume as well as circumference at varying limb heights. Garment acceptability was high throughout the study and qualitative interviews demonstrated satisfaction, ease, and willingness to use SSCG during the study and thereafter.

Conclusion(s): 3DII was effective in tracking lower extremity volume changes by providing baseline measurements used to size initial SSCG, tracking volume changes over time with SSCG, and estimating time to volume reduction plateau. In this cohort, adherence to hygiene alone reduced limb volume, and adding SSCG therapy provided a greater volume reduction. Participants found CDT using SSCG comfortable and acceptable. The availability of serial 3D limb measurements improved real-time insight into garment size needed to initiate compression, tracking response to compression, and providing accurate timing estimation of clinical need to transition from adjustable to static compression. This pilot study suggests that 3DII-enabled SSCG can help enable CDT in settings without access to trained lymphedema therapists.