Assessment of health-related quality of life in patients with lymphedema of the lower limb

The purpose of this study was to examine the use of a number of tools in the evaluation of health-related quality of life in patients with lower limb lymphedema, and to determine the consequences of cancer history and concurrent leg ulceration. Patients in one health trust having lower limb lymphedema were identified and interviewed at entry and after 24 weeks. The short form-36 (SF-36), modified Barthel scale, McGill short form pain questionnaire, and Euroqol were administered at both time points. Of the 164 (median age = 76.9 years, 70.7% women) patients who comprised the study population, 15.2% had a history of cancer and 30.4% had coexisting current leg ulceration. Internal consistencies were high for all scales (Cronbach's alpha > 0.80). There were high ceiling effects for a number of SF-36 scores, and high floor effects in these and the McGill short form pain questionaire, scales. Despite these limitations, there was strong evidence that treatment led to significant improvements in six of eight scores of the SF-36, three of three scores of the McGill short form pain questionnaire and the modified Barthel scale (all p < 0.05). The improvement in physical functioning was significantly greater for patients who entered the study with a leg ulcer (mean different = 9.1, 95% confidence interval 2.1-16.1, p = 0.011). Patients treated with compression bandaging had significantly greater improvements for physical functioning (10.2) than those treated with compression hoisery (-1.5) or no treatment (-2.0), p = 0.001. Of the tools assessed, the SF-36, appears to be the most appropriate for use in this patient group.