The Effects of Kinect-Enhanced Lymphatic Exercise Intervention on Lymphatic Pain, Swelling, and Lymph Fluid Level

Mei R Fu, Melissa L McTernan, Jeanna M Qiu, Eunjung Ko, Simay Yazicioglu, Deborah Axelrod, Amber Guth, Zhipeng Fan, Anna Sang, Christine Miaskowski, Yao Wang, Mei R Fu, Melissa L McTernan, Jeanna M Qiu, Eunjung Ko, Simay Yazicioglu, Deborah Axelrod, Amber Guth, Zhipeng Fan, Anna Sang, Christine Miaskowski, Yao Wang

Abstract

Background: The-Optimal-Lymph-Flow (TOLF) intervention aims to promote lymph flow through therapeutic lymphatic exercises to relieve lymphatic pain, swelling, lymphedema symptoms, and to decrease lymph fluid levels among breast cancer survivors. To enhance the efficacy of the TOLF intervention, an innovative, intelligent, Kinect-enhanced lymphatic exercise intervention (Kinect-TOLF) was developed to teach patients to perform the lymphatic exercises correctly.

Objectives: This feasibility trial aimed to determine the feasibility, usability, and effects of the Kinect-TOLF on lymphatic pain, swelling, lymphedema symptoms, and lymph fluid levels.

Methods: A single-arm feasibility trial with a pre- and post-test design was employed to recruit 30 breast cancer survivors with persistent lymphatic pain or swelling. Patients received a single training session to learn how to perform the lymphatic exercises using the Kinect-TOLF program. Descriptive statistics, Wilcoxon signed-rank tests, t-test, Spearman's rank correlation coefficients, linear regressions, and Cohen's d were performed for data analysis. Qualitative data were assessed for common themes.

Results: The Kinect-TOLF was effective in training patients to perform the lymphatic exercises correctly with high user satisfaction. Significant reductions were found in scores of lymphatic pain (MedΔ = -1.00, CI = [-1.5, -0.1], P = .004), arm/hand swelling (MedΔ = -1.00, CI = [-1.5, -0.5], P = .004), total swelling (MedΔ = -1.5, CI = [-2.0, -1.0], P = .003), number of lymphedema symptoms (MΔ = -3.8, CI = [-5.5, -2.1], P < .001), and lymphedema symptom severity (MΔ = -5.3, CI = [-9.5, -1.1], P = .016). A significant reduction in lymph fluid levels was found in mean L-Dex scores (MΔ = -2.68, CI = [-4.67, -0.69], P = .010). Greater decrease in mean L-Dex scores were found in patients with abnormal lymph fluid levels (L-Dex ≥ 7.1) (MΔ = -5.19, CI = [-1.75, -8.63], P = .008). Patients' qualitative feedback supported the results of the study.

Conclusions: The Kinect-TOLF is safe, feasible, and effective in reducing lymphatic pain, swelling, lymphedema symptoms, and in decreasing lymph fluid levels. Future research should focus on a randomized clinical trial to confirm the unique or synergistic efficacy of the Kinect-TOLF in comparison with current lymphedema treatment and other forms of exercises or movement therapy. This study was registered in ClinicalTrials.gov with US ClinicalTrials.gov Identifier: NCT03999177.

Keywords: breast cancer; lymph fluid; lymphatic; lymphedema; pain; swelling; symptoms.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Kinect-enhanced lymphatic exercise intervention.
Figure 2.
Figure 2.
Patient flow chart.
Figure 3.
Figure 3.
Refinement of the Kinect-enhanced lymphatic exercise training system.

References

    1. Burckhardt CS, Jones KD. Effects of chronic widespread pain on the health status and quality of life of women after breast cancer surgery. Health Qual Life Outcomes. 2005;3(30):1-8.
    1. Degnim AC, Miller J, Hoskin TL, et al.. A prospective study of breast lymphedema: frequency, symptoms, and quality of life. Breast Cancer Res Treat. 2012;134:915-922.
    1. Eaton LH, Narkthong N, Hulett JM. Psychosocial issues associated with breast cancer-related lymphedema: a literature review. Curr Breast Cancer Rep. 2020:1-9. doi:10.1007/s12609-020-00376-x
    1. Stanton AW, Modi S, Mellor RH, Levick JR, Mortimer PS. Recent advances in breast cancer-related lymphedema of the arm: lymphatic pump failure and predisposing factors. Lymphat Res Biol. 2009;7:29-45.
    1. Helyer LK, Varnic M, Le LW, Leong W, McCready D. Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients. Breast J. 2010;16:48-54.
    1. Tsai RJ, Dennis LK, Lynch CF, Snetselaar LG, Zamba GK, Scott-Conner C. The risk of developing arm lymphedema among breast cancer survivors: a meta-analysis of treatment factors. Ann Surg Oncol. 2009;16:1959-1972.
    1. Fu MR, Axelrod D, Cleland CM, et al.. Symptom reporting in detecting breast cancer-related lymphedema. Breast Cancer (Dove Med Press). 2015;7:345-352.
    1. Fu MR, Aouizerat BE, Yu G, et al.. Model-based patterns of lymphedema symptomology: phenotypic and biomarker characterization. Curr Breast Cancer Rep. 2021;13:1-18.
    1. Fu MR, Conley YP, Axelrod D, et al.. Precision assessment of heterogeneity of lymphedema phenotype, genotypes and risk prediction. Breast. 2016;29:231-240.
    1. Douglass J, Graves P, Gordon S. Self-care for management of secondary lymphedema: a systematic review. PLoS Negl Trop Dis. 2016;10:e0004740.
    1. Armer JA, Ostby P, Ginex P, et al.. ONS Guidelines for Cancer treatment-related lymphedema. Oncol Nurs Forum. 2020;47:518-538.
    1. Bennett MI, Bagnall AM, José Closs J. How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis. Pain. 2009;143:192-199.
    1. Somers TJ, Kelleher SA, Dorfman CS, et al.. An mhealth pain coping skills training intervention for hematopoietic stem cell transplantation patients: development and pilot randomized controlled trial. JMIR Mhealth Uhealth. 2018;6:e66.
    1. De Groef A, Van Kampen M, Dieltjens E, et al.. Effectiveness of postoperative physical therapy for upper-limb impairments after breast cancer treatment: a systematic review. Arch Phys Med Rehabil. 2015;96:1140-1153.
    1. Zengin Alpozgen A, Razak Ozdincler A, Karanlik H, Yaman Agaoglu F, Narin AN. Effectiveness of pilates-based exercises on upper extremity disorders related with breast cancer treatment. Eur J Cancer Care (Engl). 2017;26:1-8.
    1. Galiano-Castillo N, Cantarero-Villanueva I, Fernández-Lao C, et al.. Telehealth system: a randomized controlled trial evaluating the impact of an internet-based exercise intervention on quality of life, pain, muscle strength, and fatigue in breast cancer survivors. Cancer. 2016;122:3166-3174.
    1. Fu MR, Axelrod D, Guth AA, et al.. Proactive approach to lymphedema risk reduction: a prospective study. Ann Surg Oncol. 2014;21:3481-3489.
    1. Fu MR, Axelrod D, Guth AA, et al.. mHealth self-care interventions: managing symptoms following breast cancer treatment. Mhealth. 2016;2:28.
    1. Fu MR, Axelrod D, Guth AA, et al.. Usability and feasibility of health IT interventions to enhance self-care for lymphedema symptom management in breast cancer survivors. Internet Interv. 2016;5:56-64.
    1. Chiang AT, Chen Q, Wang Y, Fu MR. Kinect-based in-home exercise system for lymphatic health and lymphedema intervention. IEEE J Transl Eng Health Med. 2018;6:4100313.
    1. Chiang AT, Chen Q, Wang Y, Fu MR. Motion sequence alignment for a Kinect based in-home exercise system for lymphatic health and lymphedema intervention. Annu Int Conf IEEE Eng Med Biol Soc. 2018;2018:2072-2075.
    1. Chiang AT, Chen Q, Li S, Wang Y, Fu M. Denoising of joint tracking data by Kinect sensors using clustered Gaussian process regression. MMHealth17. 2017;2017:19-25.
    1. Kreuter M, Farrell D, Olevitch L, Brennan L. Tailoring Health Messages: Customizing Communication with Computer Technology. 1st ed. Lawrence Erlbaum Associates, Inc.; 2000.
    1. Nielsen J, Mack RL. Usability Inspection Methods. 1st ed. Wiley; 1994.
    1. Bright TJ, Bakken S, Johnson SB. Heuristic evaluation of eNote: an electronic notes system. AMIA Annu Symp Proc. 2006;2006:864.
    1. Browne RH. On the use of a pilot sample for sample size determination. Stat Med. 1995;14:1933-1940.
    1. Billingham AAM, Whitehead AL, Julious SA. An audit of sample size for pilot and feasibility trials being undertaking in the United Kingdom registered in the United Kingdom Clinical Research Network database. BMC Med Res Methodol. 2013;13:104.
    1. Dillon TW, McDowell D, Salimian F, Conklin D. Perceived ease of use and usefulness of bedside-computer systems. Comput Nurs. 1998;16:151-156.
    1. Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly. 1989:13:319-340.
    1. Lewis JR. IBM computer usability satisfaction questionnaires: psychometric evaluation and instructions for use. Int J Hum Comput Interact. 1995;7:57-78.
    1. Shi S, Lu Q, Fu MR, et al.. Psychometric properties of the breast cancer and lymphedema symptom experience index: the Chinese version. Eur J Oncol Nurs. 2015;20:10-16.
    1. Fu MR, Cleland CM, Guth AA, et al.. L-Dex ratio in detecting breast cancer-related lymphedema: reliability, sensitivity, and specificity. Lymphology. 2013;46:85-96.
    1. Ridner SH, Dietrich MS, Spotanski K, et al.. A prospective study of L-Dex values in breast cancer patients pretreamtent and through 12 months postoperatively. Lymphat Res Biol. 2018;16:435-441.
    1. Hedberg EC, Ayers S. The power of a paired t-test with a covariate. Soc Sci Res. 2015;50:277-291.
    1. Hasenoehrl T, Keilani M, Palma S, Crevenna R. Resistance exercise and breast cancer related lymphedema - a systematic review update. Disabil Rehabil. 2020;42:26-35.

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