Extracorporeal Shock Wave Therapy in Lower Extremity Lymphedema
Efficacy of Extracorporeal Shock Wave Therapy (ESWT) in Lower Extremity Lymphedema: A Randomized Controlled Trial
研究概览
地位
详细说明
Lower extremity lymphedema results from impairment of the lymphatic system and is characterized by progressive tissue fibrosis, chronic limb swelling, recurrent infections, and reduced quality of life. Complex Decongestive Therapy (CDT), recommended by the International Society of Lymphology, remains the gold-standard treatment. Despite adherence to CDT, many patients continue to experience persistent symptoms and functional decline, underscoring the need for effective adjunctive interventions.
Extracorporeal Shock Wave Therapy (ESWT) is a non-invasive modality that has shown potential benefits in reducing fibrosis and improving lymphatic function. While its efficacy has been reported in upper extremity lymphedema, evidence in lower extremity lymphedema remains limited.
This single-center, prospective, randomized, double-blind, placebo-controlled trial will be conducted at the Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine. Patients currently in CDT Phase 2 (maintenance phase) will be randomly assigned in a 1:1 ratio to receive either active ESWT or sham ESWT, using stratified randomization by lymphedema stage. All participants will continue standard maintenance therapy - compression garments, skin care, and exercise - throughout the study. ESWT will be applied to fibrotic tissue regions and periinguinal and peripopliteal lymph node areas using the EMS Swiss DolorClast® device, with 3,000 impulses per session at 20 Hz and 2 bar. The primary outcome is change in lower extremity circumferential measurements and limb volume. Secondary outcomes include skin and subcutaneous tissue thickness assessed by ultrasonography, pain intensity measured by the Visual Analogue Scale (VAS), lymphedema-specific quality of life evaluated by the LYMQOL-Leg, and functional status assessed by the Lower Extremity Functional Scale (LEFS). All outcomes will be assessed at baseline, immediately after treatment, and at one-month follow-up.
研究类型
注册 (估计的)
阶段
- 不适用
联系人和位置
学习联系方式
- 姓名:Ayca Utkan Karasu, M.D
- 电话号码:+903122025219 +905365759757
- 邮箱:ayca_utkan@yahoo.com
学习地点
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Yenimahalle
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Ankara、Yenimahalle、土耳其(türkiye)、06560
- 招聘中
- Gazi University Hospital, Department of Physical Medicine and Rehabilitation, Ankara, 06560
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首席研究员:
- Ayca Utkan Karasu, MD
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接触:
- Ayca Utkan Karasu, MD
- 电话号码:+903122025219 +905365759757
- 邮箱:ayca_utkan@yahoo.com
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接触:
- Turkan Gokcelik, MD
- 电话号码:+905078492343
- 邮箱:turkancanturk@gmail.com
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首席研究员:
- Turkan Gokcelik, MD
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副研究员:
- Ilknur Onurlu, MD
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参与标准
资格标准
适合学习的年龄
- 成人
- 年长者
接受健康志愿者
描述
Inclusion Criteria:
- Adults aged 18 to 80 years
- Clinical diagnosis of lower extremity lymphedema established at least 6 months prior to enrollment
- Completion of at least one cycle of CDT Phase 1 (intensive decongestive phase) within the preceding six months
- Currently in CDT Phase 2 (maintenance phase) with active use of compression garments
- Ability and willingness to provide written informed consent
Exclusion Criteria:
- Active chemotherapy or radiotherapy
- Active infection
- Lower extremity vascular diseases including deep vein thrombosis or arterial insufficiency
- Presence of a cardiac pacemaker
- Pregnancy
- Bleeding disorders
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:双倍的
武器和干预
参与者组/臂 |
干预/治疗 |
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实验性的:ESWT + CDT Maintenance
Participants in this group receive active Extracorporeal Shock Wave Therapy (ESWT) applied to fibrotic tissue regions of the affected lower extremity and periinguinal and peripopliteal lymph node areas, in addition to standard CDT maintenance therapy.
ESWT will be administered twice weekly for a total of five sessions.
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Radial shock wave therapy will be applied using the EMS Swiss DolorClast® device.
Each session will consist of 3,000 impulses delivered at 20 Hz and 2 bar using a 40 mm applicator, targeting fibrotic tissue regions and periinguinal and peripopliteal lymph node areas.
ESWT will be administered twice weekly for five sessions
其他名称:
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假比较器:Sham ESWT + CDT Maintenance
Participants in this group receive sham ESWT applied to the same anatomical regions using identical device positioning and application procedures, but with only non-energized impulses delivered.
Standard CDT maintenance therapy will be continued throughout the study.
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Sham ESWT will be applied with identical positioning and session duration as the active ESWT group.
Only non-energized impulses will be delivered, ensuring participant blinding.
Sham ESWT will be administered twice weekly for five sessions.
其他名称:
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
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Change in Lower Extremity Limb Volume
大体时间:Baseline, immediately after treatment (week 3), and 1-month follow-up
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Change in lower extremity limb volume calculated using the truncated cone formula.
Volume will be estimated from circumferential measurements taken at 4 cm intervals from approximately 2 cm proximal to the medial malleolus to the inguinal region, with the patient in the supine position.
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Baseline, immediately after treatment (week 3), and 1-month follow-up
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Change in Lower Extremity Circumferential Measurements
大体时间:Baseline, immediately after treatment (week 3) and 1-month follow-up
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Change in lower extremity circumferential measurements taken at 4 cm intervals from approximately 2 cm proximal to the medial malleolus to the inguinal region, with the patient in the supine position using a non-elastic tape measure.
The difference between baseline and post-treatment values will be compared between groups.
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Baseline, immediately after treatment (week 3) and 1-month follow-up
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Change in Skin and Subcutaneous Tissue Thickness Assessed by Ultrasonography
大体时间:Baseline, immediately after treatment (week 3), and 1-month follow-up
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Change in skin and subcutaneous tissue thickness measured by B-mode linear ultrasonography at standardized anatomical sites on the affected lower extremity.
Three measurements will be obtained at each site and averaged.
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Baseline, immediately after treatment (week 3), and 1-month follow-up
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Change in Lymphedema-Specific Quality of Life (LYMQOL-Leg)
大体时间:Baseline, immediately after treatment (week 3), and 1-month follow-up
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Lymphedema-specific quality of life will be assessed using the LYMQOL-Leg questionnaire, a patient-reported outcome measure consisting of 22 items evaluating function, body image, symptoms, and emotional well-being.
Each item is scored from 1 to 4, and an overall quality of life score is rated separately on a scale from 0 to 10, with higher scores indicating better quality of life.
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Baseline, immediately after treatment (week 3), and 1-month follow-up
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Change in Lower Extremity Functional Status (LEFS)
大体时间:Baseline, immediately after treatment (week 3), and 1-month follow-up
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Lower extremity functional status will be assessed using the Lower Extremity Functional Scale (LEFS).
The LEFS consists of 20 items, each scored from 0 to 4, yielding a total score ranging from 0 (extreme difficulty or inability to perform all activities) to 80 (no difficulty), with higher scores indicating better functional status.
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Baseline, immediately after treatment (week 3), and 1-month follow-up
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Change in Pain Intensity Measured by Visual Analogue Scale (VAS)
大体时间:Baseline, immediately after treatment (week 3), and 1-month follow-up
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Pain intensity will be assessed using a 10 cm Visual Analogue Scale (VAS).
Scores range from 0 (no pain) to 10 (worst imaginable pain), with lower scores indicating less pain.
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Baseline, immediately after treatment (week 3), and 1-month follow-up
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合作者和调查者
出版物和有用的链接
一般刊物
- Tsai YL, I TJ, Chuang YC, Cheng YY, Lee YC. Extracorporeal Shock Wave Therapy Combined with Complex Decongestive Therapy in Patients with Breast Cancer-Related Lymphedema: A Systemic Review and Meta-Analysis. J Clin Med. 2021 Dec 19;10(24):5970. doi: 10.3390/jcm10245970.
- Lee KW, Kim SB, Lee JH, Kim YS. Effects of Extracorporeal Shockwave Therapy on Improvements in Lymphedema, Quality of Life, and Fibrous Tissue in Breast Cancer-Related Lymphedema. Ann Rehabil Med. 2020 Oct;44(5):386-392. doi: 10.5535/arm.19213. Epub 2020 Sep 28.
- Cebicci MA, Sutbeyaz ST, Goksu SS, Hocaoglu S, Oguz A, Atilabey A. Extracorporeal Shock Wave Therapy for Breast Cancer-Related Lymphedema: A Pilot Study. Arch Phys Med Rehabil. 2016 Sep;97(9):1520-1525. doi: 10.1016/j.apmr.2016.02.019. Epub 2016 Mar 15.
- Zhou JP, Lin YY, Zhu MF, Situ XX, Wang J. [Clinical effects of extracorporeal shock wave combined with complex decongestive therapy in the treatment of lower limb lymphedema after cervical cancer surgery]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2025 Jun 20;41(6):543-551. doi: 10.3760/cma.j.cn501225-20250205-00051. Chinese.
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (估计的)
研究完成 (估计的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
其他研究编号
- GUFTR-LELymphedemaESWT-2026
计划个人参与者数据 (IPD)
计划共享个人参与者数据 (IPD)?
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