Introduction: Physiotherapy plays a central role in the rehabilitation of patients with lymphoedema, and limb measurement is essential to assess the course of treatment. The commonly used method is tape measurement, which provides data on the volume lost and the distribution of drained fluid, allowing treatment to be optimised. However, this method presents problems that can compromise its reliability, which are not always detected or only emerge in complex clinical situations. A clinical experience at the Asiago Hospital (ULSS 7 Pedemontana) highlighted a critical issue related to the variation of marker position after oedema reduction in a patient. This study investigates how physiotherapists perceive the tape measure method and how they manage its problems. The research, addressed to the physiotherapists of ULSS 7 Pedemontana, aims to understand the operational difficulties and to make professionals aware of the limitations of this method. Materials and methods: This qualitative, exploratory study investigates the perceptions of physiotherapists at ULSS 7 Pedemontana regarding tape measurement in patients with lymphoedema. Data were collected by means of semi-structured 8-10 minute interviews with 18 physiotherapists, conducted in confidential settings to ensure privacy. The interviews, recorded with informed consent, were transcribed and analysed using the thematic analysis approach to identify the most important themes for the study. Results: Analysis of the results shows that the tape measurement method is perceived by physiotherapists as on average reliable, but influenced by variables such as operator experience and limb size. More than 75% felt that the measurement loses reliability in cases of severe lymphoedema. The main problems identified include patient position, intra- and inter-operator reliability, reproducibility of landmarks and tape use. Specific problems, such as variation in limb geometry and marker displacement during treatment, were perceived mainly by those treating complex cases. Inter- and intra-operator reliability is the most recognised criticism (83%) despite this result being in disagreement with the literature. Conclusion: Tape circumference measurement in patients with lymphoedema is considered in the literature to be a rapid, inexpensive and reliable method. However, this study highlights a discordance between what is reported in the literature and the perception of physiotherapists of ULSS 7 Pedemontana, who identify several problems, some common to other measurement systems and some specific to lymphoedema. This study represents a starting point for future research on larger samples and the development of standardisation to improve the accuracy, reliability and comparability of the method.
Introduzione: la fisioterapia svolge un ruolo centrale nella riabilitazione dei pazienti affetti da linfedema, e la misurazione degli arti risulta essenziale per valutare il decorso del trattamento. Il metodo comunemente usato è la misurazione con nastro, che fornisce dati sul volume perso e sulla distribuzione del liquido drenato, permettendo di ottimizzare il trattamento. Tuttavia, questo metodo presenta problematiche che possono comprometterne l'affidabilità, le quali non sempre vengono individuate o emergono solo in situazioni cliniche complesse. Un'esperienza clinica presso l'Ospedale di Asiago (ULSS 7 Pedemontana) ha evidenziato una criticità legata alla variazione della posizione dei marker dopo la riduzione dell'edema in una paziente. Questo studio indaga come i fisioterapisti percepiscono il metodo di misurazione con nastro e come gestiscono le sue problematiche. La ricerca, rivolta ai fisioterapisti della ULSS 7 Pedemontana, mira a comprendere le difficoltà operative ed a sensibilizzare i professionisti rispetto ai limiti di questo metodo. Materiali e metodi: questo studio di tipo qualitativo ed esplorativo, indaga la percezione dei fisioterapisti dell'ULSS 7 Pedemontana riguardo alla misurazione con nastro nei pazienti con linfedema. I dati sono stati raccolti tramite interviste semi-strutturate di 8-10 minuti poste a 18 fisioterapisti, svolte in ambienti riservati per garantire privacy. Le interviste, registrate con consenso informato, sono state trascritte e analizzate con l'approccio dell'analisi tematica per identificarne i temi più importanti per lo studio. Risultati: dall'analisi dei risultati emerge come il metodo di misurazione con nastro sia percepito dai fisioterapisti come mediamente affidabile, ma influenzato da variabili quali l'esperienza dell'operatore e la dimensione dell'arto. Oltre il 75% ritiene che la misurazione perda affidabilità in casi di linfedema grave. Le problematiche principali individuate includono la posizione del paziente, l'affidabilità intra- e inter-operatore, la riproducibilità dei punti di riferimento e l'uso del nastro. Problemi specifici, come la variazione della geometria dell'arto e lo spostamento dei marker durante il trattamento, sono stati percepiti soprattutto da chi tratta casi complessi. L'affidabilità inter- e intra-operatore è la critica più riconosciuta (83%) nonostante questo risultato sia in disaccordo con la letteratura. Conclusione: la misurazione delle circonferenze con nastro nei pazienti con linfedema è considerata dalla letteratura un metodo rapido, economico e affidabile. Tuttavia, questo studio evidenzia una discordanza tra quanto riportato in letteratura e la percezione dei fisioterapisti dell’ULSS7 Pedemontana, che individuano diverse problematiche, alcune comuni ad altri sistemi di misura e altre specifiche per il linfedema. Questo studio rappresenta un punto di partenza per future ricerche su campioni più ampi e per lo sviluppo di una standardizzazione che migliori la precisione, l'affidabilità e la comparabilità del metodo.
Studio qualitativo sulla percezione dell’affidabilità della misurazione centimetrica nei pazienti con linfedema da parte dei fisioterapisti dell’Azienda ULSS7 Pedemontana
TRANI, ANDREA
2023/2024
Abstract
Introduction: Physiotherapy plays a central role in the rehabilitation of patients with lymphoedema, and limb measurement is essential to assess the course of treatment. The commonly used method is tape measurement, which provides data on the volume lost and the distribution of drained fluid, allowing treatment to be optimised. However, this method presents problems that can compromise its reliability, which are not always detected or only emerge in complex clinical situations. A clinical experience at the Asiago Hospital (ULSS 7 Pedemontana) highlighted a critical issue related to the variation of marker position after oedema reduction in a patient. This study investigates how physiotherapists perceive the tape measure method and how they manage its problems. The research, addressed to the physiotherapists of ULSS 7 Pedemontana, aims to understand the operational difficulties and to make professionals aware of the limitations of this method. Materials and methods: This qualitative, exploratory study investigates the perceptions of physiotherapists at ULSS 7 Pedemontana regarding tape measurement in patients with lymphoedema. Data were collected by means of semi-structured 8-10 minute interviews with 18 physiotherapists, conducted in confidential settings to ensure privacy. The interviews, recorded with informed consent, were transcribed and analysed using the thematic analysis approach to identify the most important themes for the study. Results: Analysis of the results shows that the tape measurement method is perceived by physiotherapists as on average reliable, but influenced by variables such as operator experience and limb size. More than 75% felt that the measurement loses reliability in cases of severe lymphoedema. The main problems identified include patient position, intra- and inter-operator reliability, reproducibility of landmarks and tape use. Specific problems, such as variation in limb geometry and marker displacement during treatment, were perceived mainly by those treating complex cases. Inter- and intra-operator reliability is the most recognised criticism (83%) despite this result being in disagreement with the literature. Conclusion: Tape circumference measurement in patients with lymphoedema is considered in the literature to be a rapid, inexpensive and reliable method. However, this study highlights a discordance between what is reported in the literature and the perception of physiotherapists of ULSS 7 Pedemontana, who identify several problems, some common to other measurement systems and some specific to lymphoedema. This study represents a starting point for future research on larger samples and the development of standardisation to improve the accuracy, reliability and comparability of the method.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/80552