title: Twice-weekly complete decongestive physical therapy in the management of secondary lymphedema of the lower extremities.
abstract: OBJECTIVE
  This case report describes the physical therapist examination, evaluation, and intervention for a patient with bilateral lower-extremity lymphedema who received complete decongestive physical therapy 2 days per week instead of the recommended daily frequency.
  
  
  METHODS
  The patient was a 55-year-old woman who developed bilateral lower-extremity grade II lymphedema 3 years after surgery and radiation for cervical cancer. She had impairments in hip and knee flexion range of motion and functional limitations in transfers, gait, and activities of daily living. Intervention. A twice-weekly intervention program was implemented consisting of education in skin care, manual lymph techniques, compression, and exercise.
  
  
  RESULTS
  Outcomes related to the lymphedema were measured using the sum of the circumference of each limb. At discharge, the patient had reductions in lymphedema of 9% for the left lower extremity and 10% for the right lower extremity. Her hip flexion range of motion increased from 95 degrees to 110 degrees, and her knee flexion range of motion increased from 95 degrees to 130 degrees. She had resumed all premorbid activities and was independent in self-management.
  
  
  CONCLUSIONS
  Twice-weekly management of lymphedema using a program of skin care, manual lymph techniques, compression, and exercise was followed by reduction of the impairments and functional limitations in a patient with bilateral lower-extremity lymphedema.
authors.affiliation: Department of Health Science, College of Mount St Joseph, Cincinnati, OH 45233, USA. karen_holtgrefe@mail.msj.edu
authors.forename: Karen M
authors.initials: KM
authors.lastname: Holtgrefe
mesh_terms: D005260:Female; D006801:Humans; D035002:Lower Extremity; D008209:Lymphedema / Q000534:rehabilitation*; D008875:Middle Aged; D026741:Physical Therapy Modalities