title: Health-related quality of life and associated factors in patients with primary lymphedema.
abstract: OBJECTIVE
  Primary lymphedema requires continuous conservative treatment during the patient's life, which may affect their health-related quality of life (HRQOL). Physical and psychosocial characteristics related to lymphedema are associated with their HRQOL. This study aimed to assess HRQOL in those patients undergoing conservative treatment and to determine the factors associated with their HRQOL.
  
  
  METHODS
  This was a cross-sectional, observational study that included 83 patients with primary lymphedema at an outpatient clinic for lymphedema. HRQOL was assessed with the Medical Outcomes Study 36-Item Short Form Survey (SF-36) and EuroQol 5-Dimension (EQ-5D). Lymphedema status/complications and psychosocial status were evaluated by medical records, physical assessment, and self-administrative questionnaires.
  
  
  RESULTS
  The general health perception score in the SF-36 was lower than the age- and sex-stratified national norms (P = 0.001). In the EQ-5D, the proportions of patients with some/moderate or severe problems were 42.2% for pain/discomfort, 21.7% for usual activities, and 20.5% for anxiety/depression. By multiple regression analyses, a lower physical component summary score in the SF-36 was associated with a higher lymphedema stage (P = 0.021), cellulitis within 30 days (P = 0.003), exercise (P = 0.010), and more substance use coping (P = 0.012). A lower mental component summary score was associated with skin lesions over edematous limbs (P = 0.008), less humor coping (P = 0.005), and more self-blame coping (P = 0.014).
  
  
  CONCLUSIONS
  Patients with primary lymphedema have problems in health perception, discomfort, usual activities, and anxiety/depression. Preventing cellulitis and skin lesions and humor coping may be able to improve HRQOL.
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing Department of Life Support Technology (Molten), Graduate School of Medicine, University of Tokyo Hirota Internal Medicine Clinic, Tokyo Aomori University of Health and Welfare, Aomori Department of Clinical Nursing, Division of Nursing Science, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.
authors.forename: Shizuko
authors.initials: S
authors.lastname: Okajima
authors.forename: Akio
authors.initials: A
authors.lastname: Hirota
authors.forename: Emiko
authors.initials: E
authors.lastname: Kimura
authors.forename: Misako
authors.initials: M
authors.lastname: Inagaki
authors.forename: Nao
authors.initials: N
authors.lastname: Tamai
authors.forename: Shinji
authors.initials: S
authors.lastname: Iizaka
authors.forename: Gojiro
authors.initials: G
authors.lastname: Nakagami
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Mori
authors.forename: Junko
authors.initials: J
authors.lastname: Sugama
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sanada
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000503:physiopathology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: cellulitis; coping behavior; primary congenital lymphedema; skin lesions