title: A pilot randomized trial evaluating lymphedema self-measurement with bioelectrical impedance, self-care adherence, and health outcomes.
abstract: BACKGROUND
  Less than half of breast cancer survivors with lymphedema perform self-care as directed. Effective lymphedema self-care is required to obtain acceptable health outcomes. Self-Regulation Theory suggests that objective self-measurement of physiological conditions is necessary to promote self-regulation/self-care. Bioelectric Impedance Spectroscopy (BIS) represents a potential self-measurement method for arm lymphedema. The purpose of this pilot study was to examine the impact of arm self-measurement on daily self-care activities and health outcomes in breast cancer survivors with lymphedema.
  
  
  RESULTS
  A pilot randomized clinical trial compared outcomes between breast cancer survivors with lymphedema who self-monitored for 3 months and breast cancer survivors with lymphedema who did not self-monitor. Data were collected at baseline, months 1, 2, 3, and 4. Eighty-six women with lymphedema were screened: 62 were eligible, 50 were enrolled, 10 withdrew, and 1 had incomplete data, thus N=39. No between group differences were noted in participant characteristics. The self-monitored group had higher days of garment use (p=0.005) that remained stable after self-monitoring stopped. The median number of days of simple manual lymphatic drainage increased in the intervention group (p=0.004) with a downward trend after self-monitoring ceased.
  
  
  CONCLUSIONS
  Objective self-monitoring of arms using BIS is possible. Self-monitoring may positively impact self-care behaviors. Highly symptomatic patients may require coaching or other psychological support to improve their self-care. Studies that combine a cognitive behavioral therapy component along with self-measurement should be considered as potential interventions to impact lymphedema self-care. Other applications of self-monitoring warrant investigation.
authors.affiliation: 1 School of Nursing, Vanderbilt University , Nashville, Tennessee.
authors.forename: Sheila H
authors.initials: SH
authors.lastname: Ridner
authors.forename: Ya-Chen Tina
authors.initials: YC
authors.lastname: Shih
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Doersam
authors.forename: Bethany Andrews
authors.initials: BA
authors.lastname: Rhoten
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Schultze
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
mesh_terms: D001943:Breast Neoplasms / Q000150:complications*; D016022:Case-Control Studies; D017097:Electric Impedance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008209:Lymphedema / Q000175:diagnosis* / Q000209:etiology; D008875:Middle Aged; D010349:Patient Compliance; D010865:Pilot Projects; D011379:Prognosis; D011788:Quality of Life; D012648:Self Care; D016353:Self-Examination / Q000379:methods*; D015996:Survival Rate; D017741:Survivors