title: Measurement Properties of Instruments for Measuring of Lymphedema: Systematic Review.
abstract: BACKGROUND
  Lymphedema is a common complication of cancer treatment, resulting in swelling and subjective symptoms. Reliable and valid measurement of this side effect of medical treatment is important.
  
  
  OBJECTIVE
  The purpose of this study was to provide best evidence regarding which measurement instruments are most appropriate in measuring lymphedema in its different stages.
  
  
  METHODS
  The PubMed and Web of Science databases were used, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.
  
  
  METHODS
  Clinical studies on measurement instruments assessing lymphedema were reviewed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) scoring instrument for quality assessment.
  
  
  METHODS
  Data on reliability, concurrent validity, convergent validity, sensitivity, specificity, applicability, and costs were extracted.
  
  
  RESULTS
  Pooled data showed good intrarater intraclass correlation coefficients (ICCs) (.89) for bioimpedance spectroscopy (BIS) in the lower extremities and high intrarater and interrater ICCs for water volumetry, tape measurement, and perometry (.98-.99) in the upper extremities. In the upper extremities, the standard error of measurement was 3.6% (σ=0.7%) for water volumetry, 5.6% (σ=2.1%) for perometry, and 6.6% (σ=2.6%) for tape measurement. Sensitivity of tape measurement in the upper extremities, using different cutoff points, varied from 0.73 to 0.90, and specificity values varied from 0.72 to 0.78.
  
  
  CONCLUSIONS
  No uniform definition of lymphedema was available, and a gold standard as a reference test was lacking. Items concerning risk of bias were study design, patient selection, description of lymphedema, blinding of test outcomes, and number of included participants.
  
  
  CONCLUSIONS
  Measurement instruments with evidence for good reliability and validity were BIS, water volumetry, tape measurement, and perometry, where BIS can detect alterations in extracellular fluid in stage 1 lymphedema and the other measurement instruments can detect alterations in volume starting from stage 2. In research, water volumetry is indicated as a reference test for measuring lymphedema in the upper extremities.
authors.affiliation: J.T. Hidding, PT, MSc, Department of Orthopedics, Section of Physical Therapy, Radboud University Medical Center, Geert Groteplein Noord 21, Nijmegen 6525 EZ, the Netherlands, and Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands. Janine.Hidding@radboudumc.nl.
authors.forename: Janine T
authors.initials: JT
authors.lastname: Hidding
authors.affiliation: P.B. Viehoff, PT, PhD, Department of Dermatology, Erasmus Medical Centre, Rotterdam, the Netherlands, and Centre for Physical and Manual Therapy 't Gilde, Gorinchem, the Netherlands.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Viehoff
authors.affiliation: C.H.G. Beurskens, PT, PhD, Department of Orthopedics, Section of Physical Therapy, Radboud University Medical Center.
authors.forename: Carien H G
authors.initials: CH
authors.lastname: Beurskens
authors.affiliation: H.W.M. van Laarhoven, MD, PhD, Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Hanneke W M
authors.initials: HW
authors.lastname: van Laarhoven
authors.affiliation: M.W.G. Nijhuis-van der Sanden, PT, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare).
authors.forename: Maria W G
authors.initials: MW
authors.lastname: Nijhuis-van der Sanden
authors.affiliation: P.J. van der Wees, PT, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare).
authors.forename: Philip J
authors.initials: PJ
authors.lastname: van der Wees
mesh_terms: D000886:Anthropometry / Q000295:instrumentation / Q000379:methods*; D001834:Body Water; D017097:Electric Impedance; D006801:Humans; D041741:Lower Gastrointestinal Tract; D008209:Lymphedema / Q000175:diagnosis*; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D034941:Upper Extremity