title: Future Research Priorities for Morbidity Control of Lymphedema.
abstract: BACKGROUND
  Innovation in the treatment of lower extremity lymphedema has received low priority from the governments and pharmaceutical industry. Advancing lymphedema is irreversible and initiates fibrosis in the dermis, reactive changes in the epidermis and subcutis. Most medical treatments offered for lymphedema are either too demanding with a less than satisfactory response or patients have low concordance due to complex schedules. A priority setting partnership (PSP) was established to decide on the future priorities in lymphedema research.
  
  
  METHODS
  A table of abstracts following a literature search was published in workshop website. Stake holders were requested to upload their priorities. Their questions were listed, randomized, and sent to lymphologists for ranking. High ranked ten research priorities, obtained through median score, were presented in final prioritization work shop attended by invited stake holders. A free medical camp was organized during workshop to understand patients' priorities.
  
  
  RESULTS
  One hundred research priorities were selected from priorities uploaded to website. Ten priorities were short listed through a peer review process involving 12 lymphologists, for final discussion. They were related to simplification of integrative treatment for lymphedema, cellular changes in lymphedema and mechanisms of its reversal, eliminating bacterial entry lesions to reduce cellulitis episodes, exploring evidence for therapies in traditional medicine, improving patient concordance to compression therapy, epidemiology of lymphatic filariasis (LF), and economic benefit of integrative treatments of lymphedema.
  
  
  CONCLUSIONS
  A robust research priority setting process, organized as described in James Lind Alliance guidebook, identified seven priority areas to achieve effective morbidity control of lymphedema including LF. All stake holders including Department of Health Research, Government of India, participated in the PSP.
authors.affiliation: Institute of Applied Dermatology, Central University of Kerala, Kasaragod, Kerala, India.
authors.forename: S R
authors.initials: SR
authors.lastname: Narahari
authors.affiliation: Institute of Applied Dermatology, Central University of Kerala, Kasaragod, Kerala, India.
authors.forename: Madhur Guruprasad
authors.initials: MG
authors.lastname: Aggithaya
authors.affiliation: International Lymphoedema Framework, London; Division of Nursing and Healthcare, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Christine
authors.initials: C
authors.lastname: Moffatt
authors.affiliation: Department of Dermatology, Churchill Hospital, Oxford, United Kingdom.
authors.forename: T J
authors.initials: TJ
authors.lastname: Ryan
authors.affiliation: Department of Lymphedema, Royal Derby Hospital, Derby, United Kingdom.
authors.forename: Vaughan
authors.initials: V
authors.lastname: Keeley
authors.affiliation: Department of Pathology, JSS Medical College, JSS University, Mysore, Karnataka, India.
authors.forename: B
authors.initials: B
authors.lastname: Vijaya
authors.affiliation: Department of Biochemistry and Molecular Biology, Central University of Kerala, Kasaragod, Kerala, India.
authors.forename: P
authors.initials: P
authors.lastname: Rajendran
authors.affiliation: Department of R&D, Oushadhi Ltd, Thrissur, Kerala, India.
authors.forename: S B
authors.initials: SB
authors.lastname: Karalam
authors.affiliation: Department of Kaumarabhritya, Institute for Postgraduate Teaching and Research in Ayurveda, Jamnagar, Gujarat, India.
authors.forename: S
authors.initials: S
authors.lastname: Rajagopala
authors.affiliation: Dr. TMA Pai Endowment Chair, Manipal University, Indian Council for Medical Research, Chennai, Tamil Nadu, India.
authors.forename: N K
authors.initials: NK
authors.lastname: Kumar
authors.affiliation: Institute of Applied Dermatology, Central University of Kerala, Kasaragod, Kerala, India.
authors.forename: K S
authors.initials: KS
authors.lastname: Bose
authors.affiliation: Institute of Applied Dermatology, Central University of Kerala, Kasaragod, Kerala, India.
authors.forename: K V
authors.initials: KV
authors.lastname: Sushma
keywords: Ayurveda; Yoga; integrative medicine; lymphatic filariasis; lymphedema; priority setting partnership