NATIONAL LYMPHEDEMA NETWORK LYMPHLink Article Reprint

Lymphedema therapy requires full participation by patients. The conventional ‘gold standard’ therapy of comprehensive decongestive therapy (CDT) begins with an intensive phase in which the patient’s limb(s) have to be bandaged for 24 hours every day in order to reduce the swelling. The length of treatment depends on several factors that include severity, staging, complexity of the lymphedema, and the quality of the bandaging. Usually, most of the edema reduces in the first 2 weeks. The patient will complete the intensive phase on reaching a measurement plateau that could take an additional 2 weeks to achieve. In order to maintain the results, the patient needs to be fitted with a garment which she/he will wear during the day1; however, recent published literature shows that wearing a garment during the day during the maintenance phase is probably not enough2-5. According to recent studies examining the conventional components of CDT, in addition to wearing the garment during the day, patients need to exercise and to bandage overnight. Unfortunately, adherence rates are disappointing since these treatments are highly demanding. Studies that were published by Lasinski et al in 1994, 1997, and 2002 reported that 52% were able to follow a strict protocol of 24-hour compression and twice-a-day exercise; these patients improved over time. However, those who had less than 75% adherence could not control their lymphedema and got worse over time2-4. Moreover, a recent study by Tidhar et al from 2009 showed that 40% of women with upper extremity lymphedema who had 0% adherence got worse over a 3-month period6. The conventional approach has yet to provide long-term solutions for nonadherent patients and for those who cannot follow the full strict protocol. Aqua Lymphatic Therapy (ALT) is a recentlypublished method that was designed to help people with lymphedema in their maintenance phase to maintain the results of