Development and Validation of a Self-Report Lower-Extremity Lymphedema Screening Questionnaire in Women.

Jan 2013

Yost KJ, Cheville AL, Weaver AL, Al Hilli M, Dowdy SC.

Source

K.J. Yost, Department of Health Sciences Research, Mayo Clinic, 200 First St W, Rochester, MN 55905 (USA).

Abstract

BACKGROUND:

Patient-reported signs and symptoms are often the first indication of clinically relevant lymphedema.

OBJECTIVE:

Develop and assess the diagnostic accuracy of a screening questionnaire to detect lower extremity lymphedema (LEL) among normal weight and obese women.

DESIGN:

Cross-sectional survey study.

METHODS:

We reviewed existing questionnaires assessing upper extremity lymphedema (UEL) for potential questions and worked with content experts to generate new items. A draft questionnaire with 59 items was reviewed by 5 physicians and 5 physical therapists specialized in lymphedema management and 5 female patients with clinically confirmed secondary LEL. A revised questionnaire with 45 items was administered by mail (n=186) or in a lymphedema clinic waiting area (n=28) to women with clinically confirmed LEL (cases, n=116) or UEL (controls, n=70). A parsimonious subset of items that best discriminated patients with and without LEL was identified using chi-square tests and logistic regression. Sensitivity and specificity for detecting LEL were estimated for the entire sample and for subsamples defined by obesity (BMI ≥30 versus < 30), which may confound the accurate diagnosis of LEL.

RESULTS:

Questionnaires were completed by 127 women (LEL n=88; UEL n=39). A sum of 13 items (score range 0-52) was the most discriminating. Using a cutoff score of ≥5 points, the sensitivity and specificity for detecting LEL among all participants were 95.5% and 86.5%, respectively and 94.8% and 76.5% for obese participants.

LIMITATIONS:

By enumerating a sample with a high prevalence of LEL, we may have introduced spectrum bias, which may affect the accuracy of our screening questionnaire.

CONCLUSIONS:

Our brief, 13-item self-report questionnaire is a sensitive and specific tool for detecting clinically relevant LEL among women, including those with BMI ≥30.

Physical Therapy