A prospective quantitative study was enrolled in the Clinica Godoy-Brazil in May 2013, 24 patients with bilateral lower limb lymphoedema (48 legs), sample size was determined by using an unpublished pilot work. Bioimpedance variables (impedance and reactance) were evaluated before and after five days of intensive treatment of the legs with the results being compared with a control group. The age of the 17 female and seven male patients ranged from 22 to 75-year-old (mean: 43.7 years). The patients of the control group had arm lymphoedema without clinical evidence of swelling of the legs; their ages ranged from 42 to 71-year-old (mean: 51.8 years).

The inclusion criterion of the patients in the study group was Grade II or III leg lymphoedema of whatever origin [2]. The control Group could not have evidence of oedema of the legs. All patients who fulfilled the inclusion criterion and accepted to participate in the study were consecutively enrolled as they arrived in the clinic. Patients with lymphedema grade 1 was excluded from the study.

All patients were weighed and underwent volumetry by the water displacement technique or perimetry (elephantiasis), and multi-frequency bioelectrical impedance before treatment and at the beginning and end of each day of treatment. The In Body S10 Body Composition Analyzer (BioSpace, Seoul, Korea) was used to measure impedance and reactance. The control group had a single evaluation.

All patients underwent intensive treatment of between seven and eight hours per day which included mechanical lymphatic therapy (RAGodoy®) all day, one hour of manual lymphatic therapy (Godoy and Godoy) simultaneously to the mechanical lymphatic therapy and cervical stimulation (Godoy cervical therapy) for 15 minutes per day. A home-made compression stocking of grosgrain was used and adjusted two or three times per day depending on the reduction in volume. The study was approved by Ethical Committee in Medicine School of CAAE: 278223014.8.40.54.15.

The results are reported as descriptive statistics including mean, median, standard deviation, and interquartile percentiles. The Friedman, Kruskal-Wallis (Conover-Inman) the Wilcoxon’s signed ranks tests were used for statistical analysis. Statistical significance was set for an alpha error of 5% (p-value <0.05).

All patients had volumetric reductions at the end of the five-day treatment program. There was a statistically significant difference in respect to the impedance [Table/Fig-1,2]. The Friedman test identified a significant difference as did all the multiple comparisons using the Conover-Inman test comparing before and after treatment and with the Control Group [Table/Fig-3]. There were significant differences in respect to the reactance between the Control group and the Study group both before and after treatment [Table/Fig-4,5 and 6].

[Table/Fig-2]:

Box and whisker plot comparing interquartile ranges of impedance at different frequencies between the control Group and the Treatment Group both before and after five days of treatment.

[Table/Fig-6]:

Box and whisker comparing interquartile ranges of reactance at different frequencies between the Control group and the Treatment group both before and after five days of treatment.

The present study shows that an analysis of the impedance, reactance can assist in the evolution of the treatment of lymphoedema. These parameters can improve significantly with clinical treatment, but this assessment has not been employed in the treatment of lymphoedema. In this study with the treatment, significant differences in the impedance were identified at every frequency from 1 kHz to 1 Mhz, but after treatment, there still was a significant difference compared to the Control group. This shows that the treatment improves the fluid balance. The reactance improved significantly at 5 kHz, 50 kHz and 250 kHz with treatment, however, there was still a significant difference compared to the Control group, but after five days of treatment it was still not normal. Clinically, there was a volumetric reduction in the Study group, however, the size of the legs were not normal at the end of the 5-day treatment program. A previous study shows that this reduction is around 50% of the volume per week [1]. Therefore, the oedema was not improved completely.

Another study with this group of patients showed a redistribution of fluid to other regions of the body including the arms and trunk [10]. Hence, besides the mobilisation of liquids which is normally evaluated by bioelectrical impedance, authors believe that the Impedance and reactance should also be evaluated during the evolution of these patients.

Age of the control group could not be standardised with the study group.

Impedance and reactance evaluations contribute to the diagnostic evaluation in the follow-up of lymphoedema treatment. Bioimpedance is a diagnostic method of volume and compared to volumetry by water displacement technique, it is suggested as gold standard.