WHAT MONITORING TOOLS ARE USED IN EVALUATING LIPOEDEMA PROGRESSION AND WHAT ARE THEIR PSYCHOMETRIC AND CLINIMETRIC CHARACTERISTICS? A SYSTEMATIC REVIEW

Abstract

Background Lipoedema is a chronic, progressive disorder, involving bilateral, symmetrical deposits of adipose tissue, primarily from the waist to the ankle. Although therapeutic management is undertaken in clinical practice, the current evidence-base regarding the monitoring tools used in the evaluation of lipoedema progression is limited. Objectives The aim of this systematic review was to identify current monitoring tools utilised in lipoedema progression and to evaluate the psychometric and clinimetric characteristics of each monitoring tool. Search Strategy Using pre-determined keywords, the databases of CINAHL, Scopus, Medline, Pubmed, PEDro, Pyschinfo, the Cochrane Library, Grey Literature Report, Open Grey, INVOLVE libraries and Google Scholar were searched to identify relevant articles in March of 2018. Selection Criteria All quantitative study designs that compared monitoring tools used to evaluate lipoedema progression and that met pre-determined inclusion criteria were accepted. Data Collection and Analysis The methodological quality of included studies was evaluated using the Effective Public Health Practice Project “Quality Assessment Tool for Quantitative Studies” and graded as being of strong, moderate or weak quality. Main Results One study met the inclusion criteria for this systematic review. Due to the lack of evidence, an additional systematic search was undertaken for monitoring tools used in lymphedema. Eighteen studies graded as being of either moderate or weak quality met the inclusion criteria. The accepted studies utilised six physical and seven HRQoL monitoring tools. The PBI-L shows promise to be a responsive, reliable and valid instrument for lipoedema, however further psychometric testing is required to strengthen the evidence for this tool. Circumferential measurements and the Lymph-ICF-LL were found to have the strongest clinical utility for lymphoedema populations but generalisation to lipoedema populations is limited. Conclusion There is a distinct lack of evidence supporting the psychometric and clinimetric characteristics of monitoring tools used to evaluate lipoedema progression. Furthermore, there is a clear gap in the reporting of clinically relevant benchmarks for monitoring tools that evaluate lymphoedema progression. Future research must explore and develop the psychometric and clinimetric characteristics of disease-specific monitoring tools to optimise lipoedema management.