Lymph(o)edema therapists...you might want to know about this outcome measure!
We, as therapists, love knowing if our interventions are working just as much as our patients. We respect & value the clinical utility of an outcome measure, and, with mandated insurance reporting, it can get a little squirrely!
Occasional thoughts on outcome measures:
Front office: Which one do I give them again?!
Patient: How many questions are on this thing?!
Therapist: Doh. How do I convert this one to a % disability for my G-code Modifier?
Then walks in the Lymphedema Life Impact Scale (LLIS)...an outcome measure created for the lymphedema population. One outcome measure that can be used for both the upper and lower extremities and any cause of edema! This instrument measures impairments, activity limitations and participation restrictions associated with lymphedema in the arms and legs.
Jan Weiss, a LANA-Certified Lymphedema Therapist, developed this valid and reliable lymphedema specific outcome measure in 2013 (1). It is 18 items, quick to administer, and comes with an Excel spreadsheet that will calculate your G-Code percent impairment for you! 3 sections of this document assess the physical, psychosocial and functional domains.
The first domain assesses physical affect asking the patient to quantify the severity of their symptoms from 1-5 with regards to pain, heaviness, skin tightness and movement restrictions. The patient is asked to compare the perceived size of their limb, texture and strength of affected to the non-affected side. Question 8 uniquely addresses infection, asking the patient how many times they had to take oral antibiotics or were hospitalized in the past 2 years due to infection.
The next domain addresses psychosocial concerns. 4 items question the affect lymphedema has had on body image, socialization, intimacy and the patient's emotional state.
Finally, the third domain assesses functional concerns and questions the affect lymphedema has had on the patient's ability to perform household chores, participate in recreational activities, fit in their clothing, sleep, and help others.
Research conducted by Weiss and Daniel noted good internal consistency on all domains. Content validation for “expert ranking” of questions on the LLIS was >3.0/4.0 for all questions on the assessment. High correlation was shown between the LLIS and other validated outcome measures such as the LYMQOL, DASH, and functional domain of the EORTC- QOL. In order to show a clinically significant different the patient must score an 8 point change between baseline and follow-up measures(1).
Click here to access your own free copy of the LLIS for clinical use. Sign-up and the Klose Training Lymphedema Certification school will send you a PDF of the LLIS as well as the G-Code Calculator and instructions for use.
Thank you Jan Weiss for developing this tool for therapists to use in our clinics free of charge! I believe we will start to see more research using the LLIS in the near future.
1.) Daniel, T., Weiss, J., (2015) Validation of the Lymphedema Life Impact Scale: A Condition Specific Measurement Tool for Persons with Lymphedema. Lymphology, 48, 128-138.