Supportive Care in Cancer

, Volume 22, Issue 1, pp 253–258 | Cite as

Agreement between telerehabilitation involving caregivers and face-to-face clinical assessment of lymphedema in breast cancer survivors

  • N. Galiano-Castillo
  • A. Ariza-García
  • I. Cantarero-Villanueva
  • C. Fernández-Lao
  • C. Sánchez-Salado
  • M. Arroyo-MoralesEmail author
Original Article


Lymphedema is a lifetime complication of breast cancer survivors that can limit their participation in recreational or strenuous daily activities. Follow-up of lymphedema using an Internet application could help patients to determine the influence on their condition of these activities and adapt them accordingly. We aimed to determine the level of agreement between lymphedema assessment by telerehabilitation and by the traditional face-to-face method. Thirty breast cancer survivors participated in a descriptive study of repeated measures using a crossover design. Patients attended a session for clinical face-to-face and real-time online telerehabilitation assessments of lymphedema. There was a 120-min interval between these two sessions. The order of sessions was randomly selected for each patient. A caregiver (relative or friend) conducted the telerehabilitation assessment using a system that includes a specific tool based on an arm diagram for measuring the participant's arm circumferences via a telehealth application. All outcome measures showed reliability estimates (α) ≥ 0.90; the lowest reliability was obtained for the total volume on the non-affected side (α = 0.90). The diagnosis of lymphedema by the two methods also showed good inter-rater reliability (Rho = 0.89). These preliminary findings support the use of an Internet-based system to assess lymphedema in breast cancer survivors, offering carers a useful role in helping patients to follow up this lifetime health problem.


Telerehabilitation. Face-to-face clinical assessment Lymphedema Caregivers Breast cancer 



The study was funded by a research project grant (FIS PI10/02749-02764) from the Health Institute Carlos III and PN I+D+I 2008–2011, a grant (Program FPU AP2010-6075) from Education Ministry, Madrid, Spanish Government and a grant of Andalusian Health Service, Junta de Andalucia (PI-0457-2010).

Conflict of interest

None declared


  1. 1.
    Pusic AL, Cemal Y, Albornoz C et al (2013) Quality of life among breast cancer patients with lymphedema: a systematic review of patient-reported outcome instruments and outcomes. J Cancer Surviv 7:83–92PubMedCrossRefGoogle Scholar
  2. 2.
    Huang H, Zhou J, Zeng Q (2012) Secondary lymphoedema after breast cancer surgery: a survival analysis. Int J Nurs Pract 18:589–594PubMedCrossRefGoogle Scholar
  3. 3.
    Paskett ED, Dean JA, Oliveri JM, Harrop JP (2012) Cancer-related lymphedema risk factors, diagnosis, treatment, and impact: a review. J Clin Oncol 30:3726–3733PubMedCrossRefGoogle Scholar
  4. 4.
    Shih YC, Xu Y, Cormier JN et al (2009) Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study. J Clin Oncol 27:2007–2014PubMedCrossRefGoogle Scholar
  5. 5.
    National Lymphedema Network (2011) The diagnosis and treatment of lymphedema. Accessed 6 March 2013
  6. 6.
    Penha TR, Ijsbrandy C, Hendrix NA et al (2013) Microsurgical techniques for the treatment of breast cancer-related lymphedema: a systematic review. J Reconstr Microsurg 29:99–106PubMedGoogle Scholar
  7. 7.
    Omar MT, Shaheen AA, Zafar H (2012) A systematic review of the effect of low-level laser therapy in the management of breast cancer-related lymphedema. Support Care Cancer 20:2977–2984PubMedCrossRefGoogle Scholar
  8. 8.
    Jeffs E, Wiseman T (2012) Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphoedema: a feasibility study. Support Care Cancer, in pressGoogle Scholar
  9. 9.
    Faett BL, Geyer MJ, Hoffman LA, Brieza DM (2012) Design and development of a telerehabilitation self-management program for persons with chronic lower limb swelling and mobility limitations: preliminary evidence. Nurs Res Pract 2012:608059PubMedGoogle Scholar
  10. 10.
    Karges JR, Mark BE, Stikeleather SJ, Worrell TW (2003) Concurrent validity of upper-extremity volume estimates: comparison of calculated volume derived from girth measurements and water displacement volume. Phys Ther 83:134–145PubMedGoogle Scholar
  11. 11.
    Smoot BJ, Wong JF, Dodd MJ (2011) Comparison of diagnostic accuracy of clinical measures of breast cancer-related lymphedema: area under the curve. Arch Phys Med Rehabil 92:603–610PubMedCrossRefGoogle Scholar
  12. 12.
    Dylke ES, Yee J, Ward LC, Foroughi L, Kilbreath SL (2012) Normative volume difference between the dominant and nondominant upper limbs in healthy older women. Lymphat Res Biol 10:182–188PubMedCrossRefGoogle Scholar
  13. 13.
    Deltombe T, Jamart J, Recloux S et al (2007) Reliability and limits of agreement of circumferential, water displacement, and optoelectronic volumetry in the measurement of upper limb lymphedema. Lymphology 40:26–34PubMedGoogle Scholar
  14. 14.
    Fernández-Lao C, Cantarero-Villanueva I, Ariza-Garcia A et al (2013) Water versus land-based multimodal exercise program effects on body composition in breast cancer survivors: a controlled clinical trial. Support Care Cancer 21:521–530PubMedCrossRefGoogle Scholar
  15. 15.
    Czerniec SA, Ward LC, Refshauge KM et al (2010) Assessment of breast cancer-related arm lymphedema–comparison of physical measurement methods and self-report. Cancer Invest 28:54–62PubMedCrossRefGoogle Scholar
  16. 16.
    Sander AP, Hajer NM, Hemenway K, Miller AC (2002) Upper-extremity volume measurements in women with lymphedema: a comparison of measurements obtained via water displacement with geometrically determined volume. Phys Ther 82:1201–1212PubMedGoogle Scholar
  17. 17.
    Cabana F, Boissy P, Tousignant M et al (2010) Interrater agreement between telerehabilitation and face-to-face clinical outcome measurements for total knee arthroplasty. Telemed J E Health 16:293–298PubMedCrossRefGoogle Scholar
  18. 18.
    Palsbo SE, Dawson SJ, Savard L, Goldstein M, Heuser A (2007) Televideo assesssment using Functional Reach Test and European Stroke Scale. J Rehabil Res Dev 44:659–664PubMedCrossRefGoogle Scholar
  19. 19.
    Russell TG, Blumke R, Richardson B, Truter P (2010) Telerehabilitation mediated physiotherapy assessment of ankle disorders. Physiother Res Int 15:167–175PubMedCrossRefGoogle Scholar
  20. 20.
    Palacín-Marín F, Esteban-Moreno B, Olea N, Herrera-Viedma E, Arroyo-Morales M (2012) Agreement between telerehabilitation and face-to-face clinical outcome assessments for low back pain in primary care. Spine (Phila Pa 1976), in pressGoogle Scholar
  21. 21.
    Torres Lacomba M, Yuste Sánchez MJ, Zapico Goñi A et al (2010) Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial. BMJ 340:b5396PubMedCrossRefGoogle Scholar
  22. 22.
    Bland JM, Altman DG (1999) Measuring agreement in method comparison studies. Stat Methods Med Res 8:135–160PubMedCrossRefGoogle Scholar
  23. 23.
    Steele L, Lade H, McKenzie S, Russell TG (2012) Assessment and diagnosis of musculoskeletal shoulder disorders over the Internet. Int J Telemed Appl 2012:945745PubMedGoogle Scholar
  24. 24.
    Ojea Ortega T, González Álvarez de Sotomayor MM, Pérez González O, Fernández Fernández O (2012) A new assessment for episodic memory. Episodic memory test and caregiver's episodic memory test. Neurologia, doi:  10.1016/j.nrl.2012.10.004
  25. 25.
    Watermeyer J, Kanji A, Cohen A (2012) Caregiver recall and understanding of paediatric diagnostic information and assessment feedback. Int J Audiol 51:864–869PubMedCrossRefGoogle Scholar
  26. 26.
    Steis MR, Evans L, Hirschman KB et al (2012) Screening for delirium using family caregivers: convergent validity of the Family Confusion Assessment Method and interviewer-rated Confusion Assessment Method. J Am Geriatr Soc 60:2121–2126PubMedGoogle Scholar
  27. 27.
    Silveira MJ, Given CW, Cease KB et al (2011) Cancer carepartners: improving patients' symptom management by engaging informal caregivers. BMC Palliat Care 10:21PubMedCrossRefGoogle Scholar
  28. 28.
    Stern A, Valaitis R, Weir R, Jaddar AR (2012) Use of home telehealth in palliative cancer care: a case study. J Telemed Telecare 18:297–300PubMedCrossRefGoogle Scholar
  29. 29.
    Lee TS, Kilbreath SL, Sullivan G et al (2009) Factors that affect intention to avoid strenuous arm activity after breast cancer surgery. Oncol Nurs Forum 36:454–462PubMedCrossRefGoogle Scholar
  30. 30.
    Finnane A, Liu Y, Battistutta D, Janda M, Hayes SC (2011) Lymphedema after breast or gynecological cancer: use and effectiveness of mainstream and complementary therapies. J Altern Complement Med 17:867–869PubMedCrossRefGoogle Scholar
  31. 31.
    Schmitz KH, Ahmed RL, Troxel AB et al (2010) Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial. JAMA 304:2699–2705PubMedCrossRefGoogle Scholar
  32. 32.
    Kilbreath SL, Refshauge KM, Beith JM et al (2012) Upper limb progressive resistance training and stretching exercises following surgery for early breast cancer: a randomized controlled trial. Breast Cancer Res Treat 133:667–676PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • N. Galiano-Castillo
    • 1
  • A. Ariza-García
    • 1
    • 2
  • I. Cantarero-Villanueva
    • 1
  • C. Fernández-Lao
    • 1
  • C. Sánchez-Salado
    • 3
  • M. Arroyo-Morales
    • 1
    Email author
  1. 1.Faculty of Health Sciences, Physical Therapy DepartmentUniversity of GranadaGranadaSpain
  2. 2.Health Andalusian ServiceUniversity Hospital San CecilioGranadaSpain
  3. 3.Breast Oncology UnitVirgen de las Nieves HospitalGranadaSpain

Personalised recommendations