Self-care treatment for lymphoedema of lymphatic filariasis using integrative medicine
Background: Lymphatic Filariasis (LF) is a neglected tropical disease presenting mainly as lymphoedema (elephantiasis). LF is not effectively treated. Integrative Medicine treatment (IM) for lymphoedema uses a combination of Indian traditional medicine, ayurveda, alongside yoga exercises, compression therapy, antibiotics and antifungals, providing a useful combination where resources are limited and different practices are in use
Objectives: To assess the effectiveness of the IM in the existing clinical practice of lower limb lymphoedema management and to determine whether the treatment outcomes aligned with the WHO’s global goal of LF.
Methods: Institutional data from electronic medical records of all 1698 LF cohorts between 2010-2019 were retrospectively analysed using pre- and post-treatment comparisons and NICE guidelines for clinical audit. Primary treatment outcomes evaluated were limb volume, bacterial entry points (BEEPs), cellulitis episodes, health-related quality of life (HQoL). Secondary outcomes included influence of gender, duration of illness, education, and employment status on volume reduction. Multiple regression analysis, t-tests, chi-square, analysis of variance, Mann–Whitney and Kruskal–Wallis tests were used to assess the association between IM and patients’ treatment outcomes.
Results Limb volume reduced by 24.5% (95% CI, 22.47% - 26.61%) (n = 1660) following an intensive supervised care period (14.84 ± 0.38% days, n = 1660). Volume further reduced by 1.42% (95% CI, 0.76% - 2.07%), n = 1259 in the first follow-up (after 81.45 ± 158.79 days), and from the first follow-up to the second follow-up (231.32 ± 305.39 days) by 2.3% (95% CI, 1.26% - 3.34%)n = 796. BEEPs reduced as below; excoriations (78.4%), intertrigo (26.7%) at discharge and further improved during the follow-ups. 4% of patients showed new BEEPs (4/7) in the first follow-up; eczema (3.9%), folliculitis (6.5%), excoriations (11.9%), and intertrigo (15.4%). HQoL, measured by the disease-specific tool, showed an average of 73.9 scores on admission, which increased by 17.8 at follow-up 1 and 18.6 at follow-up 2. None developed new cellulitis episodes at the first follow-up, and only five (5.3%) new cellulitis in the second follow-up
Conclusion: IM for lower limb lymphoedema successfully reduces limb volume and episodes of cellulitis, BEEPs leading to improved HQoL. It aligns with the WHO’s LF treatment goals. It is a low-cost predominantly self-care management protocol. It can potentially change care models and improve lymphoedema patients’ lives.