Practice-based evidence research design for lymphedema management
Lymphedema (LE) is treated in Maccabi Healthcare Services (Maccabi) by LE physical therapists (LPTs). Until today, the knowledge of the extent of the problem in Israel, the interventions for patients with LE, and the effectiveness of these treatments were not well studied. The aims of this dissertation were to: (1) describe the treatment code documentation as part of the PBE process and to evaluate the accuracy of treatment code documentation by LPTs in Maccabi; (2) examine the known-group construct validity of functional status (FS) scores on patients with LE at Maccabi; and (3) describe characteristics of the patients with lymphedema treated at Maccabi between the years of 2010-2017. We used a Practice-based Evidence (PBE) research design to develop a new module for LE in the Maccabi electronic medical record (EMR) to support the gathering of data to address these gaps. The intra-rater reliability of arm and leg measurements by trained LPTs was found to be very high. The treatment code documentation system in the EMR was found to be clear and accurately used by most LPTs. Specific needs for improvement were identified. The computerized adaptive testing of FS score discriminated between patient groups in clinically logical ways both at intake into and discharge from LE treatments. Finally, descriptive analyses of the patients treated by LPT's in Maccabi revealed trends in physician diagnosis and referral, LPT classifications of LE, treatment interventions, co-morbidities, and more. This is the first time such a PBE research process was conducted in a large data set in a national health system for therapists treating patients with LE, laying the foundation for on-going research and application.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License