Efficacy and Feasibility of Short-Stretch Compression Therapy for Filarial Lymphedema in Sri Lanka

Jaimee M. Hall Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado;
Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri;

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Sandani S. Thilakarathne Department of Parasitology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Nirmitha Lalindi De Silva Department of Parasitology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Janaka Ruben Department of Parasitology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Thishan Channa Yahathugoda Department of Parasitology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Philip J. Budge Department of Medicine, Washington University in St. Louis, St. Louis, Missouri

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The WHO-recommended essential package of care (EPC) for filarial limb lymphedema consists of daily limb washing, entry lesion management, limb protection, exercises, and elevation. Decongestive therapy (DT) with compression bandaging by trained lymphedema therapists adds additional benefit but is unavailable for most in low- and middle-income countries (LMICs). To determine whether DT using self-adjustable, short-stretch compression garments (SSCG), prefitted using portable, three-dimensional infrared imaging (3DII), would be effective and feasible in LMIC settings, we conducted a pilot 6-week, interventional, single-group, open-label pilot study in Galle, Sri Lanka. Ten participants with Dreyer stage 3 lymphedema used SSCG for 2 weeks after a 4-week lead-in EPC period. Effect of EPC and compression on quality of life was assessed using the 12-item WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Median participant age was 73 years (range: 32–85 years). Median percent limb volume reduction due to compression was 11.3% (range: 1.1–27.2%). WHODAS 2.0 scores did not change significantly between enrollment and study end. Garment acceptability was high throughout the study. These results provide proof of concept for 3DII-enabled SSCG in LMICs where trained therapists for filarial lymphedema may not be available.

Author Notes

Financial support: This work was supported by a grant provided from LymphaTech.

Disclosures: Study ethical approval was obtained from the Faculty of Medicine, University of Ruhuna Ethics Review Committee (2022.P.073) and the Washington University in St. Louis Institutional Review Board (approval number 202210040). All authors have contributed to this study and approved the manuscript version submitted to the AJTMH. The data supporting the findings can be obtained upon request from the corresponding author.

Authors’ addresses: Jaimee M. Hall, Department of Pediatrics, Division of Infectious Diseases, University of Colorado School of Medicine, Children’s Hospital of Colorado, Colorado Springs, CO 80920, E-mail: jaimee.hall@childrenscolorado.org. Sandani S. Thilakarathne, Nirmitha Lalindi De Silva, Janaka Ruben, and Thishan Channa Yahathugoda, Department of Parasitology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, E-mails: sandanit@sci.pdn.ac.lk, lalindidesilva@med.ruh.ac.lk, janakaruben@med.ruh.ac.lk, and tcyahath@med.ruh.ac.lk. Philip J. Budge, Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63108, E-mail: pbudge@wustl.edu.

Address correspondence to Jaimee M. Hall, Department of Pediatrics, Division of Infectious Diseases, University of Colorado School of Medicine, Children’s Hospital of Colorado, 4090 Briargate Pkwy., Colorado Springs, CO 80920; E-mail: Jaimee.hall@childrenscolorado.org; or Philip J. Budge, Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, 660 South Euclid Ave., Campus Box 8051, St. Louis, MO 60110-1093; E-mail: pbudge@wustl.edu
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