Background:

The-Optimal-Lymph-Flow (TOLF) intervention aims to promote lymph flow through therapeutic lymphatic exercises to relieve lymphatic pain, swelling, lymphedema symptoms, and to decrease lymph fluid levels among breast cancer survivors. To enhance the efficacy of the TOLF intervention, an innovative, intelligent, Kinect-enhanced lymphatic exercise intervention (Kinect-TOLF) was developed to teach patients to perform the lymphatic exercises correctly.

Objectives:

This feasibility trial aimed to determine the feasibility, usability, and effects of the Kinect-TOLF on lymphatic pain, swelling, lymphedema symptoms, and lymph fluid levels.

Methods:

A single-arm feasibility trial with a pre- and post-test design was employed to recruit 30 breast cancer survivors with persistent lymphatic pain or swelling. Patients received a single training session to learn how to perform the lymphatic exercises using the Kinect-TOLF program. Descriptive statistics, Wilcoxon signed-rank tests, t-test, Spearman’s rank correlation coefficients, linear regressions, and Cohen’s d were performed for data analysis. Qualitative data were assessed for common themes.

Results:

The Kinect-TOLF was effective in training patients to perform the lymphatic exercises correctly with high user satisfaction. Significant reductions were found in scores of lymphatic pain (Med_Δ = −1.00, CI = [−1.5, −0.1], P = .004), arm/hand swelling (Med_Δ = −1.00, CI = [−1.5, −0.5], P = .004), total swelling (Med_Δ = −1.5, CI = [−2.0, −1.0], P = .003), number of lymphedema symptoms (M_Δ = −3.8, CI = [−5.5, −2.1], P < .001), and lymphedema symptom severity (M_Δ = −5.3, CI = [−9.5, −1.1], P = .016). A significant reduction in lymph fluid levels was found in mean L-Dex scores (M_Δ = −2.68, CI = [−4.67, −0.69], P = .010). Greater decrease in mean L-Dex scores were found in patients with abnormal lymph fluid levels (L-Dex ≥ 7.1) (M_Δ = −5.19, CI = [−1.75, −8.63], P = .008). Patients’ qualitative feedback supported the results of the study.

Conclusions:

The Kinect-TOLF is safe, feasible, and effective in reducing lymphatic pain, swelling, lymphedema symptoms, and in decreasing lymph fluid levels. Future research should focus on a randomized clinical trial to confirm the unique or synergistic efficacy of the Kinect-TOLF in comparison with current lymphedema treatment and other forms of exercises or movement therapy. This study was registered in ClinicalTrials.gov with US ClinicalTrials.gov Identifier: NCT03999177.

中文翻译：

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Kinect 增强淋巴运动干预对淋巴疼痛、肿胀和淋巴液水平的影响

 背景：

最佳淋巴流(TOLF) 干预旨在通过治疗性淋巴练习促进淋巴流，以缓解乳腺癌幸存者的淋巴疼痛、肿胀、淋巴水肿症状，并降低淋巴液水平。为了提高TOLF干预的效果，开发了一种创新、智能、Kinect增强的淋巴运动干预（Kinect-TOLF）来教导患者正确进行淋巴运动。

 目标：

该可行性试验旨在确定 Kinect-TOLF 对淋巴疼痛、肿胀、淋巴水肿症状和淋巴液水平的可行性、可用性和效果。

 方法：

采用具有前后测试设计的单臂可行性试验招募了 30 名患有持续性淋巴疼痛或肿胀的乳腺癌幸存者。患者接受了一次培训，学习如何使用 Kinect-TOLF 程序进行淋巴锻炼。采用描述性统计、Wilcoxon 符号秩检验、 t检验、Spearman 等级相关系数、线性回归和 Cohen d进行数据分析。对共同主题的定性数据进行了评估。

 结果：

Kinect-TOLF 可有效训练患者正确进行淋巴锻炼，用户满意度很高。淋巴疼痛评分（ Med _Δ = -1.00，CI = [-1.5，-0.1]， P = .004）、手臂/手肿胀（ Med _Δ = -1.00，CI = [-1.5，- 0.5]， P = .004），总肿胀（ Med _Δ = -1.5，CI = [-2.0，-1.0]， P = .003），淋巴水肿症状数量（ M _Δ = -3.8，CI = [-5.5） ，-2.1]， P < .001），以及淋巴水肿症状严重程度（ M _Δ = -5.3，CI = [-9.5，-1.1]， P = .016）。平均 L-Dex 评分发现淋巴液水平显着降低（ M _Δ = -2.68，CI = [-4.67，-0.69]， P = .010）。淋巴液水平异常 (L-Dex ≥ 7.1) 的患者平均 L-Dex 评分下降幅度更大 ( M _Δ = -5.19, CI = [-1.75, -8.63], P = .008)。患者的定性反馈支持了研究结果。

 结论：

Kinect-TOLF 在减轻淋巴疼痛、肿胀、淋巴水肿症状以及降低淋巴液水平方面安全、可行且有效。未来的研究应集中在随机临床试验上，以确认 Kinect-TOLF 与当前的淋巴水肿治疗和其他形式的锻炼或运动疗法相比的独特或协同功效。本研究已在 ClinicalTrials.gov 上注册，美国 ClinicalTrials.gov 标识符：NCT03999177。