| Purpose:This research topic was based on State Administration of Traditional Chinese Medicine of the People’s Republic of China,no.SATCM—2015—BZ[287]“Treating preventable disease by Chinese medicine--wax therapy,manual lymph drainage and elastic bandage” by Delphi method through experts investigation and analysis.The clinical cases of upper /lower lymphedema after cancer operation,radiotherapy or chemotherapy were collected and analyzed to prove the useful of the technique.Finally,the criteria for technique “Chinese medicine wax therapy,manual lymph drainage and elastic bandage for lymphedema after cancer surgery,radiotherapy,or chemotherapy“ was established to improve patient’s quality of life and become a viable method for prevention and treatment of postoperative lymphadenopathy.Material & Method:1.The first paper:In the early stage of Chinese medicine wax therapy combined with lymphatic drainage and elastic bandage to prevent limb lymphedema after cancer surgery,radiotherapy,or chemotherapy has achieved good curative effect by clinical observation.In the literature research and clinical study,three rounds of the expert questionnaires were designed and sent to Taiwan 20 Chinese or Western medicine experts in the field of oncology.The questionnaires were recycled under statistical analysis by Delphi method.It was consisted of five parts,including the personal information,judgment to importance and familiarity of contents,Chinese medicine wax therapy,manual lymph drainage,elastic bandage and comprehensive questions.The first-round questionnaire was asked the experts to select the most appropriate options for each question.The percentage of statistics and the expert’s personal advices were a basis of correcting and deleting the entries as the second round contents.The first round of expert consultation questionnaire was revised in the results of statistical analysis after discussion,and the second round of questionnaire was formatted,asked the experts to score the reasonable degree for each entry.Then,a database package SPSS20.0 statistics and EXCEL for statistical analysis were used and underwent descriptive analysis,and reliability analysis.The concentration of expert advice mainly by the mean and grade,the level of coordination of expert advice by the coefficient of variation for the individual entry and Kendall’s coefficient of concordance for evaluating the consistency of experts’ opinions on all entries were detected.The reliability indicators of the questionnaire were evaluated with Cronbach’s alpha values,the higher the values,the better the reliability.The questionnaire was discussed,sorted out,and further revised to form the third round of expert consultation questionnaire,asked the experts to score the agreement degree for each entry.Then,the same statistical method was used to detect the concentration of expert advice,degree of coordination and reliability.After three results of analysis were consulted,the treatment standard of the lymphatic edema by Chinese medicine wax therapy combined with the lymphatic drainage and elastic bandage was established.2.The second paper:According to the “Chinese medicine wax therapy combined with lymphatic drainage and elastic bandage for the prevention and treatment of limb lymphedema after cancer surgery,radiotherapy,or chemotherapy”,two caases of gynecological malignancies related lower limb lymphedema and one case of breast cancer related upper limb lymphedema were discussed.The major evaluation indicator for lymphedema was the “difference of limb circumferences” measured on the first day,the tenth day and the twentieth day,and the edema reduction rate was also calculated.“Ipsilateral segment extracellular water ratio” was calculated by the body composition analyzer to evaluate the degree of edema as the secondary indicator.It was proved that the “Chinese medicine wax therapy combined with lymphatic drainage and elastic bandage for the prevention and treatment of postoperative lymphadenopathy” was a useful method.Results:1.The first paper:1.1 Three rounds of questionnaire surveys were completed.The first round of expert consults,the questionnaire returns-ratio was 95.24%,and the expert positive coefficient was 95.24%.In the second round and third round,20 questionnaires were returned,prompted the expert positive coefficient were 100%.Twenty experts engaged in the Chinese medicine or the cooperation of Chinese and Western medicine oncology or gynecology experts were conformed.1.2 Among the first round questionnaire,“the most appropriate insulation method during wax therapy”、 “elastic bandage duration”,“distance interval of circumferences measurement ” were deleted due to the percentage of each item option <50%,and the expert opinion was not concentrated.1.3 The second round questionnaire was surveyed the rationality of the indicators.New entries were added by the first round statistical analysis: “application of lymph node area under wax therapy”、“Pre-processing part of lymphatic drainage”、 “ time of upper and lower limb lymphatic drainage”、 “circumferences difference was the major observation”、 “circumferences measurement position” and “contraindications in the comprehensive therapy”.Among the second round questionnaire,entries were deleted: “number of wax therapy per treatment” and “how long after surgery to use the lymphatic drainage ” due to the mean(`X)≦3,the coefficient of variation(CV)were 0.5738,0.4319,prompted lower concentration and poor coordination.The coefficient of variation in the second round questionnaire was ranged from 0 to 0.5738,and coordination level was acceptable.Kendail’s W in the wax therapy,lymphatic drainage,elastic bandage were 0.417,0.422,and 0.254,prompted the internal consistency was acceptable,and 0.172 in the comprehensive questions,prompted the consistency was low.The values of Cronbach’s alpha were 0.752,0.803,0.686 and 0.853.Except the elastic bandage part with the medium reliability,the rest of Cronbach’s Alpha> 0.75 was prompted high reliability.1.4 The third round questionnaire on the basis of the second round questionnaire was consulted whether to "agree" the entries for the final contents.New entries were added: “the definition of Chinese medicine wax therapy combined with lymphatic drainage and elastic bandage”、“indication in the comprehensive therapy”.No entries were deleted.The coefficient of variations were <0.25 significantly different from that of the second round questionnaires in the range of 0 to 0.5738,except that "to prevent the postoperative lymphedema,elastic bandage was used 12 hours per time" was 0.336,indicating the expert opinion coordination degree of consistency was high,and no longer to do Kendall coefficient analysis.In addition,the importance and familiarity of the second and third round questionnaires were evaluated by the reliability analysis: Cronbach’s Alpha values were all >0.75,prompted high reliability.The third round reliability(Cronbach’s α>0.876)was high degree after consultation,prompted the expert opinion was more centralized,and internal consistency was strong.Therefore,the consultation was completed.The initial prevention and treatment standard of lymphatic edema by Chinese medicine wax therapy combined with the lymphatic drainage and elastic bandage was established.2.The second paper:2.1 Before treatment,the severity of lymphedema in three cases were all mind degree due to the average circumference differences was≦3cm.After treatment on twentieth day,the average circumference differences all decreased 14%、97%、30% seperately in three cases,prompted the treatment was effective.2.2 Edema reduction rate: In three cases,the average edema reduction rates of six sites on the treated limb were 1.83%、5.23%、2.75%,prompted the treatment was effective.2.3 Ipsilateral segment extracellular water ratio: Case I and case III were mild swelling because the “Ipsilateral segment extracellular water ratio” were between 0.39 and 0.4.Case II was moderate swelling due to the ratio was 0.418.After treatment,“Ipsilateral segment extracellular water ratio” decreased 0.001,0.017,0.005 in the case I,case II,and case III on the twentieth day,prompted the treatment was effective.Conclusion:1.It was feasible for the Delphi method used in the postoperative lymphadenopathy prevention and treatment of techniques standard research.Standardization studies in Chinese medicine were effective.2.Chinese medicine wax therapy,manual lymph drainage and elastic bandage in clinical practice could be a preventment and treatment for lymphedema after cancer surgery,radiotherapy,or chemotherapy. |
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