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Clinical Implementation of the Clinical Practice Guidelines for Diagnosing Upper-Quadrant Lymphedema Secondary to Cancer

Perdomo, Marisa, PT, DPT1; Ryans, Kathryn, PT, DPT, CLT-LANA2; Levenhagen, Kimberly, PT, DPT, WCC3; Davies, Claire C., PT, PhD, CLT-LANA4; Gilchrist, Laura, PT, PhD5

doi: 10.1097/01.REO.0000000000000115

Background: The Oncology Section of the APTA recently published a clinical practice guideline (CPG) for diagnosing secondary upper-quadrant lymphedema (SUQL) related to cancer. Application of any CPGs may be challenging depending upon clinical setting, patient population, and clinical expertise.

Purpose: The purpose of this article is to assist the clinician in integrating the evidence from the CPG into clinical practice. The authors present the recommendations from the CPG using a systematic approach that will enable integration of the appropriate diagnostic tools for SUQL based on presentation and stage during the patient evaluation.

Conclusion: Although this article provides the clinician with recommendations for integrating the CPG into their practice, it is beneficial for the clinician to refer back to the original CPG to understand its scope and limitations. The SUQL CPG was based on a review of the literature from 2000 to 2015. The authors acknowledge that some additional literature may have emerged since its development that may now either support or refute the use of some measures evaluated and recommended. Further collaborative research is needed between researchers and clinicians to develop and evaluate appropriate assessment and diagnostic tools to aid in early diagnosis of SUQL in body regions such as the trunk, breast, hand, head, and neck.

1Assistant Professor of Clinical Physical Therapy, Assistant Professor and Clinician, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA

2Assistant Professor and Clinician, Doctor of Physical Therapy Program, Mercy College, Dobbs Ferry, NY

3Assistant Professor and Clinician, Department of Physical Therapy & Athletic Training, Doisy College of Health Sciences, Saint Louis University, St Louis, MO

4Staff Physical Therapist and Research Consultant, Rehabilitation Services, Baptist Health Lexington, Lexington, KY

5Professor and Researcher, Doctor of Physical Therapy Program, St Catherine University, Minneapolis MN

Correspondence: Marisa Perdomo, PT, DPT, Division of Biokinesiology and Physical Therapy, University of Southern California, 488 West Palm St, Altadena, Los Angeles, CA 91001 (

The CPG group received a grant to pay travel expenses for group members during CSM for planning and follow up.

The authors declare no conflicts of interest.

©2018 (C) Academy of Oncologic Physical Therapy, APTA
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