Newman, Amy M.
(2018)
Prevalence and impact of chronic oedema in a population of obese patients prior to and following bariatric surgery.
MRes thesis, University of Nottingham.
Abstract
Background
Chronic oedema (persistent swelling) is a common, often unreported, condition, which can have severe social and psychological implications for individuals and their families. Oedema can be especially problematic for obese patients, who often struggle with: immobility, co-morbidities, and the inability to lose weight.
Aims
The main aims of the study presented in this dissertation were two-fold: to determine the prevalence and impact of chronic oedema on health-related quality of life in a population of obese patients (Stage 1) and, to assess the impact of bariatric (weight loss) surgery on chronic oedema (Stage 2).
Methods
The study was based at the Royal Derby Hospital. Stage 1 participants were newly-referred patients to the weight-management clinical pathway. Stage 2 participants were patients who would soon be having bariatric surgery. Participants (both stages) were assessed for chronic oedema using the pitting test (primarily) and Stemmer’s sign techniques. The pitting test was the gold standard test for assessing whether or not oedema was present. Quality of life questionnaires were completed by these participants to assess: anxiety, depression, impact of oedema, physical function, energy, pain and mobility. Fluid measurement techniques were used: to measure the overall fluid in the limb (using bioimpedance) and the amount of fluid in the tissue at specific points (using the tissue dielectric constant). For Stage 2, a perometer was used to measure lower limb volume. Stage 2 participants were assessed before and after surgery to determine if their oedema had improved.
Results
In Stage 1, 31 patients were recruited and 19 of these had oedema, giving a prevalence of 61.3%. However, the questionnaires indicated that the quality of life of participants with oedema did not differ significantly from those without oedema. The bioimpedance resistance at zero and infinite frequencies (Rzero and Rinfinity) for participants with oedema were significantly different to those without oedema. The tissue dielectric constant data highlighted the presence of more oedema at the foot, ankle and below the knee sites.
In Stage 2, 21 patients were recruited and eleven of these had oedema, giving a prevalence of 52.4%. The quality of life, physical health, energy and pain of participants with oedema were significantly different to those without oedema. When comparing limb volumes of participants with and without oedema for Stage 2 (before surgery), there were no significant differences between them. Rzero and Rinfinity data for those with oedema were significantly different to those without oedema. The only statistically significant tissue dielectric constant site was the right foot. Due to the size of the post-operative dataset, further post-operative assessments are required to fully assess the impact of bariatric surgery on chronic oedema.
Conclusions
This study indicates that the prevalence of chronic oedema is high among obese patients. However, biased recruitment and a small sample size limited data collection (especially data collected post-operatively in Stage 2), highlighting the limitations of recruiting in this population of patients. These issues will be addressed to allow future research to confirm the prevalence of chronic oedema in this population and to determine whether chronic oedema is impacted as a result of bariatric surgery.
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