Physiotherapy theory and practice · 2026
Responsiveness and minimal important changes of a Persian version of Lymphedema Life Impact Scale, Upper Limb Functional Index, and Quick Disability of the Arm, Shoulder, and Hand in breast cancer-related lymphedema following physiotherapy.
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Eftekhar Shima, Mostafaee Neda, Negahban Hossein, Ebrahimzadeh Saeedeh
Аннотация
INTRODUCTION: This study aimed to evaluate responsiveness and minimal important changes (MICs) of a Persian version of the Lymphedema Life Impact Scale (LLIS), the Upper Limb Functional Index (ULFI), and the Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with breast cancer-related lymphedema (BCRL) following physiotherapy intervention.
METHODS: The study included 90 participants with breast cancer-related lymphedema (BCRL) who received a physiotherapy intervention. Participants completed the LLIS, ULFI, and Quick DASH questionnaires at baseline and at a 3-week follow-up. A 7-point global rating of change (GRC) was also administered at the follow-up to serve as an external anchor for improvement. Responsiveness was assessed using correlation analysis and receiver operating characteristic (ROC) curve analysis with patients classified as improved or unimproved based on GRC scores. The ROC curve was utilized to identify the optimal cutoff value as MIC.
RESULTS: All three instruments of the LLIS, ULFI, and Quick DASH demonstrated acceptable responsiveness with the area under the curve of 0.84 (95%CI: 0.76-0.92), 0.85 (95%CI: 0.77-0.93), and 0.90 (95%CI: 0.84-0.96), respectively. Correlation analysis showed relationship of the LLIS, ULFI, and Quick DASH with the external anchor fell within moderate to good range (Spearman = 0.55-0.69). The MIC values for the LLIS, ULFI, and Quick DASH were 10.85, 9.5, and 13.05 points, respectively.
CONCLUSIONS: The LLIS, ULFI, and Quick DASH demonstrated adequate responsiveness and effectively measured the change in lymphedema, upper limb function, and disability in BCRL patients undergoing physiotherapy intervention. The MIC values reflecting improvement identified for the LLIS, ULFI, and Quick DASH can help clinicians and researchers to detect meaningful change in an individual's clinical status, and to avoid the challenge of either over- or undervaluing treatment efficacy.
METHODS: The study included 90 participants with breast cancer-related lymphedema (BCRL) who received a physiotherapy intervention. Participants completed the LLIS, ULFI, and Quick DASH questionnaires at baseline and at a 3-week follow-up. A 7-point global rating of change (GRC) was also administered at the follow-up to serve as an external anchor for improvement. Responsiveness was assessed using correlation analysis and receiver operating characteristic (ROC) curve analysis with patients classified as improved or unimproved based on GRC scores. The ROC curve was utilized to identify the optimal cutoff value as MIC.
RESULTS: All three instruments of the LLIS, ULFI, and Quick DASH demonstrated acceptable responsiveness with the area under the curve of 0.84 (95%CI: 0.76-0.92), 0.85 (95%CI: 0.77-0.93), and 0.90 (95%CI: 0.84-0.96), respectively. Correlation analysis showed relationship of the LLIS, ULFI, and Quick DASH with the external anchor fell within moderate to good range (Spearman = 0.55-0.69). The MIC values for the LLIS, ULFI, and Quick DASH were 10.85, 9.5, and 13.05 points, respectively.
CONCLUSIONS: The LLIS, ULFI, and Quick DASH demonstrated adequate responsiveness and effectively measured the change in lymphedema, upper limb function, and disability in BCRL patients undergoing physiotherapy intervention. The MIC values reflecting improvement identified for the LLIS, ULFI, and Quick DASH can help clinicians and researchers to detect meaningful change in an individual's clinical status, and to avoid the challenge of either over- or undervaluing treatment efficacy.