Application Development forLymphedema care :

More active, Self-directed Care Eun Joo Yang, MD., PhD.

Department of Rehabilitation MedicineSeoul National University Bundang

Hospital

Introduction• Lymphedema Care Continuum• Empowerment, more active, self-directed• Technique? Vs Care?• Disease issue• Technique issue• UX issue• Future step!

Cancer Care Continuum

Survivorship Care Continuum

Diagnosis Acute Cancer Treatment

Prehabilitation

Rehabilitation

No impairments

Impairments

General Exercise/Wellness

Lymphedema Care Continuum

Survivorship Care Continuum

Diagnosis Acute Cancer Treatment

No impairments

Impairments

Risk factor Natural course

Survivorship Care Continuum

Diagnosis Acute Cancer Treatment

F/40 Breast ca, Rt UOQ (IDCa), cT3N2M0

2013.12-2014.4AC #3 D #4

2014.5.13Rt MRM

2014.11 (5month after surgery)3-4 일전부터 우측 상지가 부어요Volume difference (ml) 156.89

2014.6-7PMRT to Rt C/W& SCL2014.5 zoladex+tamodifen

2014.6POD 10 days

Lifestyle..High-risk

Acute lymphedema

Active, empoweredLifestyle

Chroniclymphedema

Education -Prevention -Early detection

TreatmentEvidence-based approach

Coach Empowerment

Health-related empowerment

• Empowerment refers to an individual’s feelings of being able to manage the challenges of the cancer experience.

• Empowering an individual who had cancer during different phases of trajectory is often an objective that informs the provision of support services.

Health-Related Empowerment in Cancer

Cancer. 2014 Oct 15;120(20):3228-36.

Health-directed activity (HDA)

Positive and active engagement in life (PAE)

Emotional distress (ED)

Self-monitoring and insight (SMI)

Constructive attitudes and approaches (CAA)

Skill and technique acquisition (STA)

Social integration and support (SIS)

Health service navigation (HSN)

ActiveLifestyl

eDisease issue Lymphedema

Risk stratificationNatural course

Technical issue

IoT/ wearable device

UX issueDoctor-Patient

Predicted lymphedema probability (%)

Time course of Lymphedema

• Acute lymphedema : 60%• Chronic and/or progressive lymphedema : 30-40%• Fluctuating lymphedema : 15-22%

Norman et al.,J Clin Oncol 2009;27:390-397

Exercise and management of lymphedema

• Randomized controlled trials have challenged this belief and found no association between upper body exercise and the onset or worsening of breast cancer-related lymphedema.

Schmitz KH, et al Med Sci Sports Exerc. 2010;42(7):1409–1426.

Progressive, resistive exercise

• Some forms of exercise, mainly progressive RE, is associated with less exacerbation of lymphedema-related symptoms in BCS.

Sander AP et al. Phys Ther. 2012;92(4):525–536. Schmitz KH, et al. N Engl J Med. 2009;361(7):664–673.

Weight Lifting for Women at Risk for Breast Cancer–Related Lymphedema

Kathryn H. SchmitzN et al., Engl J Med 2009;361:664-73.

10 회 10 회 10 회 팔 증상의 변화 없는 경우 ?가장 최소량의 무게 증가 ?

2 session 연속 빠지는 경우무게 감소

10 회 10 회 10 회

ActiveLifestyl

eDisease issue Lymphedema

Technical issue

IoT/ wearable device

UX issueDoctor-Patient

Set up : Screening tool

Survivorship Care Continuum

Diagnosis Acute Cancer Treatment

무엇으로 screening ?림프부종의 조기 발견할 수 있는 도구 ?

Stage 0 or 1 ?

림프부종이 진행되는 증상 ? 징후 ? 검사 ?

• The latent stage– Before overt swelling

• Lymphedema-related symptom– Heaviness, tightness, firmness, pain,

numbness, impaired mobility

• Armer, Radina, Porock, & Culbertson, 2003; International Society of Lymphology [ISL], 2003

0 Stage

Lymphedema-Related Symptoms

Fu et al. 2008

Symptom report in detecting breast cancer-related lymphedema

Breast Cancer (Dove Med Press). 2015; 7: 345–352.

Design서울대학교 병원의 메인칼라를 활용하여 아이덴티티를 강화하였습니다 . Key Concept - Refined | Design Direction- Identity 강화 | GUI Style – 플랫디자인

운동강좌 리스트

암재활 신체활동 모니터 App UI 디자인 _ 운동강좌 페이지

운동강좌 상세페이지 탄력밴드 근력운동기록 페이지

Design서울대학교 병원의 메인칼라를 활용하여 아이덴티티를 강화하였습니다 . Key Concept - Refined | Design Direction- Identity 강화 | GUI Style – 플랫디자인

메인 화면

암재활 신체활동 모니터 App UI 디자인 _ 메인페이지

운동전 상태체크하기 운동후 상태체크하기

Design서울대학교 병원의 메인칼라를 활용하여 아이덴티티를 강화하였습니다 . Key Concept - Refined | Design Direction- Identity 강화 | GUI Style – 플랫디자인

림프부종 관리 체크 _ 아니오 했을경우

림프부종 관리 체크 _ 예 했을경우림프부종 상태체크

암재활 신체활동 모니터 App UI 디자인 _ 설문페이지

L-Dex® U400

3) 둘레측정용종이 3 4) 팔직경측정용자

5) 줄자 6) 전자줄자

ActiveLifestyl

eDisease issue Lymphedema

Technical issue

IoT/ wearable device

UX issueDoctor-Patient

의사 : 환자가 운동을 제대로 하고 있는지 ?:“ 운동을 제대로 하고 있는지 알 수 없어요 .”

환자 : 의지와는 달리 운동의 정확도 확인 어려움 : “ 운동하다가 통증이 오는데 이 정도는 괜찮은 건가요 ?”

Paradigm Shift

림프부종에 대한 fear

1) 자가기록 여부와 운동 실행력 ?2) 운동 및 자가기록 방해요소 ?3) 동기부여 요인 ?

Do Button

Closing• Lymphedema Care Continuum• Empowerment, more active, self-directed• Technique? Vs Care?• Disease issue• Technique issue• UX issue• Future step!