{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:16:32Z","timestamp":1777922192501,"version":"3.51.4"},"reference-count":47,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lymphatic Research and Biology"],"published-print":{"date-parts":[[2022,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The updated Lymphedema Life Impact Scale (LLIS, version 2) has been widely used to evaluate the effect of lymphedema from the patient's perspective. We sought to assess its ability to accurately and efficiently measure lymphedema-related impact using modern psychometric techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results:<\/jats:title>\n                    <jats:p>\n                      We collected a total of 1054 patient-reported outcome measure scores from 285 patients with upper extremity lymphedema and 65 patients with lower extremity lymphedema between 2016 and 2020. We first evaluated the relationship between the LLIS score, L-Dex score, and limb volume difference (LVD), and used classical test and item response theories to assess its psychometric performance. The LLIS score was only very weakly associated with LVD (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      \u2009=\u20090.17,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and L-Dex score (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      \u2009=\u20090.22,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The LLIS had acceptable dimensionality. Items 7 (affects body image) and 16 (affects proper fit of clothing\/shoes) were locally dependent (Yen's Q3\u2009=\u20090.45). Eight of the 17 items was interpreted differently between upper and lower limb lymphedema patients (pseudo\n                      <jats:italic toggle=\"yes\">R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2265 0.01). The scoring structure required correction for items 9 (affects intimate relations) and 12 (manages lymphedema). Removing items 18 (infection occurrence) and 7 resulted in substantially improved item response theory model fit (Tucker-Lewis index\u2009=\u20090.93, comparative fix index\u2009=\u20090.95, root mean square error of approximation\u2009=\u20090.07, and root means square of the residual\u2009=\u20090.06). The relationships between the LLIS and objective measures of lymphedema remained weak following modification (LVD;\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      \u2009=\u20090.13,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.01, L-Dex;\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      \u2009=\u20090.26,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>We were able to slightly improve the psychometric properties of the LLIS. However, these improvements did not rectify apparent issues with construct validity and both versions of the LLIS displayed a weak relationship with objective measures of lymphedema severity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/lrb.2021.0051","type":"journal-article","created":{"date-parts":[[2021,11,29]],"date-time":"2021-11-29T10:49:16Z","timestamp":1638182956000},"page":"425-434","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Measurement Properties of the Lymphedema Life Impact Scale"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1412-4229","authenticated-orcid":false,"given":"Cai","family":"Xu","sequence":"first","affiliation":[{"name":"MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA."},{"name":"Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joani M.","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tareck","family":"Haykal","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malke","family":"Asaad","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Sidey-Gibbons","sequence":"additional","affiliation":[{"name":"MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA."},{"name":"Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Schaverien","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,8,22]]},"reference":[{"key":"e_1_3_4_2_2","first-page":"33","article-title":"Epidemiology and Morbidity of Lymphedema. In: Greene AK, Slavin SA, Brorson H, eds. Lymphedema","author":"Greene AK","year":"2015","unstructured":"Greene AK. Epidemiology and Morbidity of Lymphedema. In: Greene AK, Slavin SA, Brorson H, eds. Lymphedema. Cham: Springer;, 2015:33\u201344.","journal-title":"Cham: Springer;"},{"key":"e_1_3_4_3_2","doi-asserted-by":"crossref","unstructured":"Beederman M Garza RM Agarwal S Chang DW. Outcomes for physiologic microsurgical treatment of secondary lymphedema involving the extremity. Ann Surg 2020. [Epub ahead of print]; DOI: 10.1097\/SLA.0000000000004457.","DOI":"10.1097\/SLA.0000000000004457"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2021.03.002"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000002670"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers12030565"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-020-09346-0"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.REO.0000000000000096"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40271-013-0041-0"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1037\/1040-3590.8.4.341"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1745-3992.1993.tb00543.x"},{"key":"e_1_3_4_12_2","volume-title":"Fundamentals of Item Response Theory","author":"Hambleton RK","year":"1991","unstructured":"Hambleton RK, , Swaminathan H, , Rogers HJ. Fundamentals of Item Response Theory. Newbury Park: Sage Publications; 1991."},{"issue":"2","key":"e_1_3_4_13_2","first-page":"II28","article-title":"Item response theory and health outcomes measurement in the 21st century","volume":"38","author":"Hays RD","year":"2000","unstructured":"Hays RD, , Morales LS, , Reise SP. Item response theory and health outcomes measurement in the 21st century. Med Care, 2000; 38(Suppl 2):II28\u2013II42.","journal-title":"Med Care"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23494"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-013-2655-2"},{"key":"e_1_3_4_16_2","first-page":"85","article-title":"L-Dex ratio in detecting breast cancer-related lymphedema: Reliability, sensitivity, and specificity","volume":"46","author":"Fu MR","year":"2013","unstructured":"Fu MR, , Cleland CM, , Guth AA, et al. L-Dex ratio in detecting breast cancer-related lymphedema: Reliability, sensitivity, and specificity. Lymphology, 2013; 46:85\u201396.","journal-title":"Lymphology"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2017.0070"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1348\/014466506X96931"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.7453"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-014-0719-3"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.paid.2010.08.016"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1515\/9783110813203"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.4135\/9781412984676"},{"issue":"1","key":"e_1_3_4_24_2","first-page":"e302","article-title":"Psychometric evaluation and calibration of health-related quality of life item banks: Plans for the Patient-Reported Outcomes Measurement Information System (PROMIS)","volume":"45","author":"Reeve BB","year":"2007","unstructured":"Reeve BB, , Hays RD, , Bjorner JB, et al. Psychometric evaluation and calibration of health-related quality of life item banks: Plans for the Patient-Reported Outcomes Measurement Information System (PROMIS). Med Care, 2007; 45(Suppl 1):e302.","journal-title":"Med Care"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/014662168400800201"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1177\/0146621616677520"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.6053"},{"key":"e_1_3_4_28_2","volume-title":"Item Response Theory For Psychologists","author":"Embretson SE","year":"2000","unstructured":"Embretson SE, , Reise SP. Item Response Theory For Psychologists. Mahwah: Lawrence Erlbaum Associates; 2000."},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0149973"},{"key":"e_1_3_4_30_2","volume-title":"Categorical Data Analysis","author":"Agresti A","year":"1990","unstructured":"Agresti A. Categorical Data Analysis. New York: John Wiley & Sons; 1990."},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v039.i08"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1745-3984.1990.tb00754.x"},{"key":"e_1_3_4_33_2","first-page":"1","article-title":"A handbook on the theory and methods of differential item functioning (DIF)","author":"Zumbo B","year":"1999","unstructured":"Zumbo B. A handbook on the theory and methods of differential item functioning (DIF). Ottawa Natl Def Hqrs, 1999:1\u201357.","journal-title":"Ottawa Natl Def Hqrs"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-007-9185-5"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.2044-8317.2012.02050.x"},{"key":"e_1_3_4_36_2","volume-title":"R-Project. R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2016","unstructured":"R Core Team. R-Project. R: A Language and Environment for Statistical Computing. Vienna: R Core Team; 2016."},{"key":"e_1_3_4_37_2","volume-title":"The Basics of Item Response Theory","author":"Baker FB","year":"2001","unstructured":"Baker FB. The Basics of Item Response Theory. College Park, MD: ERIC Clearinghouse on Assessment and Evaluation; 2001."},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006199-200311000-00004"},{"key":"e_1_3_4_39_2","first-page":"46","article-title":"The effect of complete decongestive therapy on the quality of life of patients with peripheral lymphedema","volume":"35","author":"Weiss JM","year":"2002","unstructured":"Weiss JM, , Spray BJ. The effect of complete decongestive therapy on the quality of life of patients with peripheral lymphedema. Lymphology, 2002; 35:46\u201358.","journal-title":"Lymphology"},{"key":"e_1_3_4_40_2","first-page":"26","article-title":"A quality of life measure for limb lymphedema (LYMQOL)","volume":"5","author":"Keeley V","year":"2010","unstructured":"Keeley V, , Crooks S, , Locke J, , Veigas D, , Riches K, , Hilliam R. A quality of life measure for limb lymphedema (LYMQOL). J Lymphoedema, 2010; 5:26\u201337.","journal-title":"J Lymphoedema"},{"key":"e_1_3_4_41_2","first-page":"1","article-title":"Impact of lymphedema and arm symptoms on quality of life in breast cancer survivors","volume":"43","author":"Hormes JM","year":"2010","unstructured":"Hormes JM, , Bryan C, , Lytle LA, et al. Impact of lymphedema and arm symptoms on quality of life in breast cancer survivors. Lymphology, 2010; 43:1\u201313.","journal-title":"Lymphology"},{"key":"e_1_3_4_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-8049(02)00770-0"},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20130285"},{"key":"e_1_3_4_44_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049732306297660"},{"key":"e_1_3_4_45_2","doi-asserted-by":"publisher","DOI":"10.2333\/bhmk.23.67"},{"key":"e_1_3_4_46_2","first-page":"197","article-title":"An item response theory model for test bias and differential test functioning. In: Holland PW, Wainer H, eds. Differential Item Functioning","author":"Shealy RT","year":"1993","unstructured":"Shealy RT, , Stout WF. An item response theory model for test bias and differential test functioning. In: Holland PW, Wainer H, eds. Differential Item Functioning. Hillsdale, NJ: Lawrence Erlbaum;, 1993:197\u2013239.","journal-title":"Hillsdale, NJ: Lawrence Erlbaum;"},{"key":"e_1_3_4_47_2","doi-asserted-by":"publisher","DOI":"10.1037\/1040-3590.16.2.155"},{"key":"e_1_3_4_48_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.18085"}],"container-title":["Lymphatic Research and Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/lrb.2021.0051","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/lrb.2021.0051","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/lrb.2021.0051","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T20:14:06Z","timestamp":1777666446000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/lrb.2021.0051"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,1]]},"references-count":47,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,8,1]]}},"alternative-id":["10.1089\/lrb.2021.0051"],"URL":"https:\/\/doi.org\/10.1089\/lrb.2021.0051","relation":{},"ISSN":["1539-6851","1557-8585"],"issn-type":[{"value":"1539-6851","type":"print"},{"value":"1557-8585","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,1]]}}}