{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T12:38:15Z","timestamp":1792759095838,"version":"4.5.0"},"reference-count":16,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Multiple Sclerosis Society","award":["2"],"award-info":[{"award-number":["2"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lymphatic Research and Biology"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Chronic lower limb edema (CLLE) is a feature of advanced multiple sclerosis (MS) but its prevalence and causative factors are not clearly established. The aims of the study were to determine the prevalence and possible causative factors of CLLE in people with MS, and to examine the impact of CLLE on participants\u2019 quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results:<\/jats:title>\n                    <jats:p>\n                      The prevalence of CLLE was determined by questionnaire (i.e., self-reported) and by clinical examination. Possible causative factors were recorded including level of disability using Expanded Disability Status Scale (EDSS) and the impact on participants\u2019 quality of life was assessed using LYMQOL. The self-reported prevalence of CLLE was 42.4% (101\/238). The prevalence determined by clinical assessment was 61.9% (99\/160). Possible causative factors were shown to include age, reduced mobility, and vasomotor autonomic dysfunction. In the multivariate analysis, only EDSS was statistically significant (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.002) with an incidence rate ratio (sd) of 2.1 (0.52). In those with CLLE, scores in the function, appearance, and symptom domains of LYMQOL demonstrated a poorer quality of life. There was a higher incidence of cellulitis in those with CLLE (14% compared with 2%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>CLLE is a common problem is people with MS but may not always be recognized by patients. It can impact a person\u2019s quality of life and poses a risk of cellulitis. Improved recognition and treatment of CLLE should improve the quality of life of people with MS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15578585261496094","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T05:11:37Z","timestamp":1792473097000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Chronic Lower Limb Edema in People with Multiple Sclerosis: Prevalence, Cause and Impact"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3004-2821","authenticated-orcid":false,"given":"Vaughan","family":"Keeley","sequence":"first","affiliation":[{"name":"Lymphoedema Service, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine","family":"Pinnington","sequence":"additional","affiliation":[{"name":"School of Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, University of Nottingham, Derby, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Riches","sequence":"additional","affiliation":[{"name":"Lymphoedema Service, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Jones","sequence":"additional","affiliation":[{"name":"Derby Clinical Trials Support Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apostolos","family":"Fakis","sequence":"additional","affiliation":[{"name":"Derby Clinical Trials Support Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Phillips","sequence":"additional","affiliation":[{"name":"Rehabilitation Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Moffatt","sequence":"additional","affiliation":[{"name":"Institute of Nursing and Midwifery Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2009.06.023"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458506070681"},{"issue":"3","key":"e_1_3_3_4_1","first-page":"71","article-title":"Effects of elastic compression on hypomobility edema and fibrinolysis activation in multiple sclerosis","volume":"53","author":"Arpaia G","year":"2011","unstructured":"3.Arpaia G, , Bavera PM, , Caputo D, et al. Effects of elastic compression on hypomobility edema and fibrinolysis activation in multiple sclerosis. Panminerva Med 2011;53(3 Suppl 1):71\u201374.","journal-title":"Panminerva Med"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.60.1.31"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcg126"},{"key":"e_1_3_3_7_1","first-page":"133","article-title":"ISL: The Diagnosis and Treatment of Peripheral Lymphedema: 2023 Consensus Document of the International Society of Lymphology","volume":"56","year":"2023","unstructured":"6.ISL: The Diagnosis and Treatment of Peripheral Lymphedema: 2023 Consensus Document of the International Society of Lymphology. Lymphology 2023;56:133\u2013151.","journal-title":"Lymphology"},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2012.10.013"},{"key":"e_1_3_3_9_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.33.11.1444"},{"issue":"1","key":"e_1_3_3_10_1","article-title":"A Quality of Life Measure for Limb Lymphedema (LYMQOL)","volume":"5","author":"Keeley V","year":"2010","unstructured":"9.Keeley V, , Crooks S, , Locke J, et al. A Quality of Life Measure for Limb Lymphedema (LYMQOL). Journal of Lymphedema 2010;5(1).","journal-title":"Journal of Lymphedema"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(87)91074-8"},{"key":"e_1_3_3_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-021-02344-z"},{"key":"e_1_3_3_13_1","doi-asserted-by":"publisher","DOI":"10.1258\/026835506777304674"},{"key":"e_1_3_3_14_1","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2012.0013"},{"key":"e_1_3_3_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.19803"},{"issue":"1","key":"e_1_3_3_16_1","first-page":"57","article-title":"Drugs that may exacerbate and those used to treat lymphedema","volume":"3","author":"Keeley V","year":"2008","unstructured":"15.Keeley V. Drugs that may exacerbate and those used to treat lymphedema. J Lymphedema 2008;3(1):57\u201365.","journal-title":"J Lymphedema"},{"key":"e_1_3_3_17_1","doi-asserted-by":"publisher","unstructured":"16.Alderaa A Moffatt C Keeley V et al. Chronic lower limb oedema in people with multiple sclerosis: An evaluation of progressive resistance exercise. In: World Physiotherapy Congress Presentation Tokyo Japan. 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