{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T13:45:59Z","timestamp":1776951959750,"version":"3.51.4"},"reference-count":46,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2020,7,30]],"date-time":"2020-07-30T00:00:00Z","timestamp":1596067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004330","name":"GlaxoSmithKline","doi-asserted-by":"publisher","award":["not given"],"award-info":[{"award-number":["not given"]}],"id":[{"id":"10.13039\/100004330","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002992","name":"Department for International Development","doi-asserted-by":"publisher","award":["not given"],"award-info":[{"award-number":["not given"]}],"id":[{"id":"10.13039\/501100002992","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Lymphatic filariasis (LF) is a major cause of lymphedema, affecting over 16 million people globally. A daily, hygiene-centered self-care protocol is recommended and effective in reducing acute attacks caused by secondary infections. It may also reverse lymphedema status in early stages, but less so as lymphedema advances. Lymphatic stimulating activities such as self-massage and deep-breathing have proven beneficial for cancer-related lymphedema, but have not been tested in LF-settings. Therefore, an enhanced self-care protocol was trialed among people affected by moderate to severe LF-related lymphedema in northern Bangladesh. Methods: Cluster randomization was used to allocate participants to either standard- or enhanced-self-care groups. Lymphedema status was determined by lymphedema stage, mid-calf circumference, and mid-calf tissue compressibility. Results: There were 71 patients in each group and at 24 weeks, both groups had experienced significant improvement in lymphedema status and reduction in acute attacks. There was a significant and clinically relevant between-group difference in mid-calf tissue compressibility with the biggest change observed on legs affected by severe lymphedema in the enhanced self-care group (\u2206 21.5%, \u22120.68 (\u22120.91, \u22120.45), p &lt; 0.001). Conclusion: This study offers the first evidence for including lymphatic stimulating activities in recommended self-care for people affected by moderate and severe LF-related lymphedema.<\/jats:p>","DOI":"10.3390\/jcm9082444","type":"journal-article","created":{"date-parts":[[2020,7,31]],"date-time":"2020-07-31T04:15:31Z","timestamp":1596168931000},"page":"2444","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Effect of an Enhanced Self-Care Protocol on Lymphedema Status among People Affected by Moderate to Severe Lower-Limb Lymphedema in Bangladesh, a Cluster Randomized Controlled Trial"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3097-3132","authenticated-orcid":false,"given":"Janet","family":"Douglass","sequence":"first","affiliation":[{"name":"Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hayley","family":"Mableson","sequence":"additional","affiliation":[{"name":"Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK"},{"name":"Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Martindale","sequence":"additional","affiliation":[{"name":"Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanya Tahmina","family":"Jhara","sequence":"additional","affiliation":[{"name":"Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad Jahirul","family":"Karim","sequence":"additional","affiliation":[{"name":"Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Mujibur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdullah Al","family":"Kawsar","sequence":"additional","affiliation":[{"name":"Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abul","family":"Khair","sequence":"additional","affiliation":[{"name":"Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ASM Sultan","family":"Mahmood","sequence":"additional","affiliation":[{"name":"Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"AKM Fazlur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Centre for Injury Prevention and Research Bangladesh, Dhaka 1206, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salim Mahmud","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Centre for Injury Prevention and Research Bangladesh, Dhaka 1206, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Kim","sequence":"additional","affiliation":[{"name":"College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Betts","sequence":"additional","affiliation":[{"name":"Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Taylor","sequence":"additional","affiliation":[{"name":"Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louise","family":"Kelly-Hope","sequence":"additional","affiliation":[{"name":"Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,30]]},"reference":[{"key":"ref_1","unstructured":"International Society of Lymphology (2016). 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