{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T03:08:08Z","timestamp":1777086488008,"version":"3.51.4"},"reference-count":46,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2020,12,17]],"date-time":"2020-12-17T00:00:00Z","timestamp":1608163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Lymphedema causes disability and exacerbates poverty in many countries. The management of lymphatic filariasis (LF) and podoconiosis-related lymphedema involves daily hygiene to reduce secondary infections, but self-massage and deep-breathing, which have proven beneficial in cancer-related lymphedema, are not included. A cluster randomized trial in northern Ethiopia investigated the effects of lymphatic stimulation for people affected by moderate to severe lymphedema. Participants were allocated to either standard (control n = 59) or enhanced (intervention n = 67) self-care groups. Primary outcomes were lymphedema stage, mid-calf circumference, and tissue compressibility. Secondary outcomes were the frequency and duration of acute attacks. After 24 weeks, fewer patients were assessed as severe (control \u221237.8%, intervention \u221242.4%, p = 0.15) and there were clinically relevant changes in mid-calf tissue compressibility but not circumference. There was a significant between-group difference in patients who reported any acute attacks over the study period (control n = 22 (38%), intervention n = 7 (12%), p = 0.014). Daily lymphedema self-care resulted in meaningful benefits for all participants with a greater reduction in acute episodes among people performing lymphatic stimulation. Observations of a change in lymphedema status support earlier findings in Bangladesh and extend the demonstrated benefits of enhanced self-care to people affected by podoconiosis.<\/jats:p>","DOI":"10.3390\/jcm9124077","type":"journal-article","created":{"date-parts":[[2020,12,17]],"date-time":"2020-12-17T21:21:49Z","timestamp":1608240109000},"page":"4077","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Addition of Lymphatic Stimulating Self-Care Practices Reduces Acute Attacks among People Affected by Moderate and Severe Lower-Limb Lymphedema in Ethiopia, a Cluster Randomized Controlled Trial"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3097-3132","authenticated-orcid":false,"given":"Jan","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":"Fikre","family":"Hailekiros","sequence":"additional","affiliation":[{"name":"National Podoconiosis Action Network, Addis Ababa 1000, Ethiopia"}],"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":"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":"Fikre","family":"Seife","sequence":"additional","affiliation":[{"name":"Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tesfahun","family":"Bishaw","sequence":"additional","affiliation":[{"name":"Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mekdes","family":"Nigussie","sequence":"additional","affiliation":[{"name":"Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kadu","family":"Meribo","sequence":"additional","affiliation":[{"name":"Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mossie","family":"Tamiru","sequence":"additional","affiliation":[{"name":"Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Getnet","family":"Agidew","sequence":"additional","affiliation":[{"name":"Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia"}],"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":[[2020,12,17]]},"reference":[{"key":"ref_1","unstructured":"Rio, D.F. 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