Physical and edema therapy management of amyloidosis in the acute care setting: A case report Journal Article

Authors: Boudreau, J.; Lagunilla, J.; Kotkiewicz, J.
Article Title: Physical and edema therapy management of amyloidosis in the acute care setting: A case report
Abstract: Background and Purpose: Currently, there are no formal guidelines describing rehabilitation interventions for those with amyloidosis. This case report explores the application of physical and edema therapy interventions, including external compression, for a patient with a diagnosis of light-chain (AL) amyloidosis and functionally limiting orthostatic hypotension in the acute care setting. Case Description: A 52-year-old man with a diagnosis of immunoglobulin AL amyloidosis presented to the acute care setting with progressed orthostatic hypotension, bilateral lower extremity edema, and episodes of syncope. The patient spent 17 days in the inpatient setting and received physical therapy (PT) and edema therapy through the inpatient lymphedema service. Rehabilitation focused on exercise, compression, and behavioral and educational interventions over the course of 9 PT sessions and 7 edema therapy sessions. Outcomes: Before interventions, the patient was unable to safely ambulate at home due to syncope. He progressed to being able to ambulate 1560 ft with seated rests. The patient demonstrated decreased limb circumferential measurements, improved performance on the 6-Minute Walk Test, improved ability to self-manage orthostatic hypotension and edema, and increased participation in activities of daily living. Discussion: The combination of physical and edema therapy services may have compensated for orthostatic hypotension and improved standing tolerance. The patient's blood urea nitrogen and brain natriuretic peptide levels may have improved because of the application of external compression. Overall, the patient experienced decreased limb size, increased exercise tolerance, decreased syncopal episodes, and improved quality of life without changes in pharmacologic management or adverse events. Copyright © 2018 Academy of Oncologic Physical Therapy, APTA.
Keywords: edema; amyloidosis; lymphedema; physical therapy; compression
Journal Title: Rehabilitation Oncology
Volume: 37
Issue: 3
ISSN: 2168-3808
Publisher: American Physical Therapy Association  
Date Published: 2019-07-01
Start Page: E1
End Page: E10
Language: English
DOI: 10.1097/01.Reo.0000000000000129
PROVIDER: scopus
Notes: Article -- Export Date: 1 October 2019 -- Source: Scopus
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