Evaluation of patient-reported outcomes in over 10,000 patients using pneumatic compression therapy for lower-extremity lymphedema

Objective: Lymphedema treatment varies from compression and manual lymphatic drainage to surgical measures. Although compression demonstrates clinical benefit, poor adherence and dissatisfaction can contribute to treatment failure. This study aimed to assess patient-reported satisfaction, device usage, and symptom improvement with pneumatic compression device therapy. Methods: This online survey-based study was conducted from January 1, 2024, to December 31, 2024, with 35,522 invitations delivered without incentive to respond. Patients with lower-extremity edema who had been prescribed a medical pneumatic compression device and were included within the company database were eligible for inclusion. Patients with multiple or different devices over the study time period were excluded. Surveys were administered in English or Spanish at 45 and 90 days, encompassing device satisfaction, device usage, and symptom improvement based on a predetermined list of symptoms. Questions were graded on a Likert scale of 1 to 5, with 5 representing complete agreement or extreme satisfaction. Results: After exclusions, survey data from 10,543 patients (30%) were analyzed. Participants had a mean age of 69.8 ± 11.8 years, 64% were female, and 92% had bilateral lymphedema. At 45 days, patients reported high device satisfaction in all categories: overall satisfaction, ease of use, functionality, quality, and reliability. Satisfaction across all categories improved as device frequency increased from less than once a week (48%-77%) to 1 to 2 d/wk (70%-91%) to daily (85%-94%) for Likert 4 and 5 (P < .0001). Furthermore, patient-reported symptoms and ability to perform activities improved with increased device usage as well from less than once a week (34%), to 1 to 2 d/wk (53%), to everyday use (67%) for Likert 4 and 5 (P < .0001). There was minimal additional benefit for both satisfaction and symptom improvement, when comparing 3 to 6 d/wk vs daily use. With daily use, most reported improvement in swelling (58%), heaviness (34%), and pain (25%). Comparing 45- and 90-day time points, across all satisfaction categories, the responses stayed the same for 85% to 92% of patients (73%-88% of which were already Likert 4-5), decreased for 4% to 8%, and increased for 3% to 7%. For device usage, responses stayed the same for 74%, decreased for 19%, and increased for 7%. For symptom improvement, responses stayed the same for 78% (56% of which were already Likert 4-5), decreased for 10%, and increased for 13%. Conclusions: Patient-reported satisfaction and symptom improvement with pneumatic compression therapy was high and improved with higher device usage. The highest improvement was in reduction in swelling, heaviness, and pain. Outcomes remained stable comparing 45 to 90 days.