Chronic Edema: Under-Recognized and Overlooked

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Step Status
Starts On: 9/26/2023: 12:00 AM
Ends On: 9/26/2025: 12:00 AM
Session Type: Internet Activity Enduring Material
Credits: 1


Emily Cahalan, OTR/L, CLT, CBIS
Emily is an OT with almost fifteen years experience in the field, having graduated from National University of Ireland, Galway in 2010. Emily is passionate about inpatient rehabilitation and specifically lymphedema therapy in this (underserved) space. In her (limited) spare time, Emily has started accepting OTD Capstone students to do her part in further promoting the advancement of OT in the rehab world.
Disclosures: No financial relationships to disclose.

Planning Committee

Michael A. Boeving, MD is the Medical Director at the Rehabilitation Institute of St. Louis (an affiliation of BJC HealthCare and Encompass Health).
Dr. Boeving has no financial relationships to disclose.
Elissa Charbonneau, DO, MS is the Chief Medical Officer of Medical Services at Encompass Health.
Dr. Charbonneau has no financial relationships to disclose.
Tedra Cleveland, MSHA, MBA is the National Director of Medical Services at Encompass Health.
Ms. Cleveland has no financial relationships to disclose.
Richard C. Senelick, MD is an Adjunct Professor of Neurology.
Dr. Senelick has no financial relationships to disclose
Joseph Stillo, MD, PhD is Vice President of Medical Services, Encompass Health.
Dr. Stillo has no financial relationships to disclose.
Barbara Winters-Todd, RN, MSN, CRRN is a Director of Clinical Excellence Informatics at Encompass Health Corporation.
Ms. Winters-Todd has no financial relationships to disclose.

Objectives: The intended result of this activity is increased knowledge/competence, and upon completion of this course, participants should be able to:
  • Review the mechanism of edema formation
  • Understand why certain conditions develop from chronic edema
    Examine the interventions that can be used to improve edema
  • Discuss how to set up an in-house program to treat edema for better outcomes
Additional Information: Target Audience: This course is designed for geriatricians, family and emergency physicians and nurse practitioners. May also be of interest to physician assistants and other allied health professionals who encounter geriatric patients in a health care setting.

Publication Date: September 26, 2023
Expiration Date: September 26, 2025
Accreditation Information:
In support of improving patient care, this activity has been planned and implemented by EncompassHealth Corporation and Washington University School of Medicine in St. Louis. Washington University School of Medicine in St Louis is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credit Awarded for this Activity:

Credit Statement:
American Medical Association (AMA Credit)
Washington University School of Medicine in St. Louis designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Nurses Credentialing Center (ANCC Credit)
Washington University School of Medicine in St. Louis designates this enduring material for a maximum of 1 ANCC contact hour.

Interprofessional Continuing Education (IPCE Credit)
This activity was planned by and for the healthcare team, and learners will receive 1 Interprofessional Continuing Education (IPCE) credit for learning and change.

References: 1. Cassie N. Kline; Brandon R. Macias; Emily Kraus; Timothy B. Neuschwander; Niren Angle; John Bergan; Alan R. Hargens.: "Inelastic Compression Legging Produces Gradient Compression and Significantly Higher Skin Surface Pressures Compared with an Elastic Compression Stocking" Vascular. 2008;16(1):25-30
2. Motykie GD, Caprini JA, Arcelus JI, Reyna JJ, Overom E, Mokhtee D.: "Evaluation of therapeutic compression stockings in the treatment of chronic venous insufficiency." Dermatol Surg. 1999 Feb;25(2):116-20
3. H. Ellison: "Diuretic Drugs and the Treatment of Edema: From Clinic to Bench and Back Again" American Journal of Kidney Diseases; Volume 23, Issue 5, May 1994, Pages 623-643
4. International Society of Lymphology: 2003 Consensus Document
5. Zuther, J., & Norton, S.: Lymphedema Management: a Comprehensive Guide for Practitioners. 3rd Edition, Thieme, 2013
6. CASE STUDY: Treatment of Post-Surgical Edema in the Orthopedic Patient — A Case Report By: Julia Rodrick, OTR, CLT-LANA
7. Jay R. Ebert, Brendan Joss, Berit Jardine, David J. Wood: "Randomized Trial Investigating the Efficacy of Manual Lymphatic Drainage to Improve Early Outcome After Total Knee Arthroplasty" Archives of Physical Medicine and Rehabilitation; Volume 94, Issue 11, November 2013, Pages 2103–2111
8. Kathrin Härén, Clas Backman, Mikael Wiberg: "Effect of manual lymph drainage as described by Vodder on oedema of the hand after fracture of the distal radius: A prospective clinical study" Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery; Volume 34, 2000 - Issue 4
9. Pichonnaz, C; Bassin, J; Lécureux, E; Christe, G; Currat, D; Aminian, K; Jolles, B (2016): "Effect of Manual Lymphatic Drainage After Total Knee Arthroplasty: A Randomized Controlled Trial". Archives of Physical Medicine and Rehabilitation; Volume 97, Issue 5, May 2016, Pages 674–682
10. Fonder, MA, Loveless, JW, Lazarus, GS. Lipedema: a frequently unrecognized problem. Journal of American Academy Dermatology, 2007, 57:S1-S3
11. NLN National Advisory Committee: Position Paper of the National Lymphedema Network. Topic: Exercise. Updated: December 2011
12. Moseley, A., Piller, N. Exercise for Limb Lymphoedema: Evidence that it is beneficial. Journal of Lymphoedema; Volume 3, Issue 1, 2008.
13. Todd, D., Todd, J. Impact of implementation intentions on exercise adherence. Journal of Lymphoedema; Volume 2, Issue 1. 2007.
14. Tsai, HJ., Hung, HC., Yang, JL. et al. Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related lymphedema? A pilot study. Support Care Cancer (2009) 17: 1353. doi:10.1007/s00520-009-0592-8
15. Białoszewski D., Woźniak W., Zarek S. Clinical efficacy of kinesiology taping in reducing edema of the lower limbs in patients treated with the ilizarov method--preliminary report. Ortopedia, Traumatologia, Rehabilitacja; 2009, 11(1):46-54
16. Finnerty, S., Thomason, S., Woods, M. Audit of the use of kinesiology tape for breast oedema. Journal of Lymphoedema; Volume 5, Issue 1, 2010.
17. Stergioulas A (2004): Low level laser treatment can reduce edema in second degree ankle sprains. Journal of Clinical Laser Medicine. 22(2):125-128.
18. Gundersen B. A Clinical Trial on Low Level Laser Therapy as a Pain Control Modality. ( Journal of The Academy of Chiropractic Orthopedists, 2005)
19. Hopkins JT, McLoda TA, Seegmiller JG, and Baxter GD (2004) Low level laser therapy facilitates superficial wound healing in humans: A triple blind, sham-controlled study. Journal of athletic Training 39(3): 223-229.
20. Bjordal JM, Lopes-Martin RAB and Iverson VV (2006): A randomized, placebo controlled trial of low level laser therapy for activated Achilles tendonitis with microdialysis measurement of peritendinous E². British Journal of Sports Medicine 40: 76-80.
21. Naeser MA, Hahn KA, Lieberman BE, Branco KF(2002): Carpal tunnel syndrome pain treated with low level laser and microamperes transcutaneous electrical stimulation: A comparative study. Archives of Physical Medicine and Rehabilitation 83(7):978-988.
22. Mayrovitz, H. (2009) The Standard of Care for Lymphedema: Current Concepts and Physiological Considerations. Lymphatic Research and Biology, Volume 7, Number 2. 101-108
23. Rockson, S. (2009) The Unique Biology of Lymphatic Edema. Lymphatic Research and Biology. Volume 7, Number 2: 97-100
24. Ridner, S. (2009) The Psycho-social Impact of Lymphedema. Lymphatic Research and Biology, Volume 7, Number 2: 109-112
25. Donec, V., Krisciunas, A. (2014) The effectiveness of Kinesio Taping after total knee replacement in early postoperative rehabilitation period. A randomized controlled trial. Eur J Phys Rehabil Med; 50-363-71
26. Adams, K. et al. (2010) Direct evidence of lymphatic function improvement after advanced pneumatic device treatment of lymphedema. Biomedical Optics Express, Volume 1, No. 1
Disclosure Information: It is the policy of Washington University School of Medicine in St. Louis, Continuing Medical Education, to ensure balance, independence, objectivity and scientific rigor in all its educational activities. All planners, faculty and other persons who may influence content of this CME activity have disclosed all relevant financial relationships commercial interests. All disclosures have been reported and are indicated with their presentations. Any potential conflicts were addressed and mitigated.
All members of the CME department have nothing to disclose.
Speakers are also expected to openly disclose inclusion of discussion of any off-label, experimental, or investigational use of drugs or devices in their presentations.
Presentations are expected to be based on evidence that is accepted within the profession of medicine as adequate justification for their indication in the care of patients. All scientific research should conform to the generally accepted standards of experimental design, data collection and analysis.
These presentations are not an endorsement of any commercial interests.
These presentations are the views and experiences of the presenters. The presenters' views do not represent the policy or position of Washington University School of Medicine in St. Louis. Washington University School of Medicine in St. Louis, Continuing Medical Education is the provider for CME credits.
  • This course is intended for healthcare professionals only.
  • Continuing Medical Education at Washington University School of Medicine fully complies with the legal requirements of the Americans with Disabilities Act rules and regulations thereof. If any participant of this course is in need of accommodations, please contact us at

  • Speaker

    Emily Cahalan, OT, ARC Seminars


    Anastasia Turner, Medical Services Coordinator, Encompass Health
    Tedra Cleveland, MBA; MSHA, Encompass Health
    Category: Encompass Health Courses, Other


    AMA: 1.00
    ANCC: 1.00
    Attendance: 1.00
    IPCE: 1.00

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