SUMMARY

Introduction

Lipedema is defined as an abnormal deposit of subcutaneous adipose tissue mainly in the lower limbs and, occasionally, in the upper limbs, which generates a notable disproportion between the upper and lower parts of the body. This abnormal fat distribution causes pain and a feeling of heaviness that sometimes limits the mobility of those affected and makes it difficult to carry out physical and/or work activities. Therefore, it often has important implications for quality of life and a psychological impact. It mainly affects women, but its prevalence is unknown due to the scarcity of epidemiological studies. It is a chronic condition that is often under-diagnosed, partly due to a lack of awareness and knowledge among health professionals who have often misdiagnosed it as generalised obesity or lymphoedema.

Current treatment of lipedema focuses on symptom reduction and management. Existing guidelines emphasize the importance of self-care as part of a comprehensive and effective treatment of lipedema. Although the definition of lipedema implies that leg fat is not reduced by diet and exercise, benefits have been observed with physical activity. Therefore, physical activity is a strong recommendation for patients with lipedema regardless of the severity of the disease. Weight loss, for its part, has not been able to influence the volume of lipedema as expected, however, it favors a better general state of health, improves mobility and reduces joint pain if osteoarthritis is also present.

The funding of compression garments for patients with lipedema is not covered by the National Health System due to the lack of evidence on their indication in this disease. Therefore, it is considered necessary to determine the real value of this medical garment by studying its safety and efficacy specifically for the treatment of lipedema.

Aims

The aim of this health technology assessment report is to evaluate the safety and efficacy of the use of compression garments in people with lipedema who perform physical exercise and hygienic dietary measures.

Method

A systematic review of the published scientific literature was carried out by consulting the following biomedical databases: MEDLINE, Embase, CENTRAL and CINAHL (search date: April 1, 2024). The comprehensive search strategy developed included controlled vocabulary and free terms. In addition, a search for studies was carried out in two World Health Organization resources: the databases available in the Biblioteca Virtual en Salud and the International Clinical Trials Registry to consult ongoing studies.

We selected studies published in English, Spanish or French that evaluated, in people of any age and sex with a diagnosis of lipedema, the efficacy and safety of the use of compression garments on upper or lower limbs in combination with treatment or usual care (physical exercise and hygienic-dietary measures) compared to treatment or usual care alone. In the study design story, only randomized clinical trials were selected. Failing that, non-randomized clinical trials and, failing that, observational studies with a control group.

The selection of studies and the extraction of information and assessment of the risk of bias of the included studies was planned to be carried out in duplicate by two reviewers. To assess the risk of bias of the randomized clinical trials, we considered using the RoB-2 tool. The evaluation of the quality of evidence was planned to be performed according to the GRADE system.

Results

The search in all the databases consulted retrieved 282 references after eliminating duplicates. In the analysis by titles and abstracts, 54 potentially relevant articles were selected for detailed full-text analysis. Five of these articles could not be obtained and are pending evaluation.

After applying the pre-established selection criteria to the remaining 49, none could be included. Only 3 studies were identified that, although they did not meet the established selection criteria, could be of interest.

Nor were any studies located that are yet to be published or are in progress that exactly answered the question posed for this report.

Conclusions

No available scientific evidence is identified on the additional benefit of using compression garments, along with standard care (physical exercise and hygienic-dietary measures), in the treatment of lipedema in the lower or upper limbs compared to usual care alone.

Keywords: lipoedema, compression garments, lower/upper limbs, physical exercise, hygienic-dietary measures.