Short-term outcomes of combined ESWT-based conservative therapy in lipedema: A retrospective cohort study

Background Lipedema is a chronic condition that is increasingly being detected and gaining public awareness; however, strongly validated therapeutic options are lacking. Objectives Given need for appropriate lipedema management approaches and demand for new studies and methods, this investigation aimed to compare effects of a combined treatment consisting of extracorporeal shock wave therapy (ESWT), manual lymphatic drainage (MLD), intermittent pneumatic compression (IPC), and lifestyle recommenda-tions to a 5-week pre-treatment period prior to treatment in patients with lipedema. Methods We conducted a retrospective evaluation of patients undergoing a 5-week pre-treatment period with lifestyle recommendations followed by a 5-week treatment period (10 sessions) with a standardized protocol including ESWT, MLD and IPC. Circumference measurements at three designated points on the lower extremities were recorded at start and end of pre-treatment period and before and after treatment. Results Data from 55 female patients (age: 46.9 ± 11.9 years; body mass index: 29.54 ± 7.33 kg/m 2 ) who completed both the 5-week pre-treatment lifestyle-only observation period and the subsequent 5-week combined treatment period were analyzed. Comparison of changes in lower extremity circumference measurements between the two periods demonstrated significantly greater reductions during the combined treatment period at five of the six evaluated measurement sites.( p < 0.05). Conclusion In this retrospective cohort study, combined use of ESWT, MLD, IPC, and lifestyle recommendations was associated with improvements in lower extremity circumference measurements; however, due to its non-randomized design, causal inferences cannot be made. Further randomized controlled trials are needed to clarify individual and combined effects of these treatments.