Disease-specific quality of life improvement after conservative treatment in women with lipedema: A prospective observational study using QuASiL

Background Lipedema is a chronic adipofascial disorder characterized by pain, edema and progressive functional impairment. Conservative treatment is widely recommended as first-line therapy, but evidence on its impact on disease-specific quality of life remains limited. This study evaluated changes in quality of life following 6 months of partially standardized conservative treatment in women with lipedema, using the Lipedema Symptom Assessment Questionnaire (QuASiL). Methods This prospective observational cohort study included 86 women with stage I–III lipedema treated at a specialized outpatient clinic. Participants underwent a multimodal conservative treatment including manual lymphatic drainage, compression therapy, exercise recommendations and pharmacological therapy when indicated. The primary outcome was change in total QuASiL score between baseline and 6 months (ΔQuASiL). A clinically meaningful improvement was defined as a ≥10 point reduction (0.5 SD). Multivariable regression analyses identified predictors of improvement. Results Mean QuASiL score decreased from 89.9 ± 19.6 at baseline to 74.4 ± 24.7 at 6 months (mean difference −15.6; 95% CI -20.4 to −10.7; p < 0.001), corresponding to a moderate-to-large effect size (Cohen’s dz = 0.69). Clinically meaningful improvement occurred in 56.0% of participants. Baseline QuASiL score independently predicted greater improvement (β = 0.36; p = 0.011), whereas weight change, baseline BMI and age were not significant predictors. The regression model explained 11.2% of variance score change (R 2 = 0.11). Conclusions Multimodal conservative treatment was associated with statistically and clinically significant improvements in disease-specific quality of life in women with lipedema, independent of weight loss. Controlled studies are needed to establish causality and identify predictors of therapeutic response.