Ask any Lymphatic Therapist where you can find research articles on any of the hundreds of conditions that benefit from MLD, and they will struggle to point to more than a few.
This is because randomised controlled trials (RCT) are not only exorbitantly expensive to run, but also because RCTs rarely tell us anything clinically relevant in MLD. Read more on why the RCT study design is not suited to MLD here.
It is easy to say that we need to publish more of our Case Studies, but that simple statement belies the very challenging and expensive process involved.
Case Studies are most frequently on medical anomalies and rare cases, and can cost over USD 2000 in article processing fees. Some Journals still offer free publishing but then the full-text is only available to subscribers of that journal.
As Massage Therapists without any experience or training in academic writing, Bronwyn Overall and Kaori Langley did a stellar job of conducting and recording their results using MLD to resolve the symptoms of long-COVID in two cases.
But overcoming the challenges in writing up their results was just the tip of the iceberg.
The Peer Review Process
Getting their Case Report accepted for publication in a high impact journal took persistence. Each rejection meant searching for a new journal and rewriting the paper to suit the guidelines for the new journal.
But they didn't give up, and eventually the manuscript was accepted for publication in Healthcare, an open access journal with an impact factor of 2.8. Read the full article here.
The impact factor is an indication of the average number of times articles in that journal are cited. An impact factor of 3 is considered good, and the average score is less than 1.
So for a journal that has only been in existence for 10 years, 2.8 is great! Healthcare also publish the whole peer review process so you can read more on how our article was reviewed, and our responses to the reviewers comment here.
What did we learn about Publishing Case Studies?
I asked Kaori and Bronnie what expectations they had before starting their case studies, what they learned during the process and what they would do differently next time.
Bronwyn Overall Dip RM
I definitely enjoyed working on the case study, and learnt a lot.
What expectations did you have when you first decided to publish?
I held no expectations beyond creating a treatment protocol for my client. Given that this was uncharted territory for me, I acquired knowledge as we developed the case study.
Upon completing the case study, the evidence unequivocally supported the treatment, and witnessing the positive outcomes for the client, both practically and on paper, was truly exhilarating.
What was the most significant learning or "aha" moment you experienced?
The pivotal lesson was the necessity to meticulously plan and create a structured outline for the case study. This involved strategizing measures and outcomes as evidence to substantiate our goals. Implementing a tailored treatment protocol based on the client's unique symptoms was crucial, considering variations in presentation.
The commitment to an ongoing case study demanded time and perseverance. Presenting measured outcomes in a comprehensible format, outlining findings and finalising the case study for scientific submission to various journals was a substantial task. Having a mentor or study buddy proved to be invaluable.
What you would do differently if you were starting again?
Regarding the planning and structure, I would adhere to the same format. However, I might consider scrutinizing time frames more closely to maintain the momentum of the case study and expedite the path towards publication.
I would strongly recommend delving into other publications to enhance knowledge on written case studies. Gaining a more detailed understanding of the expectations for a case study would also be advisable.
After completing the case study, the evidence definitely backed up the treatment and it was exciting to see the results from the client and on paper.
Kaori Langley DipRM
I had no expectations when I enrolled in the MovingLymphOnline Course to write a case report. I was more interested in planning the treatment and how to conduct it, and I wasn't sure how to bring it together to write a case report when I started.
What was the biggest learning or ah-ha moment you experienced?
In the context of treatment, I learned that as Vodder-trained therapists, we should exude confidence in our practices. This confidence should be supported by a thorough understanding of lymphatic anatomy and physiology, pathophysiology, and sequence protocols.
From a writing standpoint, I was both amazed and dismayed by the intricacies of academic writing. Journals have a global readership, meaning reviewers may not necessarily be familiar with the Australian health-care system. I found it intriguing that we needed to tailor our language depending on the intended readership.
If you were to start over, what would you do differently?
I would invest time in reading more published "case reports" to understand how other authors approach medical publishing particularly in cases, not randomized controlled trials (RCT).
While I never imagined myself publishing, based on my clinical experience, I knew MLD was effective in managing various chronic symptoms. However, I struggled with presenting it effectively. Fortunately, I had the support of my fellow therapist and friend, Bronwyn, and Jan as a writing mentor.
Finding the right publisher interested in our case report proved tricky, taking 20 months from planning to publication after a few unsuccessful attempts.
In hindsight, I would meticulously document every treatment detail to vividly recall the client's progress over many months. I realise I may have been too occupied with data collection and not enough with observing and noting feedback from previous treatments.
Overall B, Langley K, Douglass J. Manual Lymph Drainage for Post-COVID-19 Related Cough, Breathlessness, and Fatigue; Two Case Reports. Healthcare. 2023; 11(23):3085. https://doi.org/10.3390/healthcare11233085
Background: Persistent symptoms after SARS CoV-2 infection such as fatigue, shortness of breath, and cognitive dysfunction that cannot be explained by an alternative diagnosis have been termed long COVID and present a significant emerging public health problem. Current approaches include rehabilitation and symptom management involving multiple health disciplines and as yet there are no pharmaceutical approaches other than routine symptom management. Manual lymph drainage (MLD) has been used to support recovery during pulmonary rehabilitation and reduce chronic inflammation including symptoms associated with long COVID. Case description and outcomes: Two adult females who had reported long-COVID symptoms more than 10 weeks after the resolution of the acute infection were treated with MLD by Remedial Therapists trained in the Dr Vodder method of MLD. Respiratory function (Peak Flow Meter) and blood oxygen levels (Oximeter) were recorded before and after a one-minute sit-to-stand test prior to the treatment. The Dyspnea-12 Questionnaire, the Revised Piper Fatigue Scale, and Likert scales were used to collect client-reported outcomes. Six 45-min treatments were applied weekly, with a follow-up review and treatment at three months. In both cases, all outcomes improved after the third treatment with further improvement noted at three months. Conclusions: MLD may offer a non-invasive, non-pharmaceutical approach to the resolution of long-COVID symptoms such as cough, breathlessness, and fatigue.
Keywords: manual lymph drainage; long COVID; cough; breathlessness; fatigue; therapeutic intervention