The effect of taVNS on quality of life in individuals with unilateral upper extremity lymphedema

Abstract

OBJECTIVE: Lymphedema is a chronic condition characterized by the accumulation of lymphatic fluid in tissues, which significantly impairs patients' quality of life. This study aimed to evaluate the effects of transcutaneous auricular vagus nerve stimulation (taVNS) on quality of life in individuals with unilateral upper extremity lymphedema. MATERIAL AND METHODS: This study included 27 voluntary participants diagnosed with Stage 2 or 3 unilateral lymphedema and receiving treatment at Gaziosmanpaşa Training and Research Hospital. All participants met the predefined inclusion and exclusion criteria. They were randomly assigned to one of three groups: a group receiving Complex Decongestive Therapy (CDT) alone (n=9), a group receiving CDT combined with transcutaneous auricular vagus nerve stimulation (taVNS) (n=9), and a group receiving CDT combined with sham taVNS (n=9). Assessments were conducted at baseline and after the treatment period. Quality of life and arm-related symptoms were assessed using the Lymphedema Functioning, Disability, and Health Questionnaire (Lymph-ICF), a validated and lymphedema-specific measurement tool. The Lymph-ICF evaluates several domains including physical function, symptom severity, emotional well-being, and social participation. RESULT: The three groups were found to be homogeneous in terms of sociodemographic and clinical characteristics. In within-group analyses, statistically significant improvement was observed only in the CDT group. The mean Lymph-ICF score in this group decreased from 72.64 to 67.67 following treatment (p=0.03), indicating improved functional capacity. Similarly, the group receiving CDT combined with taVNS showed a significant reduction in scores, from 74.13 to 63.46 (p=0.04). Effect size analysis suggested that both CDT and taVNS had a moderate impact on functional capacity. In contrast, the sham taVNS group did not show any significant changes between pre- and post-treatment scores (p=0.83). Between-group comparisons revealed no statistically significant differences in total Lymph-ICF scores either before or after treatment. However, a significant improvement in physical function was found only in the CDT group (p=0.026), and post-treatment comparisons among groups showed a significant difference in this domain (p=0.001). Although some between-group differences were observed in other subdomains, time-related changes generally did not reach statistical significance. CONCLUSION: In conclusion, taVNS demonstrated beneficial effects on specific subdomains of quality of life in individuals with upper extremity lymphedema. Notably, improvements in physical and emotional functioning highlight the potential value of taVNS as a complementary intervention. Further studies are warranted to explore these effects in more detail. The findings suggest that taVNS may serve as an effective adjunct to complex decongestive therapy.