Heidi Shaffer, a MultiCare occupational therapist specializing in lymphedema (LE) management, proposed the research question of whether bioimpedance spectroscopy (BIS) via the L-Dex (U400 Impedimed) is the most reliable, valid, cost-effective and time-efficient assessment tool on the market for measuring LE in comparison to circumferential measurements (CM). Shaffer currently uses the L-Dex in practice and hoped to substantiate its psychometrics from the literature to promote its clinical usage and potentially obtain consistent insurance coverage. A critical appraisal of the literature revealed a strong correlation between BIS and CM, suggesting that both can be used reliably and validly in clinical practice. However, BIS can discriminate specifically between intracellular and extracellular fluid. Additionally, the research demonstrated that BIS was more sensitive, reproducible, quantifiable, time-efficient, user-friendly and generally more widely accepted by clinicians, therapists and patients.

The knowledge translation implementation consisted of an informative in-service presentation (to representatives of Multicare and Impedimed) and a brochure for MultiCare consumers and suggested outcome measures for clinicians. A qualitative questionnaire was used to assess the effectiveness of the knowledge translation process and to collect future research considerations. The outcomes suggested that there is a need for more rigorous studies to support consistent insurance coverage of BIS. Furthermore, our findings have potential to impact insurance coverage and to promote improved communication between healthcare professionals. researchers, and insurance companies.

Publication Place

Tacoma, Washington


University of Puget Sound

Faculty Advisor

George Tomlin, PhD, OTR/L, FAOTA

Project Chairperson

Publication Date



Capstone Project





Degree Program

Occupational Therapy

Degree Level

Master of Science


Occupational Therapy


University of Puget Sound