In collaboration with Heidi Shaffer, one of the occupational therapists on staff at the MultiCare lymphedema clinic in Gig Harbor, Washington, we sought to answer the question “Which patient-reported outcome assessments are most valid and reliable in measuring health-related quality of life (HRQoL) in patients with lymphedema?” We conducted a systematic literature review to answer this question. In reviewing selected databases, 19 articles were chosen to appraise the evidence supporting psychometric properties and clinical utility of 10 HRQoL assessments used for patients with lymphedema. The Disability of the Arm, Shoulder and Hand (DASH) and Lymphedema Life Impact Scale (LLIS) assessments demonstrated stronger evidence for test-retest reliability, internal consistency, and clinical utility for use in a lymphedema practice setting in the U.S. than other assessments.

The next step was to bring the findings back to Heidi and her colleagues to answer questions they had about using recommended assessments to generate G-codes for Medicare reporting and to explore strategies that could be used to implement these recommended assessments within MultiCare’s electronic medical record (EMR) system. We provided an in-service on our findings for MultiCare’s lymphedema therapists, at which time we distributed laminated calculation cards for converting DASH scores to G-code modifiers and obtained feedback through a satisfaction survey. In addition, we met with the Director of Physical Medicine and Rehabilitation at MultiCare, Sherri Olsen, to determine the best process for embedding the LLIS and the DASH into their EMR and identify future research needs. Additional steps will include follow up on the progress and outcomes of embedding the assessments into the EMR and further research to address changes in the literature, HRQoL assessments for other diagnostic populations, and determining the efficacy and benefits of prehab treatments.

Publication Place

Tacoma, Washington


University of Puget Sound

Faculty Advisor

Tatiana Kaminsky, PhD, OTR/L

Project Chairperson

Publication Date



Capstone Project





Degree Program

Occupational Therapy

Degree Level

Master of Science


Occupational Therapy


University of Puget Sound