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. 2020 Jun;18(3):277-283.
doi: 10.1089/lrb.2019.0035. Epub 2019 Sep 19.

Implementation of Single-Tab Electrodes for Bioimpedance Spectroscopy Measures

Paula M C Donahue  1   2 , Rachelle Crescenzi  3 , Liping Du  4   5 , Manus J Donahue  3   6   7
Affiliations

Implementation of Single-Tab Electrodes for Bioimpedance Spectroscopy Measures

Paula M C Donahue et al. Lymphat Res Biol. 2020 Jun.

Abstract

Background: Bioimpedance spectroscopy (BIS) demonstrates proficiency in early identification of breast cancer treatment-related lymphedema (BCRL) development. Dual-tab electrodes were designed for consistent and easy electrode placement, however, single-tab electrodes positioned to mimic dual-tab placement on the body may make BIS technology more accessible in community hospitals and outpatient settings. The purpose of this study is to evaluate use of single-tab electrodes for BIS measurements and assess whether single-tab electrodes provide consistent BIS measurements in controls and patients with BCRL. Methods and Results: Upper limb BIS ratios were obtained using ImpediMed L-Dex® U400 in controls (n = 13; age = 23-75 years; 9 repeated measurements) using dual-tab and single-tab electrodes. BCRL patients (n = 17; Stage = 1.65 ± 0.49; number nodes removed = 16.3 ± 7.7; age = 50.9 ± 10.6 years; age range = 33-77 years) and healthy controls (n = 19) were evaluated to determine if single-tab electrodes provided discriminatory capacity for detecting BCRL. Intraclass correlation coefficients (ICC), linear mixed-effects models, Wilcoxon rank-sum tests, and linear regression with two-sided p-values <0.05 required for significance were applied. Single-tab electrodes were found to be statistically interchangeable with dual-tab electrodes (ICC = 0.966; 95% confidence interval = 0.937-0.982). No evidence of differences in single-tab versus dual-tab measurements were found for L-Dex ratios (p = 0.74) from the linear mixed-effects model. Repeated trials involving reuse of the same electrodes revealed a trend toward increases in L-Dex ratio for both styles of electrodes. Single-tab electrodes were significant (p < 0.0001) for discriminating between BCRL and control subjects. Conclusion: Findings expand upon the potential use of BIS in clinic and research settings and suggest that readily available single-tab electrodes provide similar results as dual-tab electrodes for BIS measurements.

Keywords: L-Dex; bioimpedance spectroscopy; breast cancer treatment-related lymphedema; electrodes; lymphedema; physical therapy.

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Conflict of interest statement

P.M.C.D. is a consultant for PureTech Health. M.J.D. receives research related support from Philips North America and is the CEO of Biosight, LLC which provides health care technology consulting services. No competing financial interests exist with the other authors.

Figures

FIG. 1.
FIG. 1.
Electrode template. (A) Dual-tab electrode. (B) 3M single-tab electrode on plastic electrode sheet so the tab end of each single-tab electrode matches with the tab ends of the dual-tab electrode. (C) Paper copy of the electrode template with corresponding green line mark and additional orientation cues of “body” and “fingers/toes.” Color images are available online.
FIG. 2.
FIG. 2.
Positioning dual- and single-tab electrodes. (A) Dual-tab electrode positioned incorrectly on upper limb where green line is positioned between the ulnar and radial condyles, however, the side of the electrode with the green line should be oriented most proximal. (B) Dual-tab electrode positioned correctly on upper limb where the side of the green line is most proximal and positioned between the ulnar and radial condyles. (C) Using the electrode template to position the single-tabs, the template is oriented so the word “body” points proximally and “fingers/toes” points distally. We position the green bar in line with the ulnar and radial styloid processes (or medial and lateral malleoli for the ankle) and then move the template slightly off midline and place the single-tab electrodes to align with the template. (D) Single-tab electrode placement on upper limb to replicate the dual-tab electrode placement. Color images are available online.
FIG. 3.
FIG. 3.
Distance of L-Dex® leads using dual- and single-tab electrodes. (A) The red and yellow L-Dex leads are ∼8.5 cm apart where the manufacturer instructions indicate that the alligator clips should clamp onto the tab portion on each side of the dual-tab electrode. (B) The red and yellow L-Dex leads are ∼8.5 cm apart with the single-tab electrodes when first using the electrode template to assist with positioning of each electrode. Note that the size of dual-tab electrodes are larger than the single-tab electrode, although when using the electrode template to position the single-tab electrodes, the distance between the two electrode leads and the location of the leads on the body are essentially the same. Color images are available online.
FIG. 4.
FIG. 4.
Single-tab versus dual-tab electrodes. (A) Three repeated measurements (1, 2, or 3) were taken for each trial (X1, X2, or X3) using L-Dex dual-tab or 3M single-tab electrodes to evaluate interchangeability of the different electrode types. The order of the first electrode type was randomized across subjects (shown here with L-Dex first). (B) L-Dex ratio raw data acquired using dual-tab electrodes and single-tab electrodes for identical volunteer subjects where three measurements were obtained in each of the three trials performed as shown in (A). (C) Participant's mean of all measurements and trials plotted with one standard deviation depicted in the error bars. The solid line is a best fit line (slope = 0.95; intercept = −0.16) and the dashed line is a line of unity. One control volunteer (Participant 9; B) was an outlier for BIS measurements with both types of electrodes and excluded from the plot. However, inclusion of this participant did not influence the statistical significance of the findings (p < 0.001 regardless of inclusion or exclusion of the one outlier). BIS, bioimpedance spectroscopy. Color images are available online.
FIG. 5.
FIG. 5.
Descriptive statistics by group. (A) Distribution of age in the patient group compared with controls. (B) L-Dex ratios obtained using single-tab electrodes in the patient group compared with age-matched controls illustrating the significant difference (p < 0.0001) of the ratios where patients with known BCRL have higher BIS measurements. There is a greater variance in the measurements in patients versus controls. BCRL, breast cancer treatment-related lymphedema. Color images are available online.
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