Best Summary Maual lymphatic draiage (MLD) versus o itervetio for lymphedema symptoms i adults with breast cacer: Best Summary Studets: Athoy Lisacek-Kiosoglous, Caitli Prior, Corey Baker, Kristia Ricci, Peter Migliore, Rosha Wijerate Course: Based Practice 3 Period coducted: Secod half 2014 Questio: Maual lymphatic draiage (MLD) versus o itervetio for lymphedema symptoms i adults with breast cacer: Best Summary Search Strategy: The most applicable databases for this search icluded AMED, CINAHL, Cochrae Library, EMBASE ad Medlie. Databases Searched, Search Strategy ad limits MEDLINE (Ovid R) AND EMBASE AND AMED, Cochrae Library, CINAHL Table 6: Summary databases ad search terms Breast Neoplasm/ Lymphedema/ OR Edema/ OR Yellow Nail Sydrome / Search terms P I C O Draiage/ No comparator Quality Life OR Pai OR Pai, Postoperative Limits Eglish Laguage Mastectomy/ OR Lymph Node Excisio / Leged? : Iserted where spellig ca vary. : Searched exactly these words.
Cliical Effects Maual Lymphatic Draiage o lymphedema symptoms Upo aalysis the seve studies i this review, it was foud that overall MLD improved subjective lymphedema symptoms i patiets followig surgery for breast cacer. Five out the seve studies reported sigificat improvemets i specific lymphedema symptoms icludig pai, heaviess ad tesio (Aderse et al. 2000; Johasso et al. 1998; Johasso et al. 1999; Szoloky et al. 2009; Williams et al. 2002); two out the seve studies showed improved effect o QOL (Gurdal et al. 2012; Williams et al. 2002) ad oe study could ot determie ay beeficial effect MLD o subjective symptoms (Dayes et al. 2013). Therefore, while there is some evidece to idicate that MLD may be effective, it is uclear if MLD is cosistetly superior to other comparative itervetios. Give this to be the case, physiotherapists ad patiets should balace the potetial positive beefits MLD with this equivocal evidece. Possible reasos for icosistecies betwee the fidigs i these studies could be related to methodological issues ad heterogeeity i terms stadardized protocol MLD, co-itervetio ad outcome measuremet. As there are o curret validated outcome measures for chages i lymphedema symptoms, the rage outcome measures used were sigificat. Outcome measures raged from the use symptom questioaires, QOL questioaires ad VAS scales. This caused difficulty whe makig compariso betwee studies ad attemptig to idetify a true effect. Furthermore, the cliical effect MLD as a sole treatmet modality is problematic as MLD was used as a combiatio therapy i all studies comprisig this article. I additio, the cost effectiveess ad specialized traiig eeded by the Physiotherapist may also ifluece implemetatio ad uptake i cliical practice. Therefore, while there is some evidece to support the role MLD i improvig subjective lymphedema symptoms i patiets followig surgery for breast cacer, the curret evidece base is mixed ad has some methodological cocers which limits cocrete recommedatios. Study Aderse et al. 2000 38 Wome MLD, ST, educatio, ST EORTC-QLQ-C30 There was o evidece selfmassage a improved LE, 4m effect post-op addig MLD (ages 25- to the 77) treatmet (p=0.86). itervetio ad comparator Dayes et al. 95 Wome CDT- MLD, SSCB Short form-36 NSD at
Study 2013 LE (ages 36-86) Gurdal et al. 2012 Johasso et al. 1998 Johasso et al. 1999 Szoloky et al. 2009 Pseudo 2b 30 Wome Mild-mod, LE 59.8) 24 Wome LE (ages 47.5-69.5) 38 Wome LE (ages 37-83) 27 Wome mod, LE >12m post-op 55) SSCB, Educatio MLD, SSCB, ski care ad exercises CB (2 weeks), MLD (2 weeks) CB (2 weeks), MLD + CB (1 week) MLD + SSCB ad exercise, ski care SLD + IPC CB (2 weeks), CB + SPC (2 weeks) CB (2 weeks), CB (1 week) MLD + IPC Health Survey EORTC-QLQ ad ASES tests VAS scale VAS scale. Subjective Sx questioaire baselie or at ay the follow-up periods, betwee ad withi treatmet groups (P>0.1) groups for ASES ad QOL measures I Part I: A sigificat decrease i feelig tesio (p=0.004) ad heaviess (p=0.01) i the arm was foud i the total group. I Part II: the two groups i Part II. the two groups at the ed the study Sigificat reductio i symptoms for each group at each measuremet poit. the groups at ay time poit Williams et al 2002 29 Wome LE >12m post-op. 59) MLD (3 weeks) + o Rx (6 weeks) + SLD (3 weeks) + educatio SLD (3 weeks) + o Rx (6 weeks) + MLD (3 weeks) + educatio EORTC-QLQ-C30 Symptoms/altered sesatios scales EORTC QLQ C30: MLD: Improved emotioal fuctio i terms reducig worry, irritability,
Study tesio ad feeligs depressio (P = 0.006). It also improved dyspoea (P = 0.04) ad reduced sleep disturbace (P = 0.03). Symptoms ad altered sesatios: MLD was sigificatly more likely tha SLD to improve pai, discomfort, heaviess, fulless, ad hardess (P <0.005) LEGEND: = Number participats i the study, MLD = Maual Lymphatic Draiage, SLD = Simple Lymphatic Draiage, SCCB = Short Stretch Compressio Badagig, NSD = No sigificat differece, CB = Compressio Badagig, SPC = Sequetial Peumatic Compressio, IPC = Itermittet Peumatic Compressio, ST = Stadard therapy, QOL = Quality Life, VAS = Visual Aalog Scale, LE = Lymphedema, Rx = Treatmet, mi = miutes, P = p-value, Sx = Symptoms, mod = Moderate, = Radomized Cotrolled Trial, CDT = Complex Decogestive Therapy
Referece List Aderse, L, Højris, I, Erladse, M & Aderse. J 2000, Treatmet breast-cacer-related lymphedema with or without maual lymphatic draiage--a radomized study, Acta Ocologica, vol. 39, o. 3, pp. 399-405. Dayes, I, Whela, T, Julia, J, Parpia, S, Pritchard, K, D Souza, D, Kligma, L, Reise, D, LeBlac, l, McNeely, M, Machul, L, Wierikowski, J & Levie, M 2013, Radomized trial decogestive lymphatic therapy for the treatmet lymphedema i wome with breast cacer, Joural Cliical Ocology, vol. 32, o. 29, pp. 3758-3763. Gurdal, S, Kostaoglu, A, Cavdar, I, Ozbas, A, Cabioglu, N, Ozciar, B, Igci, A, Muslumaogly, M & Ozme, V 2012 Compariso itermittet peumatic compressio with maual lymphatic draiage for treatmet breast cacer-related lymphedema, Lymphatic ad Biology, vol. 10, o. 3, pp. 129-135. Johasso, K, Albertsso, M, Igvar, C & Ekdahl, C 1999, Effects compressio badagig with or without maual lymph draiage treatmet i patiets with postoperative arm lymphedema, Lymphology, vol. 32, pp. 103-110. Johasso, K, Lie, E, Ekdahl, C & Lidfeldt, J 1998, A radomized study comparig maual lymph draiage with sequetial peumatic compressio for treatmet postoperative arm lymphedema, Lymphology, vol. 31, pp. 56-64. Szoloky, G, Lakatos, B, Keskey, T, Varga, E, Varga, M, Dobozy, A & Keméy, L 2009, Itermittet peumatic compressio acts syergistically with maual lymphatic draiage i complex decogestive physiotherapy for breast cacer treatmet-related lymphedema, Lymphology, vol. 42, pp. 188-194. Williams, A, Vadgama, A, Fraks, P & Mortimer, P 2002, A radomized cotrolled crossover study maual lymphatic draiage therapy i wome with breast cacer-related lymphoedema, Europea Joural Cacer Care, vol. 11, pp. 254-261.