Low Intensity Electrostatic Stimulation

Low Intensity Electrostatic Stimulation

PEP Topic 
Lymphedema
Description 

Low-intensity electrostatic stimulation, or oscillation, is a therapeutic approach that consists in applying an intermittent electrostatic field of low intensity (U = 100–400 V; I = 150 μA) and extremely low frequency (30–200 Hz, rectangular, bi-phase) to the target area in patients with lymphedema to supplement manual lymphatic drainage.

Effectiveness Not Established

Research Evidence Summaries

Belmonte, R., Tejero, M., Ferrer, M., Muniesa, J.M., Duarte, E., Cunillera, O., & Escalada, F. (2011). Efficacy of low-frequency low-intensity electrotherapy in the treatment of breast cancer-related lymphoedema: A cross-over randomized trial. Clinical Rehabilitation, 26(7), 607–618.

doi: 10.1177/0269215511427414
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Study Purpose:

To compare efficacy of low-frequency, low-intensity electrotherapy and manual lymphatic drainage in treatment of upper-limb lymphedema

Intervention Characteristics/Basic Study Process:

Patients were randomized to two groups. Group A underwent electrotherapy therapy for 10 sessions followed by 10 sessions of manual drainage. Group B underwent manual drainage first and then received electrotherapy. There was a month washout period between treatments. Patients were assessed after every 10 treatment sessions. Electrotherapy was delivered with a system that provides massage with low-frequency electrical stimulation.

Sample Characteristics:

  • The study sample (N = 30) was comprised of female patients with breast cancer.
  • Mean age was 68 years.
  • All patients had unilateral arm lymphedema.
  • Seventy-eight percent of patients had had both chemotherpy and radiation therapy.
  • Average duration of lymphedema was 73 months.
  • Eighty-eight percent used compression garments.

Setting:

The study took place in an outpatient setting in Spain.

Phase of Care and Clinical Applications:

The study has clinical applicability for late effects and survivorship.

Study Design:

The study used a randomized crossover trial design.

Measurement Instruments/Methods:

  • Limb volume was calculated using six circumference measurements.
  • Patients completed the Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer Version 4 (FACT-B4).
     

Results:

 There were no significant differences in outcomes between the two treatments.

Conclusions:

There was no difference in benefits from manual lymphatic drainage and low-frequency, low-intensity electrotherapy.

Limitations:

  • The study had a small sample size, with less than 100 participants.
  • The study has a risk of bias because it had no blinding.

Nursing Implications:

 Findings suggest there is no difference in efficacy of these two treatment approaches for management of arm lymphedema in patients with breast cancer.

Jahr, S., Schoppe, B., & Reisshauer, A. (2008). Effect of treatment with low-intensity and extremely low-frequency electrostatic fields (Deep Oscillation) on breast tissue and pain in patients with secondary breast lymphoedema. Journal of Rehabilitation Medicine: Official Journal of the UEMS European Board of Physical and Rehabilitation Medicine, 40(8), 645–650.

doi: 10.2340/16501977-0225
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Study Purpose:

To evaluate the symptoms and functional limitations of patients with secondary breast lymphedema following surgical treatment and to assess the additional therapeutic benefit of Deep Oscillation when combined with manual lymphatic drainage

Intervention Characteristics/Basic Study Process:

Patients were randomized to the treatment group or the control group. The treatment group received 12 sessions of manual lymphatic drainage supplemented by Deep Oscillation, and the control group received manual lymphatic drainage alone.

Sample Characteristics:

  • The study sample (N = 21) was comprised of a treatment group (n = 11) and a control group (n = 10) of female patients.
  • Mean age for the treatment group was 56.6 years, with a range of 41–65 years and for the control group was 62.0 years, with a range of 42–71 years.
  • All patients had breast-sparing surgery for breast cancer and were at least six weeks since their last irradiation.

Setting:

The study took place at a single site in Berlin, Germany.

Study Design:

The study used a randomized controlled trial design.

Measurement Instruments/Methods:

  • A 10-point visual analog scale was used to subjectively assess pain, breast swelling, and the effectiveness of lymphedema treatment.
  • Range of motion of shoulder was measured using the neutral-zero method for passive range of motion.
  • Range of motion of cervical spine was measured using the Zebris ultrasound-based movement sensor for active cervical spine mobility.
  • ScanMobile served as a mobile 3D measuring system for the breast surface area in the target region.

Results:

Patients had high pain and swelling scores at baseline. Shoulder mobility was impaired in all patients; restriction of cervical spine mobility was common at baseline and declined further in the control group. Deep Oscillation resulted in significant pain reduction in the treatment group. The subjective reported reduction of swelling was confirmed objectively by 3D measurement only in the treatment group.

Conclusions:

Additional Deep Oscillation supplementary to manual lymphatic drainage can enhance pain alleviation and swelling reduction.

Limitations:

  • The study sample was small, with less than 30 patients.
  • Placebo effect may exist because of the use of a new technique.
  • The number of treatment sessions per week was higher in the treatment group with two to three sessions per week compared to control group with only one to two sessions per week.

Nursing Implications:

More attention should be paid to patients with breast lymphedema. Treatment with low-intensity and extremely low-frequency electrostatic fields could be a useful supplementary therapy in the management of patients with breast lymphedema. However, more studies with larger sample sizes are needed to duplicate the findings from this study.


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