Devoogdt, N., Christiaens, M.R., Geraerts, I., Truijen, S., Smeets, A., Leunen, K., . . . Van Kampen, M. (2011). Effect of manual lymph drainage in addition to guidelines and exercise therapy on arm lymphoedema related to breast cancer: randomised controlled trial. BMJ (Clinical Research Ed.), 343, d5326.

To determine the effect of manual lymph drainage (MLD) in addition to exercise compared to exercise alone for management of lymphedema in patients with breast cancer

After surgery, patients with axillary node dissection were recruited to the study and randomized to receive exercise, guidelines for self-care and MLD, or exercise and guidelines alone. MLD was begun one week after removal of axillary drains and 5 weeks after surgery and was provided for 20 weeks. All patients received the same guidelines and 30-minute individual exercise sessions. Standardized MLD sessions took half an hour, and patients received 40 treatments during the study period. Patient assessments were done at 1, 3, 6, and 12 months after surgery.

• The study sample was comprised of 158 patients who followed for the first six months and 154 who completed the study after 12 months.
• Most patients in the study were female (99%).
• Mean age was 55.15 years.
• Sixty-eight percent of the sample had breast conserving surgery, 85% also had radiotherapy, 67% had chemotherapy, and 76% had endocrine treatment.
• Median increase in arm volume before allocated treatment was 8 ml in both study groups.

The study took place at a singe outpatient site in the Netherlands.

Patients were undergoing multiple phases of care.

The study used a single-blind randomized controlled trial design.

• Arm volume was measured using water displacement.
• Arm circumference was measured.
• Lymphedema was defined as increase of 200 ml or more.
   

There were no differences between groups in incidence of arm lymphedema, time to lymphedema development, or maximal increase in arm circumference.

 The addition of MLD to a program of patient guidelines and education and exercise did not have an effect on prevention of arm lymphedema in patients with breast cancer after axillary node dissection.

• Key sample group differences could influence results.
• No analysis of group baseline differences was provided, and patients in the intervention group had higher percentage with level 1–3 axillary surgery. 
• The maximum percentage of patients who developed lymphedema by month 12 was 24%, so not all patients were at risk in the sample. 
• It is not known if there were substantial differences in surgeries performed that could have affected results.

Findings show that the addition of MLD to a program of exercise and patient guidelines for self-management had no benefit to prevent lymphedema development.