Didem, K., Ufuk, Y.S., Serdar, S., & Zumre, A. (2005). The comparison of two different physiotherapy methods in treatment of lymphedema after breast surgery. Breast Cancer Research and Treatment, 93(1), 49–54.

The study included an experimental group and a control group. The experimental group received complete decongestive therapy (CDT) that included lymph drainage (Foldi method), multilayer compression bandage, elevation, remedial exercises, and skin care. The control group received standard physical therapy that included compression bandages, elevation, head and neck and shoulder exercises, and skin care. Both groups had a home program of bandaging, skin care, and walking. Therapy was three times per week for four weeks.

• The study sample (N = 53) included 27 experimental group patients and 26 control group patients who were randomly assigned and blinded to the intervention.
• All patients had mild (n = 32) or moderate (n = 21) lymphedema post-breast cancer treatment (2 cm circumference difference was defined as mild lymphedema, and 2–5 cm circumference difference was defined as moderate).
• Average duration of lymphedema at the time of treatment was three years; all patients had experienced lymphedema for more than one year. 
• Patients measuring 2–5 cm were excluded from the study based on obvious psychiatric illness, severe pain in axillary region, severe cardiac disease, uncontrolled hypertension, or malignancy.
• The average mean volume was 580 ml. 
• Patients were assessed for type of breast cancer procedures, but the sample was not characterized by them.
• Of the 53 patients who were post-breast cancer treatment, 24.4% had lumpectomies, 64.2% modified radical mastectomies, and 11.3% radical mastectomies. In addition, 13.2% received chemotherapy and 49.1% hormonal therapy. 
• All patients had axillary dissection with a range of 2–35 nodes removed and a mean of 24.2.

The study took place at a school of physical therapy.

A prospective trial design was used.

• Range of motion, circumference measurement, and volumetric measurement were assessed before and after treatment.
• Circumference was measured using a standard one-inch, retractable, fiberglass tape measure.
• Measurements were taken from 10, 15, and 20 cm above and below the olecranon process, at wrist, and at metacorpophalangial joints.
• Measurements always were taken twice.
• The same procedure was used for the unaffected arm of each participant.
• To measure volume, the arm was placed in a water-filled container and displaced water was measured.
• Goniometry was used to determine shoulder mobility. 
• Function was measured as the active mobility with extension-flexion, abduction-adduction, and external rotation.

• Mean percentage reduction in edema was 55.7% in the experimental group and 36% in the control group (p < 0.05).
• Only 45% of patients had limited of range of motion to start. Reduction in shoulder mobility was 48.1% in the experimental group and 42.3% in control group before treatment.
• Shoulder flexion, abduction movements in both groups were increased after treatment (p < 0.05).
• No significant difference was found in shoulder external rotation in both groups (p > 0.05).
• No difference between groups in shoulder mobility was found.
• Similar patient classification was found using circumferential and volumetric measurements.

Either of the methods can be used.

• Patients had extensive disease of more than three years' duration.
• No description of the tissue (pitting fibrotic) was provided.
• Lymphedema was not staged.
• The sample size was small.