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 experimental group underwent complete decongestive therapy that included lymph drainage using the Foldi method, multilayer compression bandage, elevation, remedial exercises, and skin care. The control group underwent standard physical therapy that included compression bandages, elevation, head-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) was comprised of patients with lymphedema post-breast cancer treatment.
• Patients were randomly assigned and blinded to the intervention in the experimental group (n = 27) or the control group (n = 26).
• Average duration of lymphedema at the time of treatment was three years.
• Patients were experiencing mild-to-moderate lymphedema; mild lymphedema (n = 21) was defined as a 2 cm circumference difference and moderate (n = 32) a difference of 2–5 cm.
• Patients were excluded from the study if they had
  • Obvious psychiatric illness
  • Severe pain in the axillary region
  • Severe cardiac disease
  • Uncontrolled hypertension
  • Malignancy.
• The average mean volume was 580 ml.
• Patients were assessed for type of breast cancer procedures, but this was not used for characterizing the sample.
• Of patients in the sample, 24.4% had lumpectomies, 64.2% had modified radical mastectomies, and 11.3% had radical mastectomies.
• Nine patients had a history of cellulitis, and 44 had no infection.
• All patients had axillary dissection with a range of 2–35 nodes removed.

The study used a prospective trial design.

• Range of motion, circumference measurement, and volumetric measurement were assessed before and after treatment.
• Circumference measurements were taken 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.
• The arm was placed in water-filled container and displaced water was measured.
• Shoulder mobility was measured using goniometry.
• 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 experiential group and 36% in control group (p < 0.05). Only 45% had limitation of range of motion to start. Reduction in shoulder mobility was 48.1% in the experiential group and 42.3% in control group before treatment. Shoulder flexion and 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 was found between groups in shoulder mobility.

Patients were similarly classified using circumferential and volumetric measurements; therefore, either of the methods can be used.

• The sample size was small, with less than 100 patients.
• Patients had extensive disease of more than three years duration.
• The tissue was not described.
• Lymphedema was not staged.