Ezzo, J., Manheimer, E., McNeely, M.L., Howell, D.M., Weiss, R., Johansson, K.I., . . . Karadibak, D. (2015). Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database of Systematic Reviews, 5, CD003475. 

DOI Link

Purpose

STUDY PURPOSE: To assess the efficacy and safety of manual lymphatic drainage (MLD) in treating breast cancer-related lymphedema (BCRL)
 
TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: MEDLINE, EMBASE, CENTRAL, WHO ICTRP, and the Cochrane Breast Cancer Group’s Specialized Register
 
KEYWORDS: Lymphoedema, lymphedema, complete decongestive therapy, complex decongestive therapy, manual lymphatic drainage, complete decongestive physiotherapy, sequential pneumatic compression, and decongestive lymphatic therapy
 
INCLUSION CRITERIA: Randomized or quasirandomized trials; any language
 
EXCLUSION CRITERIA: Not exclusive BCRL; nonmanual form of lymphatic drainage in place of MLD; different type of massage instead of MLD; if used was MLD in both groups, altered more than the MLD component of complete decompression therapy; or addressed the prevention rather than treatment of BCRL

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 1,110
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Methodical database and bibliographic search identified 1,096 records; 14 found via other sources; removing duplicates reduced to 834; screened by two review authors; reduced to 29 full-text articles; 23 exclusions of articles that did not represent original research or were not exclusively BCRL, had no control group, or gave interventions other than MLD

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 6
  • TOTAL PATIENTS INCLUDED IN REVIEW = 208
  • KEY SAMPLE CHARACTERISTICS: All trials included MLD with some form of compression. These were placed into three categories, (a) MLD with standard physiotherapy versus standard physiotherapy, (b) MLD with compression bandaging versus compression bandaging, or (c) MLD with compression therapy versus nonmanual lymphatic drainage treatment with compression therapy 

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship

Results

Six trials were classified in three categories.
  1. MLD with standard physiotherapy versus physiotherapy: This method demonstrated improvements in both groups, but no significant differences were seen between the two.
  2. MLD with compression bandaging versus compression bandaging alone: A significant percentage in reductions were seen for bandaging alone with an additional 7.11% reduction with MLD. Significant analyses showed that participants with mild to moderate BCRL responded better to MLD than participants with more severe swelling.
  3. MLD with compression therapy versus nonmanual lymphatic drainage treatment with compression therapy: Too varied
Primary Outcomes
  1. Volumetric changes in arm, hand, or trunk indicated that more research should be done to identify the most clinically meaningful volumetric measurement.
  2. The functional outcome of range of motion showed contradictory results.
  3. Quality of life outcomes were inconclusive or not measured in all, and in two trials that measured this outcome, one did not report the results. Future research should use a lymphedema-specific quality of life tool.
MLD was safe and well-tolerated in all trials. Adverse events were minimal, and 60%–80% of participants reported feeling better regardless of the treatment received.

Conclusions

  • MLD is safe and may offer an additional benefit to bandaging for fluid reduction.
  • More studies are needed to confirm which stage of lymphedema benefits most from the addition of MLD.
  • Studies should include a lymphedema-specific quality of life tool and functional outcomes.

Limitations

  • Trials were limited in size and participants
  • Potential bias in four trials as person measuring swelling knew what treatment participants were receiving
  • All trials assessed phase 1 decongestion, but only one also looked at phase 2 maintenance.

Nursing Implications

Nurses need to provide early identification and education to affect patients' lymphedema treatment. MLD is a safe component of lymphedema therapy. Long-term adherence to treatment and garments are needed maintain reductions in swelling.

Legacy ID

5479