Gradalski, T., Ochalek, K., & Kurpiewska, J. (2015). Complex decongestive lymphatic therapy with or without Vodder II manual lymph drainage in more severe chronic postmastectomy upper limb lymphedema: A randomized non-inferiority prospective study. Journal of Pain and Symptom Management, 50, 750–757.

To compare the effects of compression bandaging and physical exercises versus the same management augmented by an additional 30 minutes of manual lymph drainage

Sixty women post mastectomy were randomly assigned to either a compression bandage group or a manual lymph drainage group. Fifty-one women then completed two weeks of intensive therapy and six months of maintenance therapy (26 weeks total).

• N = 51   
• MEAN AGE = CB-G group: 62 years (SD = 12.2), CDT-G group: 61.2 years (SD = 9.2)
• FEMALES: 100%
• CURRENT TREATMENT: Not applicable
• KEY DISEASE CHARACTERISTICS: Breast cancer–related lymphedema

• SITE: Single   
• SETTING TYPE: Outpatient    
• LOCATION: Krakow, Poland

• PHASE OF CARE: Late effects and survivorship
• APPLICATIONS: Palliative care 

• Randomized, noninferiority, prospective study

Summed truncated cone method was used to measures limb segment volume. Limb relative volume change (RVC) was measured using the formula treatment (SLafter treatmentNLbefore)/(NLafter SLbefore), where SL is swollen limb volume and NL is normal limb volume. Edema-related quality of life was measured using the Lymphedema Questionnaire.

In both groups, a significant reduction in SL volume, LE volume, and RVC occurred after each day of the first week of therapy. Within the two-week intensive phase, a significant decrease in SL and LE volumes occured (p < 0.001). A rebound effect occurred in the CB-G group within the first month, but after six months, the SL and LE volumes in both groups were not statistically significant. Six months after finishing intensive therapy, no significant difference in lymph volumes existed between the two groups (p = 0.3).

Patients with postmastectomy LE may have a similar benefit of CDT without MLD on limb edema reduction. Compression bandaging combined with physical exercise may be considered a basic treatment option in limb LE. 

• Small sample (< 100)
• Selective outcomes reporting
• Measurement validity/reliability questionable
• Findings not generalizable
• Subject withdrawals ≥ 10%

The results of this study may help guide overall treatment in women post mastectomy with breast cancer–related lymphedema. However, the effect of manual lymph drainage remains unexplored because immediate lymph fluid draining images and long-term lymphatic changes were not investigated.