Gurdal, S.O., Kostanoglu, A., Cavdar, I., Ozbas, A., Cabioglu, N., Ozcinar, B., . . . Ozmen, V. (2012). Comparison of intermittent pneumatic compression with manual lymphatic drainage for treatment of breast cancer–related lymphedema. Lymphatic Research and Biology, 10(3), 129–135.

To compare the effects of complete decongestive therapy (CDT) with intermittent pneumatic compression (IPC) and self-lymphatic drainage

Patients were randomized to receive either CDT, consisting of manual lymphatic drainage and compression bandaging, or self-lymphatic drainage and pneumatic compression. Both groups did the same exercises and wore compression garments at the end of therapy. Treatments were done every other day for six weeks. IPC was applied for 45 minutes in each treatment.   Patients did self drainage at home daily for 15 minutes during the study. Study measurements were done at the beginning and end of the six-week study period.

• N  = 30            
• MEDIAN AGE = 55
• AGE RANGE = 31–74
• MALES: 0%, FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: All participants had breast cancer and lymphedema at study entry. All had level 1 or 2 axillary lymph node dissection and had radiotherapy to the regional lymphatics. 
• OTHER KEY SAMPLE CHARACTERISTICS: Participants had no prior treatment for lymphedema.

• SITE: Single site        
• SETTING TYPE: Outpatient     
• LOCATION: Turkey

• PHASE OF CARE: Not available

• Randomized, controlled trial

• Diary of self treatments
• European Organisation for Research and Treatment of Cancer–Ouality of Life Core 30 (EOTRC QLQ-C30)
• American Shoulder and Elbow Association Quality of Life questions regarding effective use of the arm during the day
• Stillwell classification for lymphedema
• Arm circumference measurement

Both groups had significant reduction in arm volumes at one, two and six weeks (p < .001). There were no significant differences between the groups in this change. There were no significant differences between groups in other study measures. Quality of life improved significantly across the study in both groups.

There were no significant differences in lymphedema or associated quality of life between patients receiving CDT or IPC plus self lymphatic drainage. Both approaches were effective in reducing arm lymphedema volumes.

• Small sample (< 100) 
• Baseline sample/group differences of import
• Risk of bias (no blinding)
• Key sample group differences that could influence results
• Other limitations/explanation: More patients in the CDT group had total mastectomy. No information is provided as to whether patients were completely finished with adjuvant treatment.

Findings show that both approaches studied were effective in reducing lymphedema and improving QOL over a six-week period. The study is limited by the small sample size and short period of time for follow-up.