Iwersen, L.F., Sperandio, F.F., Toriy, A.M., Palu, M., & Medeiros da Luz, C. (2017). Evidence-based practice in the management of lower limb lymphedema after gynecological cancer. Physiotherapy Theory and Practice, 33, 1–8. 

DOI Link

Purpose

STUDY PURPOSE: To examine the current amount and quality of evidence for the standard treatment of lower limb lymphedema (LLL) after treatment for gynecologic cancers

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: MEDLINE (PubMed), SciVerse (SCOPUS), and PEDro (Physiotherapy Evidence Database)
 
YEARS INCLUDED: May 1993 to October 15, 2014
 
INCLUSION CRITERIA: Conservative techniques for treatment; adult women postsurgery and/or radiation for gynecologic cancers; LLL as the primary comorbidity; publication language in English, Portuguese, or Spanish
 
EXCLUSION CRITERIA: Languages other than listed above; studies published prior to May 1993; lack of physical therapy intervention

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 121
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The design was based on a prior review from the Cochrane Library, and the PRISMA recommendations were used to adapt it. Four independent reviewers evaluated the titles and summaries obtained from the search for relevance. The evidence level was evaluated using STROBE.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 3
  • TOTAL PATIENTS INCLUDED IN REVIEW = 55
  • SAMPLE RANGE ACROSS STUDIES: 54–158 participants
  • KEY SAMPLE CHARACTERISTICS: The review addressed women who had prior radiation, chemotherapy, surgery, or lymph node removal for the diagnosis of a gynecologic cancer and received standard care: complex decongestive therapy (CDT)

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship

Results

The evidence was weak (IIIC) but did show an overall decreased volume of limb(s) after CDT.

Conclusions

Despite the accepted and common recommendation to use CDT for LLL treatment, few studies support this in an evidence-based environment.

Limitations

  • Limited number of studies included
  • Mostly low quality/high risk of bias studies
  • Poor or awkward wording at times and structuring of the writeup, which were perhaps because of a typo/discrepancy between the titles initially identified as numbering 121 (in first paragraph of the Results section) and then 120 listed in Figure 1 flowchart
  • The number of final studies included was listed as “5,” then changed to “3” without a clear explanation in the Results writeup, making it difficult to review.
  • The graded evidence was weak (IIIC per results), and no randomized trials existed.
  • One of the studies seemed to focus more on quality of life, and the clinical outcomes were secondary (Kim and Park, 2008).

Nursing Implications

The value of this review is that it highlights the limited evidence and research attempted, to date, for standard LLL treatment. More research is needed in this area, particularly randomized, clinical trials. Hopefully, this encourages nurses to initiate research to better support evidence-based practice and interventions for women with LLL.

Legacy ID

6548