Karadibak, D., Yavuzsen, T., & Saydam, S. (2008). Prospective trial of intensive decongestive physiotherapy for upper extremity lymphedema. Journal of Surgical Oncology, 97(7), 572–577.

To evaluate the effects of kinesiophobia, quality of life, and home exercise programs on women with upper-extremity lymphedema

All patients underwent complete decongestive physiotherapy consisting of a combination of manual lymph drainage using the Foldi method, multi-layer bandages, remedial exercise, and skin care.

• The sample was comprised of 62 patients.
• Mean age of the sample was 56.7 years. 
• The sample was 100% female.
• All patients had upper-extremity edema following axillary node dissection after sentinel node biopsy as part of breast cancer therapy.
• Patients were included in the study if they had mild, moderate, or severe edema.
• Patients were excluded if attendance was irregular.

The study was conducted at a single-site outpatient setting at Dokuz Eylul University Hospital.

The study used a prospective trial design.

• Circumference was measured using a fiberglass tape measure.
• Water displacement in water cylinder was used to measure volume.
• Fear of movement was measured using the Tampa Scale Kinesiophobia (TSK) based on a Likert scale.
• Quality-of-life measurements were based on the Functional Assessment of Cancer Therapy for Patients With Breast Cancer (FACT-B) and four questionnaires.

• Edema of arm-volume significantly reduced after treatment with decongestive therapy (p = 0.000).
• Patient fear of activity decreased after treatment (p < 0.05).
• More exercise habits equaled less fear of activity (p < 0.05).

A correlation between severity of edema and fear of activity was established. Increased fear of activity showed to decrease quality of life.

• The study sample was small with fewer than 100 patients.
• Patients with poor attendance were eliminated from the study analysis.

Encouraging activity and education are important for the management of lymphedema in patients after sentinel node biopsy.