Complex Decongestive Therapy Enhances Upper Limb Functions in Patients with Breast Cancer-Related Lymphedema
Didem Sezgin Ozcan, Meltem Dalyan, Sibel Unsal Delialioglu, Ulku Duzlu, Cemile Sevgi Polat, and Belma Fusun Koseoglu. Lymphatic Research and Biology, 2018
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Complex Decongestive Therapy Enhances Upper Limb Functions in Patients with Breast Cancer-Related Lymphedema
Didem Sezgin Ozcan, Meltem Dalyan, Sibel Unsal Delialioglu, Ulku Duzlu, Cemile Sevgi Polat, and Belma Fusun Koseoglu. Lymphatic Research and Biology, 2018
Background: We aimed to evaluate the effects of complex decongestive therapy (CDT) on upper extremity functions, the severity of pain, and quality of life. We also searched the impact of the sociodemographic and clinical characteristics on the improvement in upper extremity functions.
Methods: A total of 37 women with breast cancer-related lymphedema (BCRL) [age, 53.6–11.2 (28–72)] were included in this study. All patients underwent CDT-phase 1 program, including meticulous skin care, manual lymphatic drainage, remedial exercises, and compression bandages. Arm volume was calculated by a formula for truncated cone using circumferential measurements. A baseline questionnaire, including sociodemographic and clinical properties, was used for each patient. Short Form-36 (SF-36), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and Visual Analog Scale (VAS) for pain and heaviness were used as clinical assessment scales.
Results: The mean of the posttreatment volume of the affected limb was lower compared to pretreatment volume (2741.81–696.85 and 2990.67–745.49, respectively), and the mean percentage change in edema volume was 38.1%–26.5%. We observed a statistically significant reduction in pain and heaviness VAS scores and improvement of shoulder mobility among upper extremities with lymphedema (p<0.001) after CDT. The mean of posttreatment DASH score was lower compared to pretreatment score (37.19–16.01, 49.81–18.84, respectively, p<0.001). All subgroups of the SF-36 parameters were increased after the CDT application (p<0.01). Besides being under 65 years old, having a body mass index above 30 and short duration of lymphedema were found to be related to greater improvement in upper extremity functions.
Conclusions: CDT provides enhancement of upper extremity functions and quality of life in patients with BCRL. The reduction in lymphedema volume, pain, and heaviness and the improvement in shoulder mobility may be the contributed factors.
Main findings
This very interesting paper evaluates the objective outcome measures we use to determine minimal clinically important difference (MCID).
The outcomes evaluated were volume, symptoms, skin changes, infection rate, quality of life, strength/ endurance/ fitness/ functional disability.
The paper concludes:
- Complex decongestive therapy-phase 1 program, consisting of meticulous skin and nail care, MLD, compression bandages, and remedial exercises, was applied to all participants. All patients received MLD for five times a week (Monday–Friday) during 3 weeks (a total of 15 sessions) by a physiotherapist trained in the Vodder method.
- Assessment and outcome measures include:
- DASH questionnre
- Medical outcomes study 36-item short-form health survey (SF-36)
- Circumferential measurements
- The results of this study reflected only the initial phase of CDT. Because of the lack of long-term follow-up evaluations, they could not comment on the efficacy of maintenance phase. In addition, they enrolled patients with stage 1 and stage 2 lymphedema into the study.
