Effect of Bandage Compliance on Upper Extremity Volume in Patients with Breast Cancer-Related Lymphedema

Gu¨lbinErgin,PT,PhD,1 Ertan S xahinog˘lu,PT,MSc,2 Didem Karadibak, PT, PhD,3 and Tug˘ba Yavuzs xen, MD4. Lymphatic Research Biology 2018

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Effect of Bandage Compliance on Upper Extremity Volume in Patients with Breast Cancer-Related Lymphedema

Gu¨lbinErgin,PT,PhD,1 Ertan S xahinog˘lu,PT,MSc,2 Didem Karadibak, PT, PhD,3 and Tug˘ba Yavuzs xen, MD4. Lymphatic Research Biology 2018

Background: Complex decongestive physiotherapy (CDP) is an effective treatment for patients with breast cancer-related lymphedema (BCRL). Bandaging is an important component of CDP. Although the literature suggests that bandages must be kept on for about 24 hours, some patients cannot tolerate keeping them on for this length of time. Also, it has been observed that limb volume decreased in patients who did not keep bandages on for 24 hours in clinical trials. But there is no evidence that this reduction in time is statistically significant. Our purpose was to compare the effectiveness of bandage compliance for a longer or a shorter period on limb volume in patients with BCRL.

Methods and Results: We retroprospectively reviewed the medical records of 39 patients who received CDP. Twenty-eight eligible patients were divided into two groups, group 1 (n=18) and group 2 (n=10), according to the average number of hours of bandage compliance, which was 13–24 and 7–12 hours, respectively. The primary outcome was the change in limb volume between groups. The values for the limb volumes showed a statistically significant decrease in both groups. There was no significant difference in volume reduction between the groups.

Conclusion: This study shows that keeping bandages on for between about 12 and 24 hours has the same effect on patients with BCRL as receiving CDP.

Main findings

  • Small sample size of 39.
  • All patients underwent CDP that consisted of a combination of manual lymph drainages, short-stretch bandages, lymph-reducing exercises, and skin care. MLD was started at the base of the neck, and then progressed to the anterior trunk, posterior trunk, and affected limb. Short-stretch bandages were applied in multiple layers after MLD. Fingers and hand were wrapped in gauze. A layer of cotton was wrapped around the arm. Bandages (6, 8, and/or 10cm) were sequentially applied in a spiral manner around the limb, with the smallest bandage starting at the hand. The most compression was applied at the most distal points and gradually decreased toward to proximally. Exercises were done to improve mobility and enhance lymphatic flow.
  • Bandage compliance was registered every session according to what each patient reported, and the average of duration was calculated after 20 sessions. The 28 patients were grouped into those complying for 13–24 hours (group 1, n=18) and those complying for 7–12 hours (group 2, n=10) according to the average time of compliance.
  • There was no significant difference in the reduction of volumes between the two groups (p>0.05) the results were better in the patients who tolerated the bandage for between 13 and 24 hours than the patients who tolerated it for between 7 and 12 hours. We don’t know what the participant did if they took off their bandages early.
  • Taking into consideration the small sample size and flaws in the limitations of this study conclusion of this study is not valid that “This study shows that compliance with bandaging during CDP for about 24 hours is not necessary for reduction in limb volume in patients with BCRL. Use of the bandage for an average of 12 hours has the same effect.”