We have collated some great articles and material published over the last month. Click on the links below to read the abstract or download the full paper.
Anatomy / Physiology /Pathophysiology
Pathological Changes in the Lymphatic System of Patients with Secondary Lower Limb Lymphedema Based on Single Photon-Emission Computed Tomography/Computed Tomography/Lymphoscintigraphy Images- click for abstract
Pathological Changes in the Lymphatic System of Patients with Secondary Lower Limb Lymphedema Based on Single Photon-Emission Computed Tomography/Computed Tomography/Lymphoscintigraphy Images
In patients with secondary upper limb lymphedema, positive correlations have been observed between the dermal back flow (DBF) type and visualization of lymph nodes around the clavicle, between the former and the lymph flow pathway type, and between the latter and the visualization of lymph nodes around the clavicle when using single photon-emission computed tomography/computed tomography/lymphoscintigraphy (SPECT-CT LSG). Methods and Results: We analyzed the associations between the visualization of inguinal lymph nodes, the lymph flow pathway type, and the DBF type using SPECT-CT LSG in 81 patients with unilateral secondary lower limb lymphedema by statistical analysis using Fisher’s exact test. We revealed that the lymph flow pathways in the lower limb can be classified into nine types because the type in the lower leg is not always equal to the type in the thigh. Associations were observed between the visualization of inguinal lymph nodes and types of DBF (p < 0.01), between the types of lymph flow pathway in the thighs and visualization of the inguinal lymph nodes (p = 0.02), and between the lymph flow pathway types in the thighs and lower legs (p < 0.01). Conclusion: Detriment to the superficial lymph flow pathways in the lower limb appears to usually start from the proximal side, and deep pathways are considered to become dominant from a compensatory perspective as lymphedema severity increases.
Diagnosis of Lymphatic Dysfunction by Evaluation of Lymphatic Degeneration with Lymphatic Ultrasound- click for abstract
Diagnosis of Lymphatic Dysfunction by Evaluation of Lymphatic Degeneration with Lymphatic Ultrasound
Hisako Hara, MD, PhD, and Makoto Mihara, M.LYMPHATIC RESEARCH AND BIOLOGY. Volume 19, Number 4, 2021
Background: The standard examination for diagnosing lymphedema is lymphoscintigraphy, which has a disadvantage in versatility and radiation exposure. We have reported the usefulness of echography in observing the
lymphatic degeneration. The purpose of this study was to investigate the usefulness of lymphatic ultrasound in
Methods and Results: The study included 14 patients (28 lower limbs) who underwent lymphaticovenous
anastomosis for lower limb lymphedema. Preoperative echography with a common 18-MHz linear probe was
used to detect lymphatic vessels. We evaluated abnormal expansion or sclerosis of lymphatic vessels in the
medial legs, which indicated the presence of lymphedema. We proposed the method ‘‘D-CUPS’’ on how to
detect and observe the lymphatic vessels. We then performed indocyanine green (ICG) lymphography to
diagnose lymphedema. The results of examination were compared. Stage 1 lymphedema was diagnosed in
9 limbs, Stage 2a in 7, Stage 2b in 8, and Stage 3 in 4. Lymphatic vessel detection was possible in all
28 medial thighs and in 27 medial lower legs. The sensitivity and specificity for diagnosis of lymphedema
based on echography of the medial leg were 95.0% and 100.0%, respectively. The accuracy rate was 94.6%.
We could detect lymphatic vessels with echography in 39 of 54 areas that failed detection using lymphoscintigraphy or ICG lymphography (72.2%).
Conclusion: The location and degeneration of lymphatic vessels in lymphedematous limbs can be evaluated
with a commonly used ultrasound device. Although exclusion of comorbidities is still necessary, lymphatic
ultrasound has potential for use in diagnosis of lymphedema or lymphatic dysfunction.
Genetic Determinants of the Effects of Training on Muscle and Adipose Tissue Homeostasis in Obesity Associated with Lymphedema- click for abstract
Genetic Determinants of the Effects of Training on Muscle and Adipose Tissue Homeostasis in Obesity Associated with Lymphedema
Andrea Vettori, PhD,1 Stefano Paolacci, PhD,2 Paolo Enrico Maltese, PhD,2 Karen L. Herbst, MD,3–6 Marina Cestari, MD,7,8 Sandro Michelini, MD,9 Serena Michelini, MD. LYMPHATIC RESEARCH AND BIOLOGY Volume 19, Number 4, 2021
It is widely accepted that metabolic changes associated with training are influenced by a person’s genetic background. In this review, we explore the polymorphisms underlying interindividual variability in response to training of weight loss and muscle mass increase in obese individuals, with or without lymphedema, and in normal-weight subjects. We searched PubMed for articles in English published up to May 2019 using the following keywords: (((physical training[Title/Abstract] OR sport activity[Title/Abstract]) AND predisposition[Title/Abstract]) AND polymorphism [Title/Abstract]). We identified 38 single-nucleotide polymorphisms that may modulate the genetic adaptive response to training. The identification of genetic marker(s) that improve the beneficial effects of training may in perspective make it possible to assess training programs, which in combination with dietary intervention can optimize body weight reduction in obese subjects, with or without lymphedema. This is particularly important for patients with lymphedema because obesity can worsen the clinical status, and therefore, a personalized approach that could reduce obesity would be fundamental in the clinical management of lymphedema.
Prevalence and Risk Factors
The Effects of Obesity on Lymphatic Pain and Swelling in Breast Cancer Patients
Mei R. Fu, Deborah Axelrod, Amber Guth, Melissa L McTernan, Jeanna M Qiu, Zhuzhu Zhou, Eunjung Ko, Cherlie Magny-Normilus, Joan Scagliola, Yao Wang Biomedicines. 2021 Jul 14;9(7):818.
Prevalence and predictors of peripheral neuropathy after breast cancer treatment
Mandana Kamgar, Mark K Greenwald, Hadeel Assad, Theresa A Hastert, Eric M McLaughlin, Kerryn W Reding, Electra D. Paskett, Jennifer W Bea, Aladdin H Shadyab, Marian L Neuhouser, Rami Nassir, Tracy E Crane, Kalyan Sreeram, Michael S Simon. Cancer Med. 2021 Aug 14
Breast cancer-related lymphoedema: Risk factors and prediction model - click for abstract
Breast cancer-related lymphoedema: Risk factors and prediction model
Patricia Martínez-Jaimez, Miriam Armora Verdú, Carlos G Forero, Samantha Álvarez Salazar, Pilar Fuster Linares, Cristina Monforte-Royo, Jaume Masia. J Adv Nurs. 2021 Aug 7.
AIMS: To identify the risk factors for lymphoedema following axillary lymph node dissection (ALND) in a European sample and to propose a lymphoedema prediction model for this population.
DESIGN: Predictive retrospective cohort study comparing women who developed lymphoedema in 2 years of undergoing ALND with those who did not developed lymphoedema.
METHODS: We reviewed the clinical records of 504 women who, between January 2008 and May 2018, underwent surgery for breast cancer that involved ALND. Logistic regression was used to identify significant risk factors for lymphoedema. The prediction accuracy of the model was assessed by calculating the area under the receiver operating characteristic curve.
RESULTS: Of the 504 women whose records were analysed, 156 developed lymphoedema. Significant predictors identified in the regression model were level of lymph node dissection, lymph node status, post-operative complications, body mass index (BMI) and number of lymph nodes extracted. The prediction model showed good sensitivity (80%) in the study population.
CONCLUSIONS: The factor contributing most to the risk of lymphoedema was the level of lymph node dissection, and the only patient-related factor in the prediction model was BMI. The model offers good predictive capacity in this population and it is a simple tool that breast care units could use to assess the risk of lymphoedema following ALND. Nurses with specialist knowledge of lymphoedema have a key role to play in ensuring that women receive holistic and individualized care.
IMPACT: What problem did the study address? Secondary lymphoedema is one of the main complications in the treatment of breast cancer. What were the main findings? The prediction model included five factors associated with the risk of lymphoedema following ALND. The strongest predictor was the level of lymph node dissection, and the only patient-related factor was BMI. Where and on whom will the research have an impact? The prediction model offers breast care units a tool for assessing the risk of lymphoedema in women undergoing surgery involving ALND. The results highlight the importance of weight reduction as a preventive measure and support a more conservative surgical approach.
A historical literature review on the role of posterior axillary boost field in the axillary lymph node coverage and development of lymphedema following regional nodal irradiation in breast cancer - click for abstract
A historical literature review on the role of posterior axillary boost field in the axillary lymph node coverage and development of lymphedema following regional nodal irradiation in breast cancer
To elucidate whether (1) a posterior axillary boost (PAB) field is an optimal method to target axillary lymph nodes (LNs); and (2) the addition of a PAB increases the incidence of lymphedema, a systematic review was undertaken. A literature search was performed in the PubMed database. A total of 16 studies were evaluated. There were no randomized studies. Seven articles have investigated dosimetric aspects of a PAB. The remaining 9 articles have determined the effect of a PAB field on the risk of lymphedema. Only 2 of 9 articles have prospectively reported the impact of a PAB on the risk of lymphedema development. There are conflicting reports on the necessity of a PAB. The PAB field provides a good coverage of level I/II axillary LNs because these nodes are usually at a greater depth. The main concern regarding a PAB is that it produces a hot spot in the anterior region of the axilla. Planning studies optimized a traditional PAB field. Prospective studies and the vast majority of retrospective studies have reported the use of a PAB field does not result in increasing the risk of lymphedema development over supraclavicular-only field. The controversies in the incidence of lymphedema suggest that field design may be more important than field arrangement. A key factor regarding the use of a PAB is the depth of axillary LNs. The PAB field should not be used unless there is an absolute indication for its application. Clinicians should weigh lymphedema risk in individual patients against the limited benefit of a PAB, in particular after axillary dissection. The testing of the inclusion of upper arm lymphatics in the regional LN irradiation target volume, and universal methodology measuring lymphedema are all areas for possible future studies.
Lymphedema and Post-Operative Complications after Sentinel Lymph Node Biopsy versus Lymphadenectomy in Endometrial Carcinomas—A Systematic Review and Meta-Analysis - click for abstract
Lymphedema and Post-Operative Complications after Sentinel Lymph Node Biopsy versus Lymphadenectomy in Endometrial Carcinomas—A Systematic Review and Meta-Analysis
Rianne J.A. Helgers 1, Bjorn Winkens 2, Brigitte F.M. Slangen 3 and Henrica M.J. Werner 3,*.J. Clin. Med. 2021, 10, 120
Background: Lymph node dissection (LND) is recommended as staging procedure in presumed low stage endometrial cancer. LND is associated with risk of lower-extremity lymphedema and post-operative complications. The sentinel lymph node (SLN) procedure has been shown to have high diagnostic accuracy, but its effects on complication risk has been little studied. This systematic review compares the risk of lower-extremity lymphedema and post-operative complications in SLN versus LND in patients with endometrial carcinoma.
Methods: A systematic search was conducted in PubMed and Cochrane Library.
Results: Seven retrospective and prospective studies (total n = 3046 patients) were included. Only three studies reported the odds ratio of lower-extremity lymphedema after SLN compared to LND, which was 0.05 (95% CI 0.01–0.37; p = 0.067), 0.07 (95% CI 0.00–1.21; p = 0.007) and 0.54 (95% CI 0.37–0.80; p = 0.002) in these studies. The pooled odds ratio of any post-operative complications after SLN versus LND was 0.52 (95% CI 0.36-0.73; I2 = 48%; p < 0.001). For severe post-operative complications the pooled odds ratio was 0.52 (95% CI 0.28–0.96; I2 = 0%; p = 0.04).
Conclusions: There are strong indications that SLN results in a lower incidence of lower extremity lymphedema and less often severe post-operative complications compared to LND. In spite of the paucity and heterogeneity of studies, direction of results was similar in all studies, supporting the aforementioned conclusion. These results support the increasing uptake of SLN procedures in endometrial cancer.
Risk Factors for Lymphedema After Breast Conservation Therapy and Oncoplastic Reduction - click for abstract
Risk Factors for Lymphedema After Breast Conservation Therapy and Oncoplastic Reduction
Arvind U. Gowda, MD, James Nie, BS, Elbert Mets, BS, Michael Alperovich, MD, and Tomer Avraham, MD. Annals of Plastic Surgery, Volume 87, Number 3, September 2021.
Background: Lymphedema is a known complication after the surgical management of breast cancer, yet the incidence is poorly defined after breast conserving therapy and oncoplastic reduction. The primary aim of this study was to define lymphedema incidence in this population. Furthermore, we sought to correlate demographic factors, surgical approach, and complementary treatment modalities with incidence.
Methods: Data were collected retrospectively on patients who underwent breast conserving therapy at our institution from 2012 to 2015 with greater than 1 year of follow-up. Patients were excluded if they underwent breast surgery before treatment, completion mastectomy, delayed breast reconstruction, or delayed
Results: Five hundred and eighty-four patients met study criteria with a 11% lymphedema rate. Patients developing lymphedema had higher preoperative body mass index (P = 0.02), larger breast mass resection volume (P < 0.01),
higher rate of axillary dissection (P < 0.01), increased rate of adjuvant whole-breast radiation (P = 0.03), supraclavicular radiation (P < 0.01), axillary radiation (P < 0.01), and neoadjuvant medical therapy (P < 0.01). Multivariate analysis showed breast specimen mass, axillary radiation, and neoadjuvant medical therapy, which were associated with lymphedema (P < 0.05). There was no difference in lymphedema incidence between partial mastectomy and oncoplastic reduction cohorts with independent multivariate analyses for each showing axillary radiation and neoadjuvant medical therapy were significantly associated with lymphedema (P < 0.05), although breast specimen mass was not.
Conclusions: Elevated preoperative body mass index, radiation, axillary dissection, and neoadjuvant medical therapy are associated with an increased risk of lymphedema after breast conserving surgery. Oncoplastic reconstruction is not a risk factor for lymphedema.
Risk factors of recurrent erysipelas in adult Chinese patients: a prospective cohort study - click for abstract
Risk factors of recurrent erysipelas in adult Chinese patients: a prospective cohort study
Ang Li1*, Ni Wang2, Lingzhi Ge3, Hongyan Xin4 and Wenfei Li. BMC Infectious Diseases (2021) 21:26
Background: Erysipelas is a common skin infection that is prone to recur. Recurrent erysipelas has a severe effect
on the quality of life of patients. The present study aimed to investigate the risk factors of recurrent erysipelas in
adult Chinese patients.
Methods: A total of 428 Chinese patients with erysipelas who met the inclusion criteria were studied. The patients
were divided into the nonrecurrent erysipelas group and the recurrent erysipelas group. Clinical data were collected on the first episode and relapse of erysipelas. The patients were followed up every 3 months. Statistical analysis was performed to analyze and determine the risk factors of erysipelas relapse.
Results: Univariate analysis was performed to analyze the data, including surgery, types of antibiotics administered in the first episode, obesity, diabetes mellitus, venous insufficiency, lymphedema, and malignancy. The differences between the groups were statistically significant (p < 0.05). The Cox proportional hazards regression model analysis showed that the final risk factors included surgery, obesity, diabetes mellitus, venous insufficiency, and lymphedema.
Conclusions: Surgery, obesity, diabetes mellitus, venous insufficiency, and lymphedema are considered as risk factors for recurrent erysipelas.
Impact of lymphadenectomy and lymphoedema on health-related quality of life one year after surgery for endometrial cancer. A prospective longitudinal multicentre study - click for abstract
Impact of lymphadenectomy and lymphoedema on health-related quality of life one year after surgery for endometrial cancer. A prospective longitudinal multicentre study
Madelene Wedin, Karin Stålberg, Janusz Marcickiewicz, Eva Ahlner, Åsa Åkesson, Gabriel Lindahl, Ninnie Borendal Wodlin, Preben Kjølhede, LASEC study group
BJOG. 2021 Aug 26.
OBJECTIVE: To assess the impact of lymphadenectomy and lymphoedema of the lower limbs (LLL) on health-related quality of life (HRQoL) one year after surgery for endometrial cancer (EC).DESIGN: Prospective longitudinal cohort multicentre study
SETTING: Departments of obstetrics and gynaecology at four university, six central and four county hospitals in Sweden.
POPULATION: Two-hundred-and-thirty-five women with early stage EC were included; 116 with high-risk EC underwent surgery including lymphadenectomy (+LA), and 119 with low-risk EC had surgery without lymphadenectomy (-LA).
METHODS: The generic SF-36 and EQ-5D-3L and the lymphoedema-specific LYMQOL questionnaire were used to assess HRQoL. LLL was assessed by systematic circumferential measurements of the legs enabling volume estimation, clinical evaluation, and patient reported perception of leg swelling. All assessments were carried out on four occasions; preoperatively, four to six weeks, six months, and one year postoperatively.
MAIN OUTCOME MEASURE: HRQoL scores RESULTS: No significant differences were seen in HRQoL between the +LA and -LA groups one year postoperatively. Irrespective of method of determining LLL women with LLL were significantly more affected in the LYMQOL domains Function, Appearance/body image and Physical symptoms, but not in the domain Emotion/mood, than women without LLL. No such differences were seen in the generic HRQoL or in the LYMQOL global score between the groups with and without LLL.
CONCLUSIONS: Lymphadenectomy did not seem to affect generic HRQoL adversely. Irrespective of the method of measuring, LLL affected the lymphoedema-specific HRQoL negatively, mainly in physical domains, but had no impact on the generic HRQoL.
Sensory signs and symptoms in women with self-reported breast cancer-related lymphedema: a case-control study close up - click for abstract
Sensory signs and symptoms in women with self-reported breast cancer-related lymphedema: a case-control study close up
An De Groef, Nele Devoogdt, Ceren Gursen, Niamh Moloney, Victoria Warpy, Jolien Daelemans, Lore Dams, Vincent Haenen, Elien Van der Gucht, An-Kathleen Heroes, Tessa De Vrieze, Elizabeth Dylke
J Cancer Surviv. 2021 Aug 28
PURPOSE: It is not clear to what extent signs and symptoms other than arm swelling, including pain, altered sensory function, and body perception disturbances, differ between women with measurable and non-measurable breast cancer-related lymphedema (BCRL). A case-control study was performed to compare these signs and symptoms between (1) women with self-reported BCRL with objectively measurable swelling; (2) women with self-reported BCRL without objective confirmation; and (3) a control group with no self-reported BCRL.
METHODS: The three groups were compared for (1) the severity of self-reported signs and symptoms of BCRL, (2) problems in functioning related to BCRL, (3) pain-related outcomes, (4) sensory functions, and (5) body perception.
RESULTS: All self-reported outcomes related to signs and symptoms of BCRL and problems in functioning were significantly different between the control group and the other two groups with and without measurable self-reported BCRL (p < 0.001-0.003). Except for "skin texture" (p = 0.01), no differences were found between groups. For pain-related outcomes, sensory function, and body perception, significant differences were found for the mechanical detection threshold (p < 0.01) and self-reported disturbances in body perception (p < 0.001) between the self-reported BCRL groups and control group.
CONCLUSIONS: Diverse signs and symptoms related to BCRL, sensory function, and perception were different among women with self-reported BCRL compared to controls. No differences between women with and without measurable self-reported BCRL were found.
IMPLICATIONS FOR CANCER SURVIVORS: The presence of self-reported BCRL, with or without measurable swelling, is a first indication for the need of further diagnostic evaluation
Hemodynamic Responses in Lower Limb Lymphedema Patients Undergoing Physical Therapy
Bianca Brix, Olivier White, Christian Ure, Gert Apich, Paul Simon, Andreas Roessler, Nandu Goswami. Biology (Basel). 2021 Jul 10;10(7):642.
Manual Lymphedema Drainage for Reducing Risk for and Managing Breast Cancer-Related Lymphedema After Breast Surgery: A Systematic Review - click for abstract
Manual Lymphedema Drainage for Reducing Risk for and Managing Breast Cancer-Related Lymphedema After Breast Surgery: A Systematic Review
Ausanee Wanchai, Jane M Armer. Nurs Womens Health. 2021 Aug 27:S1751-4851(21)00165-3.
OBJECTIVE: To examine the effects of manual lymphatic drainage (MLD) on reducing the risk of and managing breast cancer-related lymphedema (BCRL).
DATA SOURCES: The electronic databases ScienceDirect, Scopus, PubMed, and CINAHL were searched for articles published in the English language from January 2000 to June 2020.
STUDY SELECTION: A total of 518 articles were retrieved. After the removal of duplicates, 472 articles remained, 433 of which were excluded based on title and abstract consideration. Thereafter, 39 studies were further inspected, and 27 articles were excluded because they were not randomized controlled trials, did not measure BCRL, and/or were an incomplete study. Ten studies were included for the final review.
DATA EXTRACTION: Data from the 10 studies were extracted and compiled into a summary table.
DATA SYNTHESIS: Based on the results of this systematic review, it cannot be concluded that MLD helps reduce the risk of BCRL for women after breast surgery. Regarding the effect of MLD on managing BCRL, the findings indicate that MLD alone or MLD combined with other treatments was likely to give similar benefits in terms of reducing arm volume for women diagnosed with BCRL.
CONCLUSION: Scientific evidence to support the benefits of MLD on preventing or reducing BCRL remains unclear. More rigorous studies to confirm findings on the effectiveness of MLD are needed.
Effectiveness of Combined Complex Decongestive Therapy and Resistance Exercises in the Treatment of Lymphedema Associated with Breast Cancer and the Effect of Pain on Treatment Response - click for abstract
Effectiveness of Combined Complex Decongestive Therapy and Resistance Exercises in the Treatment of Lymphedema Associated with Breast Cancer and the Effect of Pain on Treatment Response
Mustafa Corum, MD,1 Ceyhun Basoglu, MD,2 Merve Damla Korkmaz, MD,3 Mustafa Aziz Yildirim, MD,1 and Kadriye Ones, MD, LYMPHATIC RESEARCH AND BIOLOGY Volume 19, Number 4, 2021.
Background: The aim of this study was to compare the effects of complex decongestive therapy (CDT)
accompanied by resistance exercises on extremity circumference, lymphedema volume, grip strength, functional status, and quality of life in the treatment of breast cancer-related lymphedema (BCRL) in patients with
and without pain.
Methods and Results: Fifty patients with unilateral BCRL were divided into groups: with pain (Group 1, n = 25)
and without pain (Group 2, n = 25). Thirty minutes of manual lymphatic drainage and multilayered short-stretch
bandaging were applied to all patients five times a week for 4 weeks. In addition, all patients were informed
about skin care and given a supervised resistance exercise program throughout the treatment. During the 1-
month follow-up period, patients were asked to use low-tension elastic garments and to continue their home
exercise program. Differences in upper extremity circumference and volume; grip strength; Quick Disabilities
of the Arm, Shoulder, and Hand; and Functional Assessment of Cancer Therapy-Breast scores were evaluated at
baseline, after treatment (week 4), and at 1-month follow-up. Moreover, the pain intensity of patients in Group 1
was measured using the visual analog scale (VAS). Patients in both Group 1 and Group 2 showed a statistical
improvement in all outcome measures after treatment and at follow-up ( p < 0.05); however, no significant
difference was observed between the groups ( p > 0.05). In Group 1, a statistically significant decrease was
observed in the VAS score both at the end of treatment (-1.7 – 0.9) and at 1-month follow-up (-3.5 – 1.2)
( p < 0.05).
Conclusion: Combined CDT and resistance exercises appear to be effective in BCRL patients both with and
Treatment of Breast Cancer−Related Lymphedema Using Negative Pressure Massage: A Pilot Randomized Controlled Trial- click for abstract
Treatment of Breast Cancer−Related Lymphedema Using Negative Pressure Massage: A Pilot Randomized Controlled Trial
Riikka Lampinen, DPT,a Jeannette Q. Lee, PhD,b Janella Leano, DPT,a Christine Miaskowski, PhD,c Judy Mastick, MN,c Lisa Brinker, MA,a Kimberly Topp, PhD,d Betty Smoot, DPTScd. Archives of Physical Medicine and Rehabilitation 2021;102:1465−72.
Objective: To evaluate the efficacy of negative pressure massage treatment (NPMT) compared with manual lymphatic drainage (MLD) in women with chronic breast cancer−related lymphedema (LE). We hypothesized that NPMT would result in greater improvements in LE and upper limb function.
Design: Pilot single-blinded randomized controlled trial.
Setting: Health sciences university.
Participants: Of 64 women screened, 28 met eligibility requirements (ie, >18y of age; completed active treatment for breast cancer; had unilateral arm LE for ≥1y; were not receiving LE care; had stable LE) and were randomized to the NPMT (n=15) and control groups (n=13).
Interventions: The intervention group received NPMT and the control group received MLD; both received twelve 60-minute sessions over 4- 6 weeks.
Main Outcome Measures: Bioimpedance (lymphedema index [L-Dex] units]), limb volume (mL) calculated from limb circumference, and Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) score.
Results: Outcomes were analyzed for 28 women. Compared to the MLD group, the NPMT group demonstrated greater improvement with a large effect size in L-Dex scores (P=.001; standardized mean difference [SMD]=-1.15; 95% confidence interval, – 1.96 to -0.35) and interlimb volume differences (P=.038; SMD= -0.83; 95% confidence interval, -1.60 to -0.05). Differences in DASH scores were not statistically significant (P=.067).
Conclusions: Compared to MLD, treatment with NPMT resulted in greater improvement in L-Dex scores and interlimb volume differences in women with a duration of unilateral upper limb LE of >1 year. Our findings need to be confirmed in a larger randomized controlled trial.