The effect of relaxation techniques on edema, anxiety and depression in postmastectomy lymphedema patients undergoing comprehensive decongestive therapy: A clinical trial

Abbasi B, Mirzakhany N, Angooti Oshnari L, Irani A, Hosseinzadeh S, Tabatabaei SM, et al. (2018)

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The effect of relaxation techniques on edema, anxiety and depression in postmastectomy lymphedema patients undergoing comprehensive decongestive therapy: A clinical trial

Abbasi B, Mirzakhany N, Angooti Oshnari L, Irani A, Hosseinzadeh S, Tabatabaei SM, et al. (2018)

Objectives

Lymphedema is sometimes accompanied by high degrees of anxiety and depression. This study aimed to assess the effects of relaxation techniques on the level of edema, anxiety and depression in women undergoing Comprehensive Decongestive Therapy (CDT).

Design

This clinical trial compared two treatment methods in 31 women with post-mastectomy lymphedema, including 15 cases who received CDT and 16 who received RCDT (Relaxation plus CDT). The edema volume, anxiety and depression scores were compared at the first and last sessions of the first phase of the treatment and six weeks afterwards.

Results

The edema, anxiety and depression scores were 63.6%, 54.1% and 65.5% in the RCDT group and 60.7%, 31.4% and 35.2% in the CDT group. There were significant differences between the two groups in terms of the reduction in depression (p = 0.024) and anxiety (p = 0.011) scores throughout the study. This significant relationship was due to the differences in the depression score in the 3rd and 9th weeks of the study between the two groups. Similarly, anxiety levels differed significantly between the two groups at the 9th week of the study (P = 0.013).

Conclusion

Relaxation techniques reduced the anxiety and depression scores and the volume of edema in the patients with lymphedema. The addition of this intervention to the therapeutic package for lymphedema patients requires further studies in terms of cost-effectiveness.

Main findings

  • The inclusion criteria were unilateral lymphedema in the upper limbs (more than 200 cc of difference between the two sides), a post-surgery interval of at least one year, a minimum score of eight in each subscale of the Hospital Anxiety and Depression Scale (HADS), not having received treatment or relaxation techniques for lymphedema prior to the study and no history of severe psychological disorders requiring psychological pharmacotherapy.
  • 15 cases who received CDT and 16 who received RCDT (Relaxation plus CDT).
  • The treatment was carried out in two phases. The first phase (acute phase) included 60-minute sessions held six days a week (excluding Fridays) for three consecutive weeks. In this phase, the CDT group was treated by MLD, multi-layer bandaging, rehabilitation exercises and skin and nail care training. The participants were trained to continue therapy during the second phase. In the second phase, therapy was performed at home using an educational brochure and CD for self-lymphatic drainage and exercises and by wearing an arm sleeve during the day, multi-layer bandaging at night, remedial exercises and continuing the skin and nail care.
  • In the RCDT group, the first phase involved 15 minutes of progressive muscle relaxation before each CDT session. During these sessions, the therapist instructed the patients on how to contract their different muscle groups for 5–7 seconds and then relax them for 10 seconds. This combined technique continued into the second phase of the treatment. In both groups, oedema, anxiety and depression were assessed at the beginning and the end of the first phase and in the second phase too (six weeks after the completion of the first phase) by a blinded person not involved in the treatment.
  • The simultaneous application of daily CDT and progressive muscle relaxation over nine weeks leads to a greater percentage of reduction in depression, anxiety and oedema volume in women with lymphedema. The significant overall trend of changes in anxiety and depression during the study showed the effectiveness of relaxation techniques on these variables in the RCDT group.
  • The authors believe a major advantage of this study was recruiting the participants on two different occasions. Despite the absence of a randomization process, this design minimized the chance of contact and the exchange of information between the two groups and in turn reduced the effect of the potential confounding factors and eliminated ethical concerns about not providing the control group with relaxation training.
  • The proper and effective application of the relaxation techniques besides the increasing participants’ adherence to intervention were ensured through the researcher’s constant supervision.
  • The authors state “The results confirm the effectiveness of progressive muscle relaxation in reducing anxiety and depression and its mild effects on the oedema volume in patients with lymphedema undergoing CDT. Examining the efficacy and cost-effectiveness of different combinations of psychological and lymphedema treatments, especially in people with psychological disorders, requires more extensive studies.”