Effectiveness of a precast adjustable compression system compared to multilayered compression bandages in the treatment of breast cancer–related lymphoedema: a randomized, single-blind clinical trial
Vicenta Pujol-Blaya, Sira Salinas-Huertas, M Luisa Catasús, Teresa Pascual5 and Roser Belmonte. Clinical Rehabilitation 2019
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Effectiveness of a precast adjustable compression system compared to multilayered compression bandages in the treatment of breast cancer–related lymphoedema: a randomized, single-blind clinical trial
Vicenta Pujol-Blaya, Sira Salinas-Huertas, M Luisa Catasús, Teresa Pascual5 and Roser Belmonte. Clinical Rehabilitation 2019
Objective: To compare the effectiveness of a precast adjustable compression system with that of multilayered compression bandages in the treatment of breast cancer–related lymphoedema. Design: Multicenter, randomized, single-blind parallel-group clinical trial.
Setting: The rehabilitation services of four general university hospitals.
Subjects: Patients with upper limb breast cancer–related lymphoedema. Interventions: All the patients received manual lymphatic drainage, followed by a precast adjustable compression system or multilayered compression bandages, according to the group allocation. The treatment included 10 consecutive sessions over a two-week period from Monday to Friday, followed by some sessions on three alternate days per week, until the patient received a tailored compression garment. Primary measurements: The patients were evaluated just before the treatment, after 10 sessions and at three months posttreatment. The primary outcome was the change in excess lymphoedema volume. Secondary outcomes were changes in the symptoms of pain, heaviness, tightness and hardness. Analyses were performed using an intention-to-treat approach.
Results: In all, 42 patients were included; there were 22 in the precast adjustable compression system group and 20 in the multilayered compression bandages group. Both groups exhibited significant decreases in excess volume and symptoms after 10 sessions and at three months. There were no significant differences regarding excess volume or symptoms between the precast adjustable compression system and multilayered compression bandages groups after 10 sessions and at the three-month follow-up exam.
Conclusion: The precast adjustable compression system and the multilayered compression bandages have similar efficacy for the reduction of excess lymphoedema volume or symptoms.
Main findings
- In the precast adjustable compression system group, the physiotherapist first performed manual lymphatic drainage and then applied the system to the affected upper limb. The Circaid Reduction® was the system used.
- In the multilayered compression bandages group, the physiotherapist first performed manual lymphatic drainage and then applied the bandages to the affected upper limb. Both groups were treated by a physiotherapist who was well trained in lymphoedema. Beginning the therapy sessions on Monday was avoided to prevent the 10th session from coinciding with the weekend. Then, the first 10 sessions were performed daily on weekdays. The patients were asked to maintain the precast adjustable compression system or the multilayered compression bandages as set until the next treatment session, even during the weekend (Saturday and Sunday). After the first 10 sessions, the treatment was applied on alternate days (three per week), until the patient received a tailored compression garment (7–14 days).
- The multilayered compression bandages group had a higher percentage of mild lymphoedema than did the precast adjustable compression system group, which implies a bias that could have
influenced the results.
- The number of hours of daily use of the compression system during the decongestive phase was significantly lower in the precast adjustable compression system group than in the multilayered compression bandages group. The lack of a no-treatment control group could be a limitation.
- Both treatments achieved significant decreases in the percentage of excess volume and in the symptoms of pain, heaviness, tightness and hardness. They found no significant differences between the treatments using the same variables of volume and symptoms. This finding implies a new choice in the compression treatment of lymphoedema. To the authors knowledge, there have been no clinical trials comparing these two compression systems in upper limb lymphoedema.
- The authors conclude in patients with lymphoedema after breast cancer treatment, a standardized precast adjustable compression system is as effective as a multilayered compression bandage and is less difficult to apply.
