Manual lymphatic drainage and quality of life in patients with lymphoedema and mixed oedema: a systematic review of randomised controlled trials

Martin Müller; Karsten Klingberg; Maria M. Wertli; Helena Carreira. Quality of Life Research 2018

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Manual lymphatic drainage and quality of life in patients with lymphoedema and mixed oedema: a systematic review of randomised controlled trials

Martin Müller; Karsten Klingberg; Maria M. Wertli; Helena Carreira. Quality of Life Research 2018

Purpose To assess the impact of manual lymphatic drainage (MLD) on the health-related quality of life (HRQoL) of adults with lymphoedema or mixed oedema, through a systematic review of randomised controlled trials (RCTs).

Methods MEDLINE, EMBASE, PsycINFO, CENTRAL, the Cochrane Database of Systematic Reviews and ClinicalTrials.gov were searched to identify RCTs evaluating HRQoL after a MLD intervention compared to non-MLD interventions (PROSPERO 2016:CRD42016042255). We extracted the effect of the interventions on the HRQoL (primary outcome) as well as data on volume and functional changes, and adverse events when available (secondary outcomes).

Results Eight studies were eligible. The studies were heterogeneous in the aetiology of oedema, schemes of MLD applied, additional treatments offered with MLD, length of follow-up, instruments used to assess HRQoL and interventions offered to the control group. Five studies included patients with breast cancer-related arm lymphoedema; one study reported increased HRQoL among patients randomised to the MLD group. The two RCTs that involved patients with leg mixed oedema due to chronic venous insufficiency did not find between-group differences in the overall HRQoL. One trial included patients with hand oedema from systemic sclerosis and showed higher HRQoL in the group that received MLD. No studies reported reductions in HRQoL, or severe adverse events after MLD. The small numbers of patients analysed in all studies may have resulted in lack of power to detect between-group differences in HRQoL.

Conclusions The effect of MLD on the HRQoL of patients with chronic oedema is unclear.

Main findings

  • There is conflicting evidence of the impact of MLD on the HRQoL of adult patients with lymphoedema or mixed oedema.
  • Most studies showed that MLD did not significantly increase the HRQoL of the patients with BCRL or mixed oedema due to venous diseases.
  • However, significant increases in HRQoL or some of its domains were reported in patients with systemic sclerosis and hand oedema, and in one out of the five studies that included patients with BCRL.
  • In summary, the quantity, quality and heterogeneity of the trials preclude definitive conclusions.
  • More high-quality studies, in patients with oedema at different locations and of different severity, are needed to provide a definitive answer to this question. If MLD proves to have a positive effect on the HRQoL of patients with chronic oedema, more research is needed to find an optimal treatment duration and frequency, and to quantify the relative Quality of Life Research contribution of the treatment effect of MLD in multimodal therapy concepts.