Abstract

Role of intermittent pneumatic compression in the treatment of breast cancer–related lymphoedema: a randomized controlled trial

Engin Tastaban1 , Aykut Soyder2, Elif Aydin1,  Omer Faruk Sendur1, Yasemin Turan1, Mevlut Ture3  and Mehmet Bilgen4. Clinical Rehabilitation, 2019.

Objective: To evaluate the role of intermittent pneumatic compression in the treatment of breast cancer–related lymphoedema. Design: Randomized controlled trial. Setting: Physical medicine and rehabilitation clinic at a university hospital. Subjects: Seventy-six patients with lymphoedema. Interventions: Patients were allocated into Group 1 (complex decongestive treatment, n = 38) and Group 2 (complex decongestive treatment + intermittent pneumatic compression, n = 38). The complex decongestive treatment involved skin care, manual lymphatic drainage, compression bandaging, and exercise for 20 sessions. Group 2 additionally received intermittent pneumatic compression.

Main measures: Quantitative outcomes consisted of volumetric measures prior to and after the treatment. Clinical assessments included severity of pain, heaviness and tightness, disability, grip strength, and depression.

Results: Lymphoedema was similar at baseline, but treatments significantly reduced the excess volume (from 373 mL to 203 mL in Group 1 and 379.5 mL to 189.5 mL in Group 2). Percentage excess volumes (PEVs) decreased in both groups. The percentage reduction of excess volume was better in Group 2 than Group 1, but the intergroup difference was not significant. The clinical scores reflected improvements, but the heaviness and tightness read significantly lower in Group 2 than Group 1.

Conclusion: Intermittent pneumatic compression seems to add no benefit when combined with complex decongestive treatment of lymphoedema, but, may be functional in reducing the sensations of heaviness and tightness for the patients with pitting oedema.

Main findings

• N = 76
• Group 1, the patients received complex decongestive therapy including skin care, manual lymphatic drainage, multi-layer compression bandaging, and exercises. The patients received 30-minute manual lymphatic drainage involving stationary circular, pumping, scooping, and rotary movements. Multi-layer compression was applied to the affected limb to promote the flow of excess interstitial fluid out of the extremity using Rosidal lymphoedema upper extremity bandaging set.
• In Group 2, the patients received complex decongestive therapy in combination with intermittent pneumatic compression. The complex decongestive therapy was the same as above, but additionally, 30 minutes of intermittent pneumatic compression was instituted using a pump (Pulse Press Multi 6 Pro; MJS Healthcare Ltd, UK) operating at 30– 40 mmHg of pressure. Patient underwent a daily 60–90 minutes of therapy session, five days per week for four weeks.
• The volume (V) of every part of the limb was calculated by the truncated cone formula according to circumferential measurements and the total volume is estimated by the sum of the increments.
• The indentation of the tissue at the test site was considered as “pitting,” while the absence of tissue changes is regarded as “non-pitting.
• Clinical symptoms of pain (during activity, resting, and night), heaviness, and tightness in the affected arm were evaluated using Visual Analog Scale (VAS) with a 0–10 Numerical Rating Scale.18 The patients’ functional situation was assessed by the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) outcome questionnaire.
• Grip strength was measured by using Jamar hydraulic hand dynamometer.
• Beck Depression Inventory, a 21-item, self-administered inventory that measures clinical depression, was also administered to the patients.
• The differences, especially in the excess volume and PEV values, between the groups were statistically insignificant. The severity of lymphoedema at baseline was similar in both groups (18.4% vs 18.9 %), but after the treatment, excess volume exhibited significant improvement, as it was reduced from 373 mL to 203 mL in Group 1 and from 379.5 mL to 189.5 mL in Group 2. The PEV decreased from 18.4% to 10.7% in Group 1 and from 18.9% to 8.9% in Group 2. The PREV was better in Group 2 (54.6 %) than Group 1 (49.6 %), but the intergroup difference was not significant.
• This study had a limitation. The outcomes reflected only the initial phase of the therapy. Because of the lack of extensive follow-up assessments, the long-term efficacy could not be validated during the maintenance phase.
• It appeared to be useful in reducing the sensations of heaviness and tightness or when applied to the patients with pitting oedema. Further studies are needed to identify the sensitive and specific parameters that would accurately reflect the outcome and to establish clinical settings that would be preferred for applying the intermittent pneumatic compression.