Complex Decongestive Therapy in the intensive care of lymphedema: systematic review

Paz, Isabel de Almeida; Fréz, Andersom Ricardo; Schiessl, Larissa; Ribeiro, Larissa Gulogurski; Preis, Cássio; Guérios, Lara

doi:10.1590/1809-2950/15002623032016

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SYSTEMATIC REVIEW • Fisioter. Pesqui. 23 (3) • Jul-Sep 2016 • https://doi.org/10.1590/1809-2950/15002623032016 copy

Complex Decongestive Therapy in the intensive care of lymphedema: systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Lymphedema is characterized by accumulation of proteins and fluids in the interstice, with physical and psychological changes. Among the physiotherapeutic techniques used to reduce lymphedema we have the complex decongestive therapy. The objective of this review is to identify evidence for the practice of complex decongestive therapy for intensive care of lymphedema. A search was carried out in the PubMed, EMBASE and PEDro databases. The articles chosen were randomized and cohort studies, which have been evaluated and selected independently by two reviewers who evaluated the methodological quality of the studies within the PEDro Scale. The search resulted in 414 studies, reduced to seven eligible studies for quality analysis, classified by PEDro scale as high quality and moderate effectiveness studies. The analyzed articles showed good methodological quality and their results showed the effectiveness of complex decongestive therapy in reducing the volume of lymphedema in intensive care.

Keywords:
Drainage; Lymphedema; Lymphatic Diseases; Breast Neoplasms

Studies	Pekyavas et al.⁽^²²22. Pekyavas NO, Tunay VB, Akbayrak T, Kaya S, Karatas M. Complex decongestive therapy and taping for patients with postmastectomy lymphedema: a randomized controlled study. Eur J Oncol Nurs. 2014;18(6)585-90.⁾	Dayes et al.⁽^²³23. Dayes IS, Whelan TJ, Julian JA, Parpia S, Pritchard KI, D'Souza DP, et al. Randomized trial of decongestive lymphatic therapy for the treatment of lymphedema in women with breast cancer. J Clin Oncol. 2013;31(30)3758-63.⁾	King at al.⁽^²⁴24. King M, Deveaux A, White H, Rayson D. Compression garments versus compression bandaging in decongestive lymphatic therapy for breast cancer-related lymphedema: a randomized controlled trial. Support Care Cancer. 2012;20(5):1031-6.⁾	Gurdal et al.⁽^¹1. Gurdal SO, Kostanoglu A, Cavdar I, Ozbas A, Cabioglu N, Ozcinar B, et al. Comparison of Intermittent pneumatic compression with manual lymphatic drainage for treatment of breast cancer-related lymphedema. Lymphat Res Biol. 2012;10(3):129-35.⁾	Vignes et al.⁽^²⁵25. Vignes S, Porcher R, Arrault M, Dupuy A. Factors influencing breast cancer-related lymphedema volume after intensive decongestive physiotherapy. Support Care Cancer. 2011;19(7):935-40.⁾	Vignes et al. ⁽^²⁶26. Vignes S, Porcher R, Arrault M, Dupuy A. Long-term management of breast cancer-related lymphedema after intensive decongestive physiotherapy. Breast Cancer Res Treat. 2007;101(3):285-90.⁾	Vignes et al.⁽^²⁷27. Vignes S, Porcher R, Champagne A, Dupuy A. Predictive factors of response to intensive decongestive physiotherapy in upper limb lymphedema after breast cancer treatment: a cohort study. Breast Cancer Res Treat. 2006;98(1):1-6.⁾
PEDro Scale	9	8	7	7	5	5	5
Study design	Randomized	Randomized	Randomized	Randomized and controlled prospective	Prospective cohort	Prospective cohort	Cohort
Variables evaluated	Pain, limitations of daily life activities, discomfort, heaviness sensation, tension, stiffness, paresthesia, quality of life and limb volume.	Quality of life, limb function and limb volume.	Pain, heaviness sensation, tension, functional compromise and limb volume	Quality of life and limb volume.	Limb volume	Limb volume	Limb volume
Interventions	- G1 CDT + bandaging - G2 CDT + kinesiotaping + bandaging - G3: CDT + kinesiotaping without bandaging	- Experimental Group: CDT - Control group: Elastic compression clothes.	All patients underwent CDT. G1: compression sleeves G2: compression bandages	- CDT - IPC + SLD	All patients were submitted to CDT and moderate exercises	All patients underwent CDT.	All patients were treated with CDT.
Treatment duration	10 sessions (2 weeks)	20 sessions (4 weeks)	10 sessions (2 weeks)	6 weeks	5 days a week	5 days a week, with 11 days of intensive treatment	2 weeks
Assessment tools	- VAS - SF-36 - Limb circumference	- Limb circumference - SF-36 - DASH	- Volumetry - Limb circumference - VAS - DASH	- Limb circumference - ASES - EORTC-QLQ-C30	- Limb circumference	Lymphedema volume with the truncated cone formula	Lymphedema volume with the truncated cone formula
Conclusion	KinesioTaping associated with CDT can stimulate long-term edema reduction.	Compared to the control group, it did not demonstrate significant results for the lymphedema treatment with CDT.	Compression bandages result in a better effect on volume reduction, but the application of compression garments may result in fewer symptoms and improve the function.	Treatment modalities reviewed with skin care and exercises are effective and tolerable in the lymphedema treatment.	The use of elastic gloves and bandaging at night are the main components of the maintenance therapy for lymphedema after CDT.	Bandages and elastic sleeves are important for maintenance therapy after intense decongestive physiotherapy.	The lymphedema volume was significantly reduced after CDT. The duration of the lymphedema and body mass index were the predictors of absolute volume reduction after CDT.

Study	n	Initial volume (mL)	Final volume (mL)	p-value
Vignes et al.²⁵25. Vignes S, Porcher R, Arrault M, Dupuy A. Factors influencing breast cancer-related lymphedema volume after intensive decongestive physiotherapy. Support Care Cancer. 2011;19(7):935-40.	682	936	335	<0,0001
Vignes et al.²⁶26. Vignes S, Porcher R, Arrault M, Dupuy A. Long-term management of breast cancer-related lymphedema after intensive decongestive physiotherapy. Breast Cancer Res Treat. 2007;101(3):285-90.	537	1054	647	<0,0001
Vignes et al.²⁷27. Vignes S, Porcher R, Champagne A, Dupuy A. Predictive factors of response to intensive decongestive physiotherapy in upper limb lymphedema after breast cancer treatment: a cohort study. Breast Cancer Res Treat. 2006;98(1):1-6.	357	1067	663	<0,001

Studies	n	CDT Group		Control Group
		Initial volume (mL)	Final volume (mL)	Initial volume (mL)	Final volume (mL)
Dayes et al.²³23. Dayes IS, Whelan TJ, Julian JA, Parpia S, Pritchard KI, D'Souza DP, et al. Randomized trial of decongestive lymphatic therapy for the treatment of lymphedema in women with breast cancer. J Clin Oncol. 2013;31(30)3758-63.	103	3,422	3,094	3,266	3,043
King at al.²⁴24. King M, Deveaux A, White H, Rayson D. Compression garments versus compression bandaging in decongestive lymphatic therapy for breast cancer-related lymphedema: a randomized controlled trial. Support Care Cancer. 2012;20(5):1031-6.	21	2,335	−5	2,45	−70
Gurdal et al.¹1. Gurdal SO, Kostanoglu A, Cavdar I, Ozbas A, Cabioglu N, Ozcinar B, et al. Comparison of Intermittent pneumatic compression with manual lymphatic drainage for treatment of breast cancer-related lymphedema. Lymphat Res Biol. 2012;10(3):129-35.	30	3533	3004	3581	3142

Study	n	Compression bandage		Compression bandage +KT		KT
		BL	BT-AT (p)	LB	BT-AT (p)	LB	BT-AT (p)
Pekyavas et al.²²22. Pekyavas NO, Tunay VB, Akbayrak T, Kaya S, Karatas M. Complex decongestive therapy and taping for patients with postmastectomy lymphedema: a randomized controlled study. Eur J Oncol Nurs. 2014;18(6)585-90.	45	921,15	313,90 (0,023)	1303,67	373,29 (0,008)	983,72	358,21 (0,008)

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