Table 2.
Results of systematic reviews with meta-analyses.
| Author, year | Intervention | Control | K | N | Outcome | Main result |
|---|---|---|---|---|---|---|
| Manual lymphatic drainage | ||||||
| Shao, 201727 | MLD | Standard therapy (variety of compression garments, exercise, skin care, education) | 3 | 181 | Primary: volume reduction. Secondary: symptoms and arm function | Significant volume reduction by adding MLD. Mean difference 72.10 (95% CI 13.65–130.55) No subgroup analyses |
| McNeely, 201130 | MLD + compression garment or bandage + self-massage for some | Compression bandage or garment and self-massage for some | 5 | 198 | Primary: volume reduction. Secondary: QoL, function, and lymphedema symptoms (pain, tension, heaviness, discomfort) | Significant effect of addition of MLD to treatment (effect 0.37, p-value 0.02) No subgroup analyses |
| Lytvyn, 202010 | MLD, compression garment, compression pump or combination | Standard therapy | 4 | 276 | Primary: volume reduction. Secondary: fatigue, function, lymphedema symptoms, pain, QoL | Network meta-analysis. Low to very low evidence of effect of conservative treatment |
| Huang, 201328 | MLD + standard care | Compression or simple lymphatic drainage or sequential pneumatic compression or a combination | 6 | 237 | Volume reduction | No significant effect of additional MLD (mean difference 75.12; 95% CI −9.34 to 159.58) No subgroup analyses |
| Ezzo, 201529 | MLD + compression bandaging | Compression bandaging | 2 | 83 | Primary: volumetric changes in arm, hand, breast, or trunk; adverse effects. Secondary: functional measures (Range of motion, strength), subjective sensations, QoL, cost of care, any other outcome reported by the trial | No significant difference in volume reduction. Mean difference 26.21 ml (95% CI −1.04 to 53.45) Subgroup: significant percent volume reduction (MD 12.09%; 95% CI 0.15–24.04%, n = 36, p = 0.05) for mild BCRL (defined as <23% excess volume) but not for moderate/severe. No difference in relation to BCRL duration |
| Liang, 202013 | MLD | Compression bandaging or standard therapy | 8 | 338 | Volume reduction | No significant difference in volume reduction. SMD −0.09 (95% CI −0.85 to 0.67) Subgroup: significant volume reduction for those <60 years: SMD −1.77 (95% CI −2.23 to −1.31; k = 2, n = NR) and when treatment >4 weeks: SMD: −1.77 (95% CI −2.23 to −1.30; k = 4, n = NR). No difference for research region, publication year, sample size, type of surgery, ≥60 years, ≤4 weeks treatment, or the statistical analysis method |
| Qiao, 202331 | MLD | Compression bandaging or standard therapy | 8 | 457 | Primary: volume or circumference reduction. Secondary: lymphedema symptoms, anxiety, mobility, QoL | No significant difference in volume reduction. SMD 0.43 (95% CI −0.10 to 0.96) Subgroup: Significant volume reduction in favor of MLD when duration >2 weeks SMD 0.23 (95% CI 0.02–0.44; k = 5 n = 347) or ≥20 sessions SMD 0.33 (95% CI 0.03–0.58; k = 3 n = 213). No difference for pain. SMD −0.09 (95% CI −0.43 to 0.25) |
| Rangon, 202234 | Complex physical therapy | Multimodal approaches | 7 | 690a | Primary: volume reduction. Secondary: pain, physical function | Significant reduction in volume. SMD −0.18 (95% CI 0.35–0.00). No difference for pain or function |
| Compression pump | ||||||
| Rogan, 201632 | Compression pump | Standard therapy | 2 | 135 | Volume reduction | Volume reduction with additional use of pump. SMD −0.54 (95% CI −1.01 to −0.064). Other analyses include women at risk of BCRL and are thus not relevant here |
| Li, 202233 | Compression pump + CDP | CDP | 3 | 159 | Morbidity of lymphedema, volume reduction, range of motion | No difference in volume reduction. Mean difference 4.51 (95% CI −7.01 to 16.03) Significant improvement in range of motion |
| Shao, 20149 | Compression pump | MLD | 3 | 159 | Primary: percent of volume reduction. Secondary: subjective symptoms and joint mobility | No difference in adding compression pump to MLD. Mean percent difference 4.51 (95% CI −7.01 to 16.03) No subgroup analyses |
| Laser therapy | ||||||
| Chen, 20198 | Laser therapy | No treatment or conventional therapy group (including compression garments, MLD, and remedial exercises) | 6 | 239 | Primary: arm circumference, volume. Secondary: grip strength, pain scores | No difference in volume reduction. SMD 0.04 (95% CI −0.32 to 0.41). No difference in arm circumference: SMD −0.47 (95% CI −1.34 to 0.39) Subgroup: No difference in strength or pain |
| Smoot, 20157 | Laser therapy | Sham laser or no treatment or compression | 4 | 138 | Upper extremity swelling and pain | Reduction in volume with addition of laser. Pooled effect size −0.62 (95% CI −0.97 to −0.28) No difference in pain |
| Exercise | ||||||
| Yeung, 201835 | Water based exercise | Any comparison intervention, including standard care, habitual activity, wait and see, or alternative land-based exercise | 2 | 66 | Lymphedema limb volume measured by water displacement, perometer, or circumferential tape measure, tissue fluid measurement via TDC or BIS, physical function (strength, ROM), symptoms (e.g., pain, heaviness, tightness), QoL | No difference in volume reduction. SMD 0.14 (95% CI −0.37 to 0.64) No difference in function |
| Lytvyn, 202010 | Exercise (resistance, aerobic, yoga or water based) | Standard therapy | 11 | 523 | Primary: volume reduction. Secondary: fatigue, function, lymphedema symptoms, pain, quality of life | Network meta-analysis. Low to very low evidence of effect of exercise |
| Kinesio taping | ||||||
| Kasawara, 20186 | Kinesio taping + standard treatment | Standard treatment (variety of MLD, CDP, compression pump) | 6 | 199 | Lymphedema limb volume measured by perimetry or volumetry | No difference between KT and control in reduction of lymphedema volume (SMD 0.04; 95% CI −0.24 to 0.33) No subgroup analyses |
| Gatt, 20175 | Kinesio taping | Compression bandaging or compression hosiery with or without CDP (complete decongestive physiotherapy) | 4 | 159 | Primary: limb volume and/or circumference, adverse effects. Secondary: patients’ subjective experience, severity of lymphedema symptoms, QoL | No difference in volume reduction. Mean difference −413.45 ml (95% CI −896.55 to 69.64) No difference in QoL, discomfort, itching |
| Acupuncture | ||||||
| Hou, 20194 | Acupuncture | Non-acupuncture therapy, including Western medicine, functional exercise, and sham acupuncture | 5 | 374 | Total effective rate, extent of lymphedema, adverse effects | Significant improvement in total effective rate with acupuncture. OR 4.62 (95% CI 2.61–8.17) Subgroup: significant improvement in arm circumference. Mean difference 0.79 (95% CI 0.57–1.01) |
| Jang, 202036 | Manual acupuncture, ear acupuncture, and electro-acupuncture | Sham acupuncture, medicine (venlafaxine, hormone therapy), exercise, relaxation, enhanced self-care, no-treatment, and wait-list control groups | 2 | 133 | Climacteric symptoms, pain, nausea and vomiting, lymphedema (level of edema, arm circumference), neuropathic pain, cognitive impairment, and gastrointestinal symptoms | Significant reduction in arm circumference in control group. Mean difference −1.61 cm (95% CI −1.92 to −1.31) No subgroup analyses |
BIS = bioimpedance spectroscopy; CDP = complex decongestive physiotherapy; 95% CI = 95% confidence interval; K = number of RCTs; KT = kinesio taping; MLD = manual lymphatic drainage; N = total number of participants in the RCTs; QoL = quality of life; ROM = range of motion; SMD = standardized mean difference; TDC = tissue dielectric constant.
a
The meta-analysis by Rangon et al. includes the same RCTs multiple times and thus is the sample size (n) not the number of unique participants.