Table 2.
Main characteristics and results of the studies analyzed
| Author year | Study design | Sample size and population | Intervention CG | Intervention EG | Outcome (lymphedema) | Results | Adverse effects |
|---|---|---|---|---|---|---|---|
| Atar et al. 2022 | RCT |
N = 58 Patients diagnosed with secondary HNL longer than 3 months who had undergone surgery with unilateral/bilateral neck dissection and radiotherapy (with or without chemotherapy) • CG = 28 • EG = 30 |
4 weeks→ Home exercise program (15 repetitions of each exercise 1/day) + MLD (45 min 5 days/week the first week and 2 days/week the remaining 3 weeks) + non-therapeutic kinesio taping (does not follow placement parameters) 4 weeks follow-up→ continue with the home exercise program |
4 weeks→ Home exercise program (15 repetitions of each exercise 1/day) + MLD (45 min, 5 days/week the first week and 2 days/week the remaining 3 weeks) + therapeutic kinesio taping (placement using the lymphatic technique) 4 weeks follow-up→ continue with the home exercise program |
External lymphedema (MDACC-HNL → tape measurements of facial circumference, facial point to point, neck circumference and total circumference landmarks) Stage of lymphedema (MDACC-HNL Scale) Internal lymphedema (Endoscopy + Patterson Edema scale) |
Baseline vs end of intervention: External lymphedema Between-group effects: • Facial circumference: EG > CG (P = 0.032; ES = 0.39) • Facial point to point: EG = GC (P = 0.237; ES = 0.124) • Neck circumference: EG > CG (P = 0.001; ES = 0.688) • Total circumference: EG > CG (P = 0.002; ES = 0.513) Within-group effects: NR Stage of lymphedema Between-group effects: NR Within-group effects: • EG ↑ (P = 0.001) ○ Stage 2 (13% → 0%) ○ Stage 1b (70% → 17%) ○ Stage 1a (17% → 83%) • CG ↑ (P = 0.001) ○ Stage 2 (12% → 4%) ○ Stage 1b (76% → 32%) ○ Stage 1a (12% → 64%) Internal lymphedema Between-group effects: • EG = CG (P = 0.890) Within-group effects: NR End of intervention vs follow-up: External lymphedema Between-group effects: NR Within-group effects: NR Stage of lymphedema Between-group effects: NR Within-group effects: • EG ↑ (P = 0.001) ○ Stage 1b (17% → 7%) ○ Stage 1a (83% → 93%) • CG ↑ (P = 0.001) ○ Stage 2 (4% → 0%) ○ Stage 1b (32% → 32%) ○ Stage 1a (64% → 68%) Internal lymphedema Between-group effects: • EG = CG (P = 0.860) Within-group effects: NR |
Mild (grades 1–2): skin irritation, slight itching and rashes (related to the application of kinesio taping) |
| Ozdemir et al. 2021 | RCT |
N = 21 patients diagnosed with lymphedema secondary to HNC currently in remission (for at least 3 months) and that had undergone surgery with unilateral/bilateral neck dissection and received chemo and/or radiotherapy • CG = 7 • EG1 = 7 (CDT) • EG2 = 7 (home program) |
4 weeks→ No intervention. Medical check-ups without physiotherapeutic intervention or counseling |
EG1 → 4 weeks: 30 min of MLD (1/day and 5 days/week) + compression mask at least 4–6 h/day + skin care + neck, face, tongue, and postural exercises while wearing the compression mask (10 repetitions of each exercise 1/day and 5 days/week) EG2 → 4 weeks: self-administered lymphatic drainage on several face and neck areas (1/day) + neck, face, tongue and postural exercises (10 repetitions of each exercise 1/day) |
External lymphedema (MDACC-HNL → tape measurements of facial circumference, facial point to point, neck circumference, and total circumference landmarks) External lymphedema volume (3D scanning of face and neck surface with Artec Eva 3D scanner) Stage of lymphedema (MDACC-HNL Scale) |
At the end of intervention: External lymphedema Between-group effects: • Facial circumference: EG 1–2 = CG (P = 0.701) • Facial point to point: EG 1–2 = CG (P = 0.228) • Neck circumference: EG 1–2 = CG (P = 0.935) • Total circumference: EG 1–2 = CG (P = 0.625) Within-group effects: • Facial circumference: ○ EG1 ↔ (P > 0.05) ○ EG2 ↔ (P > 0.05) ○ CG ↓ (P < 0.05) • Facial point to point: ○ EG1 ↑ (P < 0.05) ○ EG2 ↑ (P < 0.05) ○ CG ↔ (P > 0.05) • Neck circumference: ○ EG1 ↔ (P > 0.05) ○ EG2 ↔ (P > 0.05) ○ CG ↔ (P > 0.05) • Total circumference: ○ EG1 ↑ (P < 0.05) ○ EG2 ↔ (P > 0.05) ○ CG ↔ (P > 0.05) External lymphedema volume (3D scan) Between-group effects: • EG 1–2 = CG (P = 0.723) Within-group effects: NR Stage of lymphedema Between-group effects: NR Within-group effects: • EG1 ↑ (P = 0.014) ○ Stage 2 (14.3% → 0%) ○ Stage 1b (71.4% → 14.3%) ○ Stage 1a (14.3%→ 85.7%) • EG2 ↑ (P = 0.830) ○ Stage 2 (14.3% → 0%) ○ Stage 1b (28.6% → 14.3%) ○ Stage 1a (57.1% 85.7%) • CG ↔ (P = 0.998) ○ Stage 2 (28.6% → 28.6%) ○ Stage 1b (28.6% → 28.6%) ○ Stage 1a (42.9% → 42.9%) |
None |
| Ridner et al. [22] | RCT |
N = 43 patients with a clinical diagnosis of lymphedema secondary to HNC currently in remission • CG = 24 • EG = 19 |
8 weeks→ usual care: lymphedema self-care learning program (skin and postural care, gentle exercises, and compression) + self-care tools (diary, self-care checklists and a record of upcoming medical appointments) | 8 weeks→ usual care + APCD (pressotherapy) 2 times a day (23–45 min per application) |
Subjective perception of lymphedema symptoms (LSIDS-HN and VHNSS plus GSS v2.0 Questionnaires) External lymphedema (visual inspection -photographs of head and neck- and palpation) Internal lymphedema (Endoscopy + Modified Patterson Scale: a grade of normal, mild, moderate, or severe was documented for each site or space) |
At the end of intervention: LSIDS-HN Between-group effects: • Soft tissue EG > CG (P = 0.004; ES: 0.86) • Neurological symptom EG > CG (P = 0.047; ES: 0.60) • Other clusters EG = CG (P > 0.05) Within-group effects: NR VHNSS-GSS Between-group effects: • Swallowing solids EG > CG (P = 0.016; ES = 0.8) • Mucous related symptoms EG > GC (P = 0.05; ES = 0.57) • ↓Pain GE < CG (P = 0.008; ES = 0.89) • Other clusters EG = CG (P > 0.05) Within-group effects: NR External lymphedema Between-group effects: • Front view EG > CG (P < 0.001; ES = 1.26) • Right view EG > CG (P = 0.004; ES = 0.96) • Left view EG > CG (P = 0.005; ES = 0.84) Within-group effects: • Front view: ↑24% EG vs ↓5% CG • Right view: ↑22% EG vs ↑7% CG • Left view: ↑17% EG vs ↑4% CG Internal lymphedema Between-group effects: • % of visible sites with swelling EG = CG (P = 0.961; ES = 0.01) • Severity of the swelling EG = CG (P = 0.948; ES = 0.02) Within-group effects: NR |
Severe (grade 3–5): cellulitis, stroke, hyponatremia and death (not related to the intervention) Mild (grade 1–2): erythema, oedema, ecchymosis, tenderness, numbness and lumps (these AEs were common) |
| Tsai et al. 2022 | RCT |
N = 39 patients with oral cavity cancer • CG = 20 • EG = 19 |
Until discharge → 30-min exercise sessions (breathing exercises, neck and shoulder mobilizations, and coughing) | Until discharge→ 30-min exercise sessions (breathing exercises, neck and shoulder mobilizations, and coughing) + 30 min MLD |
External lymphedema. skin-to-bone distance (US at 6 sites on face and neck) Stage of lymphedema (Földi and Miller scales) Facial distances (tape measurements) |
At the end of intervention: External lymphedema. Skin-to-bone distance (ultrasound) Between-group effects: • Ascending mandibular ramus right side EG > CG (P < 0.0001) • Horizontal mandible right side EG > CG (P < 0.0001) Within-group effects: • Ascending mandibular ramus right side: EG ↑ (P < 0.05) • Horizontal mandible right: EG ↑ and CG ↑ (P < 0.05) • Ascending mandibular ramus left side: EG ↑ and CG ↑ (P < 0.05) • Horizontal mandible left side: EG ↑ and CG ↑ (P < 0.05) Stage of lymphedema Between-group effects: • Miller: EG = CG (P = 0.987) • Földi: EG = CG (P = 0.172) Within-group effects: • Miller: ○ EG ↔ (P > 0.05) ○ CG ↔ (P > 0.05) • Földi: ○ EG ↔ (P > 0.05) ○ CG ↔ (P > 0.05) Facial distances Between-group effects: • For both sides EG = GC (P = 0.224) Within-group effects: • For right side EG ↑ and CG ↑ (P < 0.001) |
None |
AE, adverse effects; APCD, advanced pneumatic compression devices; CDT, complex decongestive therapy; CG, control group; EG, experimental group; ES, effect size; HNL, head and neck lymphedema; LSIDS-HN, lymphedema symptom intensity and distress survey-head and neck; MDACC-HNL, MD Anderson Cancer Center-Head and Neck Lymphedema; MLD, manual lymphatic drainage; NR, not reported; RCT, randomized controlled clinical trial; US, ultrasound; VHNSS-GSS, Vanderbilt Head and Neck Symptom Survey plus General Symptom Survey; ↑, improvements in the outcome; ↓, worsening in the outcome; ↔, maintenance of the outcome.