Table 2.
Data extraction for key questions
| Study | 1) Patient Outcomes | |||
|---|---|---|---|---|
| Treatment Protocols | Length of Follow-up | Tx-related Harms? | ||
| 2) Results | ||||
| RCT | ||||
| Andersen | IG: standard care + MLD + self-massage | 1) Limb volume, self-reported SE symptoms | 12 month | NR |
| 2000 [21] | (standard care: compression garment + exercise instruction + skin care) | |||
| Denmark | 2) NS | |||
| CG: standard care | ||||
| Bertelli | IG: sleeve (6 h/day for 6 mths) + IPC (2 cycles of 2 week spaced by 5 week interval | 1) Limb circumference ≥ 25% compared to baseline | 6 month | NR |
| 1991 [22] | ||||
| Italy | CG: sleeve (6 h/day for 6 months) | 2) NS | ||
| Bialoszewski | IG: Kinesiotaping (10 days) + standard physiotherapy (not described) | 1) Limb circumference | 10 days | NR |
| 2009 [23] | ||||
| Poland | CG: Lymphatic drainage (1 × /day × 10 days) + standard physiotherapy (not described) | 2) Significant reduction in limb circumference with kinesiotaping | ||
| Carati | IG: LLLT (9 sessions, 17 min each, 3 × /week × 3 week; 8-week rest and repeat) | 1) Limb circumference and volume | 24 month | NR |
| 2003 (11) | ||||
| Australia | CG: Sham LLLT | 2) NS | ||
| (9 sessions as above; 8-week rest) + 'active' LLLT (as above) | ||||
| Damstra | IG: Low-stretch bandage | 1) Limb volume, pain and discomfort | 24 h | Patients with high pressure bandages reported more pain and discomfort |
| 2009 [24] | ||||
| Netherlands | CG: High-stretch bandage | 2) NS (volume) | ||
| Didem | IG: MLD + compression garment + exercise + skin care | 1) Limb circumference, range of motion | 4 week | NR |
| 2005 [25] | ||||
| Turkey | CG: Physiotherapy (bandage + limb elevation + exercises) + compression garment + exercise + skin care | 2) Greater decrease in circumference in IG (p < 0.05), NS (ROM) | ||
| Dini | IG: IPC (2 cycles over 2 week; each cycle separated by 5-week interval) | 1) Limb circumference | 9 week | No harms |
| 1998 [26] | ||||
| Italy | CG: Skin care, prophylaxis | 2) NS | ||
| Hayes | IG: Aerobic and resistance exercise (12 week) | 1) Bioimpedance, perometry | 12 week | Swelling (n = 1) |
| 2009 [27] | ||||
| Australia | CG: NR | 2) NS | ||
| Hou | IG: BMSC + compression garment | 1) Limb volume, self-reported pain | 52 week | NR |
| 2008 [28] | ||||
| China | CG:CDT (MLD + compression therapy + exercise) | 2) Volume and pain reductions greater in BMSC group at 52 week (p < 0.05) | ||
| Irdesel | IG: Exercise + compression garment | 1) Limb circumference, shoulder range of motion | 6 month | NR |
| 2007 [29] | ||||
| Turkey | CG: Exercise | 2) NS | ||
| Jahr | IG: low-intensity electrostatic field (2-3 ×/week × 4 week) + MLD | 1) Visual analogue pain scale | 8 week | NR |
| 2008 [30] | ||||
| Germany | CG: MLD | 2) NS | ||
| Johansson | IG: IPC (2 h/day, 5 days/week for 2 week) + compression garment | 1) Limb volume | 2.5 year | NR |
| 1998 [31] | ||||
| Sweden | CG: Vodder MLD + compression garment | 2) NS | ||
| Kaviani | IG: LLLT (3 × /week × 3 week; 8 week interval, then repeat same protocol × 3 week) | 1) Limb circumference, visual analogue pain scale | 22 week | NR |
| 2006 [32] | ||||
| Iran | CG: Sham laser | 2) IG more efficacious than CG, but authors report no p-values | ||
| Kessler | IG: Daily physiotherapy exercises + MLD | 1) Limb volume | NR | NR |
| 2003 [33] | ||||
| Switzerland | CG: Daily physiotherapy exercises | 2)% volume reduction-IG vs. CG (6.4% vs. 0.1%, p = 0.011) | ||
| Kozanoglu | IG: Laser (20 min/3 × wk × 4 week) + exercise + skin care | 1) Limb circumference, visual analogue pain scale, grip strength | 12 month | None |
| 2009 [34] | ||||
| Turkey | CG: IPC (2 h at 60 mmHg × | 2) IG improved over CG on circumference (p = 0.02), pain and grip strength (NS) | ||
| 20 sessions over 4 week) + exercise + skin care | ||||
| Lau | IG: LLLT 3 × /week for 4 week | 1) Limb volume, tissue resistance, DASH score | 8 week | NR |
| 2009 [35] | ||||
| China | CG: no Tx | 2) Mean volume less in IG (p = 0.04), greater tissue resistance in IG at 3 of 4 sites (p < 0.05), DASH (NS) | ||
| Maiya | IG: LLLT (34 min/day for 10 days) + exercise (after laser) | 1) Limb circumference, pain scale | 10 days | None |
| 2008 [36] | ||||
| India | CG: Compression garment (10 days) + exercise | 2) IG improved over CG on both outcomes (p < 0.05) | ||
| McKenzie | IG: Stretching, resistance, and aerobic exercise training (3 × /week for 8 week | 1) Arm circumference and volume, quality-of-life (SF-36 scale) | 8 week | NR |
| 2003 [37] | ||||
| Canada | CG: No Tx | 2) NS (all outcomes) | ||
| McNeely | IG: MLD (5 days/week × 4 week) + bandaging | 1) Limb circumference and volume | 4 week | Skin reaction (n = 1), bandage discomfort (n = 1) |
| 2004 [38] | ||||
| Canada | CG: Bandaging | 2) NS | ||
| Pilch | Different IPC protocols (4 groups): | 1) Limb volume | 5 week | NR |
| 2009 [39] | -single chamber, 90 s on: 90 sec off | |||
| Poland | -3 chamber, 90 sec on: 90 sec off | 2) NS | ||
| -single chamber, 45 sec on: 15 sec off | ||||
| -3 chamber, 45 sec on: 15 sec off | ||||
| Radakovic | IG: IPC (60 min/day × 10 days) + compression bandage | 1) Change in arm volume (limb circumference) | 10 days | NR |
| 1998 [40] | ||||
| Yugoslavia | CG: MLD (30 min/day × 10 days) + compression bandage | 2) Circumference reduction greater in IG vs. CG (2.24 cm vs. 0.95; p < 0.05) | ||
| Schmitz | IG: Weight lifting (supervised for13 week, unsupervised for 39 week) + compression garment during exercise | 1) Limb volume | 12 month | Authors report no serious harms |
| 2009 [41] | ||||
| U.S. | CG: 1-year fitness membership and 13 week of supervised instruction (not mandatory) | 2) NS | ||
| (companion Schmitz [42]) | ||||
| Shaw | IG: Dietary advice for weight loss | 1) Limb volume | 12 week | NR |
| 2007 [43] | ||||
| U.K. | CG: Healthy eating booklet + compression garment | 2) Significant reduction in SE arm volume IG vs. CG (7% vs. 3% reduction: p < 0.05) | ||
| Shaw | IG: Weight reduction-reduced energy intake OR low fat diet-no reduced energy intake (2 groups) | 1) Limb volume | 24 week | NR |
| 2007 [44] | ||||
| U.K. | CG: No Tx | 2) NS | ||
| Sitzia | IG: MLD (40-80 min 5 × wk × 2 week) | 1) Limb volume | 2 week | NR |
| 2002 [45] | ||||
| U.K. | CG: SLD (20 mins 5 × wk × 2 week) | 2) NS | ||
| Szuba | IG: MLD (daily, self-administered) + compression garment | 1) Limb volume, tonometry, range of motion | 6 month | None |
| 2002 [47] | ||||
| U.S. | CG: As above + IPC (1 h daily at 40-50 mmHg) | 2) Greater mean volume reduction with IPC (p < 0.05); NS (tonometry, range of motion) | ||
| Szuba | IG: MLD (daily) + IPC (30 min at 40-50 mmHg) + compression garment | 1) Limb volume, tonometry | 30 days | Repetitive headache and small blood pressure increase during IPC (n = 1) |
| 2002 [46] | ||||
| U.S. | CG: MLD (daily) + compression garment | 2) NS | ||
| (Maintenance therapy-IG & CG: compression garment + self-administered MLD) | ||||
| Tsai | IG: Kinesiotape bandage | 1) Limb volume and circumference, symptom severity on visual analogue scales, QoL | 3 month | NR |
| 2009 [48] | ||||
| China | CG: Short-stretch bandage | 2) NS | ||
| (IG & CG: MLD + IPC + exercise) | ||||
| Wilburn | IG: IPC (1 h/day) | 1) Limb volume, QoL | 42 days | NR |
| 2006 [49] | ||||
| U.S. | CG: Self-message (1 h/day) + compression garment | 2) Mean volume reduction greater in IG (-208 ml vs. | ||
| + 52 ml; p = 0.007), NS (QoL) | ||||
| Williams | IG: MLD (daily × 3 week) | 1) Limb volume, caliper creep, dermal thickness, QoL | 12 week | NR |
| 2002 [50] | ||||
| U.K. | CG: SLD (daily × 3 week) | 2) NS (limb volume, caliper creep), no intergroup differences reported in article (dermal thickness, QoL) | ||
| Observational | ||||
| Balzarini | IG: Ultrasound | 1) Limb volume | 12 month | NR |
| 1993 [51] | (2 cycles at 4 month intervals-one cycle = 10-30 min session) | |||
| Italy | 2) NS | |||
| CG: IPC (6 h/day × 5 days once every 4 month for 12 month) | ||||
| Berlin | IG 1: IPC (90-120 mmHg for 20-30 min 2 × /day 5 day/week) + compression garment (25-50 mmHg × 4 week) | 1) Limb volume | 5 year | NR |
| 1999 [52] | ||||
| Sweden | IG 2: IPC (80 mmHg ≥ 20 min/day × 4 week) | 2) NS | ||
| CG: Compression garment (25-50 mmHg × 4 week) | ||||
| Brambilla | IG: Compression garment (custom-made, mean pressure = 40 mmHg, worn morning-to-night, changed every 6 month) | 1) Limb volume | IG: Mean 66 week | NR |
| 2006 [53] | ||||
| Italy | CG: No Tx | 2) IG: 30/50 mean reduction = 9.3 ml; 20/50 mean increase = 78.7 ml | CG: Mean 64 week | |
| CG: 15/15 mean increase = 29.6 ml | ||||
| (p < 0.0001 between groups) | ||||
| Frischenschlager | IG: Psychosocial therapy and exercise (2 h/week × 10 week) + MLD (3 × /day × 10 week) + compression stocking during day | 1) Psychic well being and physical complaints scales | 10 week | NR |
| 1991 [54] | ||||
| Austria | CG: As above except for psychosocial therapy | 2) Improved psychic well-being in IG (p = 0.02), NS (physical complaints) | ||
| Johansson | IG: Compression bandage (2 week) + MLD (45 min/day × 5 days in wk 3) | 1) Limb volume, body weight, pain/heaviness/tension using visual analogue scales | 19 days | NR |
| 1999 [55] | ||||
| Sweden | CG: Compression bandage (2 week) | 2) NS (mean volume reduction, body weight, pain/heaviness/tension),% volume decrease favored IG (11% vs. 4%; p = 0.04) | ||
| Pinell | IG: CDT (MLD + bandaging; MLD modified for patients with axillary or inguinal disease) | 1) Limb volume | 39 month | NR |
| 2007 [56] | ||||
| U.S. | CG: As above (no modified MLD) | 2) NS | ||
BMSC Bone Marrow Stromal Cell Transplantation; CDT: Complex Decongestive Therapy; CG: Control Group; DASH: Disability of Arm Shoulder and Hand; hr hour(s); IG Intervention Group; IPC Intermittent Pneumatic Compression; LLLT Low-level Laser Therapy; MLD Manual Lymph Drainage; mo: month(s); NR Not Reported; NS No Statistically Significant Difference Between Groups; QoL Quality of Life; RCT Randomized Control Trial; ROM Range of Motion; SE Secondary Lymphedema; SF-36 Short Form 36; SLD Simple Lymphatic Drainage; Tx Treatment; wk week(s); yr year(s).