Table 2.

Summary of adherence studies.

Study	Topic/Sample	Outcome Measure	Findings
Ridner, S.H.; Bonner, C.M.; Doersam, J.K.; Rhoten, B.A.; Schultze, B.; Dietrich, M.S. Bioelectrical impedance self-measurement protocol development and daily variation between healthy volunteers and breast cancer survivors with lymphedema [62].	Home measurement program using bioelectrical impedance to establish feasibility and acceptability by patients with and without BCRL. (n = 11 with and n = 11 without BCRL)	Participant feedback used to adjust number of home measures. Participants were involved in determining feasibility of using home measures to monitor BCRL and were able to see limb volume changes.	Goal setting, informed decision-making, and experience satisfaction with outcome information relevant to limb volume measures were achieved. Ridner et al. suggests patients’ perception of a lack of results in self-care and subsequent feelings of decreased self-efficacy lead to poor adherence.
Armer, J.; Shook, R.P.; Schneider, M.K.; Brooks, C.W.; Peterson, J.; Stewart, B.R. Enhancing supportive-educative nursing systems to reduce risk of post-breast cancer lymphedema [27].	Prospective surveillance study to assess for BCRL with self-care using manual lymphatic drainage (MLD). (N = 27)	Motivational interviewing and solution-focused therapy.	When participants were found to be non-adherent to the MLD intervention, motivational interviewing and solution-focused therapy enabled staff to identify strengths and weaknesses associated with non-adherence.
Brown, J.; Cheville, A.; Tchou, J.C.; Harris, S.R.; Schmitz, K.H. Prescription and adherence to lymphedema self-care modalities among women with breast cancer-related lymphedema [9].	Adherence to BCRL self-care modalities at 3-, 6-, and 12-month intervals. (N = 141)	A questionnaire developed to assess adherence to self-care modalities. Adherence = percentage of time that self-care modalities were completed at the frequency recommended by the lymphedema therapist. Adherence ≥ 75%.	At 12 months, adherence was sub-optimal at 69%. Results identified a need for an infrastructure of support and education.
Forner-Cordero, I.; Muñoz-Langa, J.; Forner-Cordero, A.; DeMiguel-Jimeno J. Predictive factors of response to decongestive therapy in patients with breast-cancer-related lymphedema [63].	Adherence to bandaging during combined decongestive therapy (CDT). (N = 171)	Bandaging of the extremity at home and arriving for therapy each day with bandages in place constituted adherence. Adherence was assigned percentages as follows: 90% = Good 60%–89% = Fair >60% = Bad	Adherence to bandaging during CDT was predictive of better treatment outcomes.
Tidhar, D.; Katz-Leurer M. Aqua lymphatic therapy in women who suffer from breast cancer treatment-related lymphedema: a randomized controlled study [64].	Comparison of adherence, limb volume, and QOL in women who perform only self-management treatment for BCRL and those who perform self-management treatment for BCRL and aqua lymphatic therapy (ALT). (n = 16 study group; n = 32 control group).	Adherence diary based on attendance based on an assumption of 50% adherence in the control group and 85% in the ALT group. Limb volume measures and QOL questionnaires were also used.	The mean adherence rate to self-management for both groups was lower than 30% at entry time and during the study period. The adherence for ALT was 79%. Eighty-six percent of the women adhered to more than 75% of the ALT sessions. This was significantly higher compared with self-management therapy and each of its components (p < 0.05).
Letellier, M.E.; Towers, A.; Shimony, A.; Tidhar D. Breast cancer-related lymphedema: A randomized controlled pilot and feasibility study [65].	Comparison of home-based exercise to home-based exercise and weekly aqua lymphatic therapy (ALT). (ALT group n = 13; control group n = 12)	Diaries used to measure adherence. Arm disability, pain intensity scores, and QOL were also examined.	The ALT group demonstrated a significant difference over the home exercise alone group (control) with a reduction in pain intensity scores, arm disability, and increased QOL. Association of adherence with self-management practices and outcome measures were prohibited due to a 52% return rate of diaries.
Sherman, K.; Koelmeyer, L. The Role of Information Sources and Objective Risk Status on Lymphedema Risk-Minimization Behaviors in Women Recently Diagnosed With Breast Cancer [31].	A measure of demographics, lymphedema knowledge, lymphedema information sources used, and adherence to risk-minimization recommendations in women recently diagnosed with breast cancer. (N = 106)	A survey questionnaire of 12 self-report items was administered at the time of surgery and 3-months post-operatively. For each recommendation practice, a score of 1 was given, with a total score summed out of 12.	Women breast cancer survivors at risk for BCRL scored high on performing most BCRL risk-reduction activities. Mean total adherence was 9.53, with 32 women performing every recommendation and 2 performing none. The scale demonstrated a high internal consistency with a Cronbach alpha of 0.86.
Sherman, K.; Miller, S.; Roussi, P.; Taylor, A. Factors predicting adherence to risk management behavior of women at increased risk for developing lymphedema [38].	Adherence to risk minimization behaviors and psycho-educational factors was assessed. (N = 103)	Adherence was measured using a 12-item self-report yes/no dichotomous items based on the ACS lymphedema risk management guidelines. The survey questionnaire was administered at baseline, 6-, and 12-months after giving printed information about breast cancer.	Women breast cancer survivors who understand BCRL risk and feel confident in managing it are more likely to adhere to recommended strategies. The study demonstrated an increase in knowledge over time, lower distress, and higher self-efficacy and self-regulation abilities.