Table 1.
Summary of Included Reviews
| Study | Treatment | Search time | Included study No. | Results | Conclusions | Evidence level |
|---|---|---|---|---|---|---|
| Devoogdt 2010 | CPT | - | 2 | The overall improving in the CPT group was shown to be greater than the SP group but when the evaluation results of both groups were compared before and after treatment, a significant statistical difference in edema according to circumferential and volumetric measurements results was found in favor of CPT. | In the patients with upper extremity LE, the shoulder mobility can be increased and edema can be decreased by the use of CPT. | low |
| Ezzo 2015 | MLD | 2013.5.24 | 6 | MLD + standard physiotherapy versus standard physiotherapy: no statistically significant between-groups difference in per cent reduction | MLD is safe and may offer additional benefit to CB for swelling reduction. | very low |
| MLD +CB vs. CB: LE volume: -60.73 (-194.43 72.96); volume reduction: 26.21 (-1.04 53.45); per cent reduction: 7.11% (1.75% 12.47%) | In trials where MLD and sleeve were compared with a nonMLD treatment and sleeve, volumetric outcomes were inconsistent within the same trial. For symptoms such as pain and heaviness, 60% to 80% of participants reported feeling better regardless of which treatment they received. | |||||
| CS + MLD vs. CS+ IPD: LE volume: 122 (-57.59 301.59); volume reduction: 47 (15.25 78.75); per cent reduction: 8 (-0.75 16.75) | ||||||
| CS + MLD vs. CS + SLD: LE volume: -230 (-450.84 -9.16); volume reduction: 10 (-90.54 110.54); per cent reduction:-2.40 (-14.11 9.31) | ||||||
| MLD + CB vs. SLD + CB: per cent reduction: 11.80 (-2.47 26.07) | ||||||
| Huang 2013 | MLD | 2012,12 | 10 | MLD + standard treatment vs. standard treatment reduction in arm volume: 75.12 (−9.34 159.58) | The addition of MLD to compression and exercise therapy for BCRL is unlikely to produce a significant reduction in LE volume. | very low |
| Shao 2014 | IPC | 2013.12.20 | 7 | The percent of volume reduction: CPT +IPC vs. CPT 4.51 (–7.01, 16.03). Both CDP and IPC could improve symptoms, but no differences existed between CPT +IPC and CPT. | Current trials fail to show the effectiveness of the addition of IPC to the routine management of BCRL. | very low |
| Singh 2015 | Exercise | 2015,1.1 | 25 | LE volume: Single bout of exercise -0.1 (-0.3 0.1); Regular exercise -0.1, (-0.3 0.4); Exercise vs. control: -0.1 (-0.3 0.1); Exercise + compression vs. exercise : -0.2 (-0.5 0.1) | Exercise, irrespective of mode, appeared to have no effect on LE and related symptoms. | low |
| Heaviness: Single bout of exercise 0.0 (-0.3 0.3) | There were no benefit of wearing compression for LE and associated symptoms, and exercise without compression does not exacerbate LE. | |||||
| Tightness: Single bout of exercise0.1 (-0.3 0.4) | ||||||
| pain: Regular exercise vs. control: -0.1 (-0.6 0.1) | ||||||
| Poage 2015 | botanicals (coumarin, BN165 (gamma benzopyrone)) | 2011 | 2 | The LE volume increased by 21 ml during placebo treatment and 58 ml during coumarin treatment (P=0.80). | Evidence supporting the use of botanicals for the treatment of BCRL is insufficient. | low |
| Moseley 2007 | Daflon /Cyclo-fort/ | 2004 | 01/01/2001 | Daflon did not have significant difference in evolution of lymphedema volume in comparison with placebo, despite a tendency in favor of Daflon. 5,6–benzo-[alpha] -pyrone achieved a statistical significance in lymphedema volume reductions and percent reduction as compared with placebo. | Varying volume reductions and subjective improvements could be obtained from oral pharmaceuticals such as Daflon (1000 mg) and Cyclo-fort, with the greatest limb reduction (840 ml, 35.6%) being obtained from the 5–6 Benzo-a-pyrone (200 mg). | |
| 5–6 Benzo- a-pyrone | For Cyclo-fort the reduction in volume of arm edema was 12.9% after 3 months of treatment as compared with a placebo (p=0.009). | |||||
| Leung 2015 | Surgery | 2014.2 | 03/02/2006 | Liposuction reduces the volume and symptoms of LE, but requires continual compressive therapy to avoid recurrence. Lymphatic reconstruction or bypass techniques show promise in reducing LE significantly. | The developing modern surgical management of BCRL has a role in the management of these patients. | very low |
| Smoot 2015 | LLLT | 2014.10.16 | 9 | LE volume: within-group: −0.52 (−0.78 −0.25); between-groups: −0.62 (−0.97 −0.28) | LLLT was associated with clinically relevant within-group reductions in volume and pain. Greater reductions in volume were found in LLLT than that in treatments without it. | low |
| pain: within-group: −0.62 (−1.06 −0.19); between-groups: -1.21 (−4.51, 2.10) | ||||||
| Ridner 2012 | Weight reduction | 2011 | 1 | The results indicated a significant reduction in swollen arm volume at the end of the 12-week period in the intervention weight-reduction group. | Weight loss achieved by dietary advice to reduce energy intake can reduce breast cancer-related LE significantly. | low |
| Toyserkani 2015 | stem cells | 2014.7.31 | 2 | There was improvement in the volume of LE in autologous stem cells and compression sleeves, with no significant difference. | Most studies showed a decrease in LE and an increased lymphangiogenesis when treated with stem cells and this treatment modality has so far shown great potential. | very low |
| There were decreases in LE volume and pain in BMSC transplantation and CPT. BMSC was associated with more decrease than CPT at 3 and 12 months, respectively. | ||||||
| Morris 2013 | KTT | 2012.4 | 1 | No significant differences for limb size, water composition of the upper-limb, LE-related symptoms and health-related quality of life. | In the short-term KTT is no more effective than usual care SSB for BCRL outcomes. | low |
| Dos Santos 2010 | acupuncture | 2009.4 | 1 | Range of shoulder flexion and abduction, degree of LE volume, heaviness or tightness could be improved after traditional acupuncture. | There is a paucity of high quality evidence to support the use of acupuncture to decrease range of motion with LE. | very low |
| Garcia 2014 | acupuncture | 2011.12 | 1 | Mean reduction in arm circumference difference was 0.90 cm (0.72-1.07). 33% exhibited a reduction of ≥30% without serious adverse events and infections or severe exacerbations. | Acupuncture appears to be safe and may reduce arm circumference. | very low |
LE, lymphedema; CPT, complete decongestive therapy (combined Physical Therapy, complex decongestive physiotherapy, decongestive lymphatic therapy); BMSC, bone marrow stromal cells; IPC, Intermittent Pneumatic Compression Pump; LLLT, low-level laser therapy; MLD, Manual lymphatic drainage; CB, compression bandaging; CS, compression sleeve; SLD, simplified/self-MLD; KTT, Kinesio Tex taping