Table 1.
Systematic reviews summarizing trials about MLD
| References | Trials included (N) | Number of patients (N) | Meta-analysis performed? | Results | Conclusion |
|---|---|---|---|---|---|
| Muller et al. [34] |
8 (5 with BCRL): Beltmonte (2012), Dayes (2013), Gradalski (2015), Odebiyi (2014), Ridner (2013) |
236 | No | One study reported increased HRQoL among patients randomized to the MLD group. No studies reported reductions in HRQoL, or severe adverse events after MLD | The effect of MLD on the HRQoL of patients with chronic edema is unclear |
| Huang et al. [37] |
10: Andersen (2000), Didem (2005), Johansson (1998), Johansson (1999), McNeely (2004), Sitzia (2002), Williams (2002), Szolnoky (2009), Devoogdt (2011), Torres Lacomba (2010) |
566 | Yes; 8 studies included | Two studies evaluating the preventive outcome of MLD found no significant difference in the incidence of lymphedema between the MLD and standard treatment groups, with a risk ratio of 0.63 and a 95% confidence interval (CI) of 0.14–2.82. Seven studies assessed the reduction in arm volume and found no significant difference between the MLD and standard treatment groups, with a weighted mean difference of 75.12 (95% CI − 9.34 to 159.58) | The current evidence from RCTs does not support the use of MLD in preventing or treating lymphedema |
| Ezzo et al. [33] |
6: Johansson (1998), Johannson (1999), Andersen (2000), McNeely (2004), Sitzia (2002), Williams (2002) |
NM | No |
Result I: group I: MLD + physiotherapy vs. group II: physiotherapy solely; improvements in both groups, no difference for percent reduction between groups Result II: group I: MLD + compression bandaging vs. group II: compression bandaging; additional 7.11% reduction for MLD (p = 0.06) |
MLD is safe and may offer additional benefit to compression bandaging for swelling reduction. Individuals with mild-to-moderate BCRL may be the ones who benefit from adding MLD. In trials where MLD and sleeve were compared with a nonMLD treatment and sleeve, volumetric outcomes were inconsistent within the same trial |
| Shao et al. [38] |
4: Andersen (2000), Dayes (2013), McNeely (2004), Didem (2005) |
234 | No | There was a significant difference in volume reduction between MLD plus routine treatment and sole routine treatment | Adding MLD to the ST could enhance the effectiveness of treating volume reduction of lymphedema, but might not improve subjective symptoms or arm function |
| Liang et al. [39] |
17: Tambour (2018), Devoogdt (2018), Zhang (2016), Cho (2016), Bergmann (2014), Ridner (2013), Zimmernann (2012), Belmonte (2012), Devoogdt (2011), Szolnoky (2009), Didem (2005), McNeely (2004), Williams (2002), Sitzia (2002), Andersen (2000), Johansson (1999), Johansson (1998) |
1911 | Yes; 12 studies included |
MLD did not significantly reduce lymphedema compared with the control group (standardized mean difference (SMD): 0.09, 95% confidence interval (CI): [0.85 to 0.67]) MLD could significantly reduce lymphedema in patients under the age of 60 years (SMD: 1.77, 95% CI: [2.23 to 1.31]) and an intervention time of 1 month (SMD: 1.77, 95% CI [2.23–1.30]). Meanwhile, 4 RCTs including, 1364 patients, revealed that MLD could not significantly prevent the risk of lymphedema (risk ratio (RR): 0.61, 95% CI [0.29–1.26]) for patients having breast cancer surgery |
Meta-analysis of 12 RCTs showed that MLD cannot significantly reduce or prevent lymphedema in patients after breast cancer surgery. However, well-designed RCTs with a larger sample size are required, especially in patients under the age of 60 years or an intervention time of 1 month |
| Wanchai et al., [36] |
10: Andersen (2000), Gradalski (2015), Gurdal (2012), Maher (2012), McNeely (2004), Sitzia (2002), Szolnoky (2009), Williams (2002), Devoogdt (2011), Zimmermann (2012) |
NM | No | Based on the results, it cannot be concluded that MLD helps to reduce the risk of BCRL for women after breast surgery. Regarding the effect of MLD on managing BCRL, the findings indicate that MLD alone or MLD combined with other treatments was likely to give similar benefits in terms of reducing arm volume for women diagnosed with BCRL | Scientific evidence to support the benefits of MLD on preventing or reducing BCRL remains unclear. More rigorous studies to confirm findings on the effectiveness of MLD are needed |
| Thompson et al., [35] |
17: Andersen (2000), Belmonte (2012), Bergmann (2014), Gradalski (2015), Ha (2017), McNeely (2004), Johansson (1998), Odebiyi (2014), Ridner (2013), Sanal-Toprak (2019), Sitzia (2002), Tambour (2018), Williams (2002), Cho (2016), Devoogdt (2011), Devoogdt (2018), Zimmermann (2012) |
869 | No | Some studies reported positive effects of MLD on volume reduction, quality of life, and symptom-related outcomes compared with other treatments, while other studies reported no additional benefit of MLD as a component of complex decongestive therapy. In patients at-risk, MLD was reported to reduce incidence of lymphedema in some studies, while others reported no such benefits | The reviewed articles reported conflicting findings and were often limited by methodological issues. This review highlights the need for further experimental studies on the effectiveness of MLD in lymphedema |
HRQoL health-related quality of life, MDL manual lymphatic drainage, NM not mentioned, BCRL breast-cancer-related lymphedema, ST standard therapy, RCT randomized-controlled trials