Finnane, A., Janda, M., & Hayes, S.C. (2015). Review of the evidence of lymphedema treatment effect. American Journal of Physical Medicine and Rehabilitation, 94, 483–498. 

DOI Link

Purpose

STUDY PURPOSE: To evaluate evidence from systematic reviews for the treatment of lymphedema

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: MEDLINE, PubMed, CINAHL, and the Cochrane Collaboration
 
KEYWORDS: Lymphedema, treatment and systematic review, review, and meta analysis
 
INCLUSION CRITERIA: Reviews that focused on the effects of lymphedema treatment; search strategy was reported; inclusion and exclusion criteria were defined; methods of assessing study quality were described and applied

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 206
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The Cochrane risk of bias tool was used to evaluate review quality.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 21
  • TOTAL PATIENTS INCLUDED IN REVIEW = Sample sizes not reported
  • KEY SAMPLE CHARACTERISTICS: Not reported

Results

  • There was agreement that complete decongestive therapy (CDT) was effective in reducing limb volume. However, the most effective components and factors that affected efficacy were not defined. It appeared that ongoing therapy was needed to maintain the initial improvements of intensive CDT.
  • There were inconsistent findings regarding the efficacy of manual lymphatic drainage, and the evidence did not support its efficacy as a stand-alone treatment.
  • Volume reduction was demonstrated with low-level laser therapy, but the optimal dose and type was not clear.
  • Pneumatic compression achieved volume reduction, but greater effects were seen when pneumatic compression was combined with other therapies.
  • Compression bandaging or garments resulted in significant volume reductions.
  • There was insufficient evidence to determine the contribution of exercise to volume reduction.
  • Surgical treatments resulted in volume reduction, but these also had potential complications, and the continued use of conservative treatments was needed to maintain improvements.

Conclusions

Compression therapy alone and combined with manual lymphatic drainage was supported by strong evidence. Preliminary evidence suggested that a range of other treatments also are beneficial.

Limitations

  • The methodologic quality of the studies included was variable, and the quality of most was deemed to be poor.
  • Little attention was given to the subjective aspects of treatment outcomes.

Nursing Implications

CDT and compression bandaging alone or with manual lymphatic drainage were effective in managing lymphedema. Ongoing maintenance is needed to keep these gains, and nurses need to educate patients regarding this ongoing need.

Legacy ID

5476