Liao, S.F. (2015). Lymphedema characteristics and the efficacy of complex decongestive physiotherapy in malignant lymphedema. American Journal of Hospice and Palliative Care. Advance online publication.

DOI Link

Study Purpose

To review the efficacy of complex decongestive physiotherapy (CDP) in patients with malignant lymphedema (LE) and to identify predictors for and characteristics of outcomes

Intervention Characteristics/Basic Study Process

Twenty-nine patients with malignant LE and stage 4 cancer with recurrence were included in this study. In this sample, 74% of participants had LE for less than six months. All patients received intensive CDP from 4–12 sessions consisting of 45 minutes of manual lymphatic drainage, compression therapy with a short stretch bandage, remedial exercise, and instructions for skin and nail care. Patients received 10.5 sessions of daily CDP, and 13 patients were recorded with a bandaging time of 19.5.

Sample Characteristics

  • N = 29
  • AVERAGE AGE = 49.2 years
  • MALES: 6.9%, FEMALES: 93.1%
  • KEY DISEASE CHARACTERISTICS: Malignant LE was defined as a percentage of excess volume greater than 5%. Patients had stage 4 cancer with a local regional recurrence. The acute onset or rapid progression of disease was present. Patients had combined skin ulcers, pain, paresthesia, or paralysis.
  • OTHER KEY SAMPLE CHARACTERISTICS: Duration of LE, LE stage, pain rating scale, and range of motion of shoulder and knee

Setting

  • SITE: Single site    
  • SETTING TYPE: Outpatient    
  • LOCATION: Changhua Christian Hospital Department of Physical Medicine and Rehabilitation in Taiwan

Phase of Care and Clinical Applications

  • PHASE OF CARE: End of life care
  • APPLICATIONS: Palliative care 

Study Design

Retrospective

Measurement Instruments/Methods

  • Numeric Rating Scale (NRS) 0–10 for pain
  • Circumferential volume measurements
  • Percentage excess volume (PEV)
  • Percentage reduction of excess volume (PREV)
  • Descriptive statistics with categorical variables, nonparametric test, and mcNemar test

Results

Excess circumference decreased, and CDP efficacy as defined by the PREV was 46.6%. Pain scores improved from 4.8 to 2.8. Shoulder range of motion improved from a mean of 151.7 to 159.7.

Conclusions

The authors demonstrated that intensive CDP improved lymphedema volume, pain, heaviness, tension, and range of motion in a small study of patients with malignant LE.

Limitations

  • Small sample (< 30)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment) 
  • Risk of bias (sample characteristics)
  • Unintended interventions or applicable interventions not described that would influence results
  • Other limitations/explanation: No quality of life measurement was used. Bandaging techniques were not clearly identified.

Nursing Implications

Previous thoughts or teachings may have suggested that cancer could be spread by manual lymphatic drainage. This study shows the importance of early treatment in patients with malignant LE with CDP, providing improvements in limb volume and range of motion. Patient tolerance and variations in bandaging were not clearly identified in this study, and these may require modifications to the patient’s comfort level.