McNeely, M.L., Magee, D.J., Lees, A.W., Bagnall, K.M., Haykowsky, M., & Hanson, J. (2004). The addition of manual lymph drainage to compression therapy for breast cancer related lymphedema: A randomized controlled trial. Breast Cancer Research and Treatment, 86(2), 95–106.

To compare the reduction in arm lymphedema volume achieved from manual lymphatic drainage (MLD) in combination with compression bandaging (CB) to that achieved by CB alone

All subjects receive four weeks of allocated treatment, which also included standard education on proper arm and skin care. The MLD and CB group received 45 minutes of daily MLD Monday through Friday each week. Both groups receive CB.

Patients were included in the study if they

• Were female
• Had a breast cancer diagnosis
• Previously had unilateral surgery with axillary node dissection
• Were diagnosed with lymphedema
• Had not received treatment for lymphedema within six months prior to study.

Patients were excluded from the study if they

• Had distant metastases or local recurrence
• Were at the time receiving treatment with chemotherapy or radiotherapy
• Had any sign of infection in affected limb
• Had contraindications to intervention therapy.

The study took plact at the Cross Cancer Center in Edmonton, Canada.

The study used a prospective, randomized controlled study design.

• Water displacement volumetric and calculated volume determined from measurement of circumference were used to assess lymphedema volume.
• The primary outcome was the volume of lymphedema in the affected arm.
• Each person’s unaffected arm served as a control.
• Change score was represented by difference in volumes from the initial measurement to the final measurement at the end of four weeks.
• Data were analyzed comparing baseline characteristics using independent samples t-tests for continuous data and Pearson’s chi-squared test for categorical data.
• Outcome data was analyzed using the independent samples t-tests to compare changes between groups in outcomes from baseline to post-intervention.
• The rate of reduction was analyzed using a two-way analysis of variance repeated measures.
• Alpha level was set at p < 0.05.

A total of 45 participants completed the study. A significant reduction in lymphedema volume was found over a four-week period for both groups. No significant difference was noted in volume reduction (p = 0.812) or percent reduction (p = 0.297) between the groups. Therefore, a reduction in lymphedema volume occurred over the time period irrespective of the treatment group. The findings from the calculated volume determined from circumference measurements were consistent with the water displacement findings.

Findings suggest that CB alone should be considered as a primary treatment option in reducing lymphedema arm volume. It also suggests that treatment of lymphedema should be implemented as soon as possible after onset of the condition when treatment is likely to be more effective.

• Treatment on lymphedema volume over a one-month period with no further follow-up.
• Upper-extremity range of motion was not assessed.
• The study did not assess of effects of treatment on pain, function, body image, and quality of life.
• Staff that is knowledgeable in the application of CB is required for the intervention.
• Therapists certified in MLD are required.
• Staff must be trained and certified.
• CBs can be costly.