Ochalek, K., Gradalski, T., & Szygula, Z. (2014). Five-year assessment of maintenance combined physical therapy in postmastectomy lymphedema. Lymphatic Research and Biology, 13, 54–58. 

DOI Link

Study Purpose

To analyze the outcome of maintenance combined physical therapy (MCPT) for five years in patients with unilateral breast cancer-related lymphedema

Intervention Characteristics/Basic Study Process

This was a review of the outcomes of MCPT after five years in patients with lymphedema after unilateral mastectomies, noting adherence to therapy and garments as prescribed. Maintenance consisted of compression garments, a program of physical exercise, preventive and hygiene education, and regular follow-up visits every six months. Outcomes were compared between those who continued regular follow-up and those who did not.

Sample Characteristics

  • N = 60
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Unilateral mastectomy with lymphedema
  • OTHER KEY SAMPLE CHARACTERISTICS: Recurrent cancer diagnoses were excluded.

Setting

  • SITE: Single site
  • SETTING TYPE: Outpatient
  • LOCATION: Lymphedema clinic St. Lazarus Hospice in Kraców, Poland

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship
 
APPLICATIONS: Pediatrics and elder care  

Study Design

Descriptive

Measurement Instruments/Methods

  • Limb volume measurements
  • Garment suitability assessment

Results

Group A, which consistently followed up, experienced a 9% volume reduction after initial CPT that was maintained by MCPT for five years. This measure increased after five years compared to immediately following initial CPT. Group B experienced a volume reduction with initial CPT, but during the next five years demonstrated a volume increase by 7% back to initial status.

Conclusions

Factors determining effectiveness included access to treatment. Patients who completed initial CPT and regularly followed up showed a reduction in volume and maintained this reduction.

Limitations

  • Small sample (< 100)
  • Baseline sample/group differences of import
  • Risk of bias (sample characteristics)
  • Selective outcomes reporting
  • Other limitations/explanation: Potential treatment bias was seen in a statement not measured by the article: \"A marked and rapid improvement was achieved using the full scope of ICDT although similar results can also be obtained without manual lymph drainage.\"

Nursing Implications

Adherence to long-term therapy is important for successful maintenance. Identifying barriers such as access to treatment, financial issues related to garments, and perceived barriers to maintenance, which was not fully addressed in this article, is important.