Ridner, S.H., Murphy, B., Deng, J., Kidd, N., Galford, E., Bonner, C., … Dietrich, M. S. (2011). A randomized clinical trial comparing advanced pneumatic truncal, chest, and arm treatment to arm treatment only in self-care of arm lymphedema. Breast Cancer Research and Treatment, 131, 147–158.

To compare advanced pneumatic truncal, chest, and arm treatment to arm only treatment to determine which therapy provides a larger reduction in lymphedema in post-operative patients with breast cancer

Participants were randomly assigned to receive truncal, chest, and arm compression or arm compression only. The compression was performed for one-hour, once per day for 30 days.

• The study reported on 42 patients.
• The mean age of patients was 56.9 years (SD = 8.1 years) with a range of 38–71.
• The sample was 100% female.
• Patients had breast cancer and were diagnosed with lymphedema stage II (2 cm circumference difference or a lymphedema index ratio of 1.163 with dominant arm affected or 1.109 when the nondominant arm was affected).
• Patients were at least 6 months postsurgery or postradiation treatment.

The study was conducted in Nashville, TN. The site and setting were not stated.

Patients were undergoing active lymphedema treatment.

This was a randomized control trial.

Demographic and medical data was collected via nurse interviews. The participants completed a Lymphedema Symptom Intensity and Distress Survey—Arm (LSIDS-A) and a functional assessment screening questionnaire (FASQ).

A statistically significant reduction was found in the number of symptoms and overall burden from the symptoms in both groups (p < 0.01). However, no statistical significance was found in the number of symptoms between groups (p = 0.145). No statistically significant change was found in functioning from baseline to the end of the study for either group, and no difference was found between the control and intervention group. The physical arm measurements indicated a significant reduction in bioelectrical impedance within both groups at the end of the study compared to baseline (p = 0.004 for arm only and p = 0.023 for truncal, chest, and arm). The combined groups were found to have a significant reduction at p = 0.018.

Both groups experienced a significant improvement but no difference was found based on treatment of arm alone or of truncal, chest, and arm. Some differences were noted between the intervention and control group that may have led to these conclusions. For example, the participants in the experimental group had more symptoms at baseline than the control group; whether these patients would have benefited equally from the arm-only treatment was not clear. Another variable that may have affected results is that the experimental group developed lymphedema more quickly after surgery and at a younger age. Researchers have hypothesized that opening truncal lymph channels is necessary to promote volume reduction, but this study suggested that the procedure may not play as a big of a role as originally thought. Repeating this study with a larger sample size, while holding these possible confounding variables constant, would be worthwhile.

• The sample size was small with fewer than 100 patients.
• Important baseline sample differences exist, such as the fact that the patients in the experimental group developed lymphedema more quickly after surgery and at a younger age.
• A risk of bias exists because of the lack of blinding and the particular sample characteristics.

This study suggested that truncal, chest, and arm pneumatic compression therapy is not significantly better than arm pneumatic compression alone. Differences between the control group and the experimental group could have contributed to these findings. Repeating the study with more rigorous inclusion and exclusion criteria is needed to ensure that these variables did not affect the results of the study.