Rodrick, J. R., Poage, E., Wanchai, A., Stewart, B. R., Cormier, J. N., & Armer, J. M. (2013). Complementary, alternative, and other non-complete decongestive therapy (CDT) treatment methods in the management of lymphedema: A systematic search and review. PM&R, 6, 250–274.

STUDY PURPOSE: To provide a critical analysis of the contemporary published research that pertains to complementary, alternative, and other noncomplete decongestive therapies for treatment of lymphedema (LE) and to provide practical applications of that evidence to improve care of patients with or at risk for LE

TYPE OF STUDY: Systematic review

DATABASES USED: PubMed, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, PapersFirst, Proceedings-First, Worldcat, PEDro, National Guideline Clearing House, ACP Journal Club, DARE, and the authors' archives

KEYWORDS: Best practice for the management of lymphoedema, plus expanded terms for all literature related to lymphedema (2004–2012)

INCLUSION CRITERIA: No specific inclusion criteria identified

EXCLUSION CRITERIA: No gray literature was included; nonrefereed articles, abstracts, and dissertations were excluded. Exclusion of 574 articles took place due to duplication, inability to obtain the English translation, inadequate sample size, insufficient level of evidence due to study design, and failure to meet inclusion criteria. Another 47 articles were rejected because they fell outside the systematic review inclusion criteria by definition of four categories (i.e.,botanical, pharmaceutical, physical agent modalities, and modalities of contemporary value), by design, or for lack of an English translation. The categories of pharmaceuticals and botanicals were excluded as well.

TOTAL REFERENCES RETRIEVED: 659 articles were reviewed.

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The authors used first screening, second screening, and third screening to determine final body of reviewed articles. The level of evidence for each study assessed by using the research grading system from the Putting Evidence into Practice (PEP) level of evidence guidelines.

• FINAL NUMBER STUDIES INCLUDED = 22
• SAMPLE RANGE ACROSS STUDIES/TOTAL PATIENTS INCLUDED IN REVIEW: Not applicable; included several singles and several review articles
• KEY SAMPLE CHARACTERISTICS: Human being with lymphedema and animal model with lymphedema (i.e., a rabbit ear model with “created” secondary lymphedema and rat tail model with “created” secondary lymphedema)

PHASE OF CARE:  Multiple phases of care

Limited high-level evidence was available for all categories. Well-constructed randomized, controlled trials related specifically to lymphedema were limited. Objective outcome measures over time were absent from several studies. The rationale for the use and benefits of the specific modality, as related to lymphedema, was often anecdotal. Participant numbers were fewer than 50 for most studies.

No interventions were ranked as "recommended for practice." Two treatment modalities (low-level laser therapy and Kinesio taping combined with decongestive lymphatic therapy and pneumatic compression, with Kinesio taping compared with compression bandaging) in three studies were ranked as "likely to be effective." The literature review indicated that many of the physical agent modalities demonstrated long-standing support within the literature, with broad parameters for therapeutic application and benefit for secondary conditions associated with lymphedema. However, additional investigation regarding the individual contributory value and the factors that contribute to their efficacy specific to lymphedema is critically needed.

Inclusion criteria were not clearly stated. Sample range across studies and total patients included in review were not specified.

More rigorous human research in complementary and alternative modalities is needed to optimize patient outcomes.