Szolnoky, G., Lakatos, B., Keskeny, T., Varga, E., Varga, M., Dobozy, A., & Kemény, L. (2009). Intermittent pneumatic compression acts synergistically with manual lymphatic drainage in complex decongestive physiotherapy for breast cancer treatment-related lymphedema. Lymphology, 42, 188–194.

To investigate whether the combination of pneumatic pump with manual lymph drainage (MLD) compared to MLD alone in standard complex decongestive physiotherapy (CDP) treatment can improve outcomes in women with stage 2 lymphedema after treatment for breast cancer

Participants were randomly enrolled into 60-minute MLD or 30-minute MLD plus 30-minute intermittent pneumatic compression (IPC) followed by standardized components of CDP (compression bandaging, physical exercise, and skin care 10 times in a two-week period). Patient assessment was completed at baseline, beginning of therapy, end of therapy, and one and two months after the start of the therapy.

• The study sample (N = 27) was comprised of female patients with breast cancer who were assigned to the CDP group (n = 13) or the CDP and IPC group (n = 14).
• Mean age was 54.83 years in the CDP group and 56.60 years in the CDP and IPC group.
• Patients were included in the study if they were more than 12 months after surgery or adjuvant treatment.
• Patients were excluded from the study if they had any sign of local recurrence or distant metastases or if they were within the obligatory treatment-free period of one year.

The study took place at an outpatient setting at the Lymphedema Care Unit of the University of Szeged, Hungary.

The study used a randomized controlled trial design.

• Limb volume was measured using tape at every four centimeters.
• The percentage reduction in total arm volume at each point was calculated with the formula ∆V% = [(pre-treatment arm volume – post-treatment arm volume)/pre-treatment arm volume] × 100.
• Patients completed subjective symptom questionnaires measuring function, heaviness, tension, and pain as well as their effects on related activities.
• Percentage improvement in the subjective complains was calculated with the formula ∆S% = [(total sum of pre-treatment scores – total sum of post-treatment scores)]/total sum of pre-treatment scores] × 100.

Mean reductions in limb volumes for each group at the end of therapy and at one and two months were 7.93% and 3.06%, 9.02% and 2.9%, and 9.62% and 3.6%, respectively (p < 0.05 from baseline for each group and also between groups at each measurement). A significant decrease in the subjective symptom survey was found for both groups compared to baseline, but no significant difference between the groups was found at any time point.

The application of IPC with MLD provided a synergistic enhancement of the effect of CDP in arm volume reduction.

• The sample size was small, with less than 30 participants.
• The study took place at a single site.

More studies involved in multisite settings with large sample sizes are needed to duplicate the findings from this study.