Uzkeser, H., Karatay, S., Erdemci, B., Koc, M., & Senel, K. (2013). Efficacy of manual lymphatic drainage and intermittent pneumatic compression pump use in the treatment of lymphedema after mastectomy: A randomized controlled trial. Breast Cancer. Advance online publication.

To investigate efficacy and contribution of an intermittent pneumatic compression pump in lymphedema management and evaluation of measurement method correlation

Patients were randomized into two groups by consecutive alternating allocation by time of admittance. Group 1 received complete decongestive therapy (CDT) treatment (skin care, manual lymphatic drainage, compression bandage, compression garments, and exercise). Group 2 received CDT in combination with the intermittent pneumatic compression pump after manual drainage for 45 minutes at 40mmHg. Both groups were treated five times per week for three weeks for a total of 15 sessions. Measurements were obtained initially, post-therapy in week three, and one month postcompletion.

• N = 31 (final sample); 15 in Group 1 and 17 in Group 2
• MEAN  AGE = 56 years (Group 1), 55 years (Group 2)
• AGE RANGE = 37–75 years (Group 1), 42–75 years (Group 2) 
• MALES: 0%, FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Patients with unilateral upper extremity lymphedema postmastectomy, no history of physical therapy prior to trial, and more than 2 cm circumference difference or more than 10% difference in arm volume between unaffected and affected arm
• OTHER KEY SAMPLE CHARACTERISTICS: Patients with bilateral lymphedema, metastases, continuing radiation therapy, cellulites, thrombosis, elephantiasis, infection, carcinomatosa, congestive heart disease, and those currently using medication that affects body fluids or electrolye balance were excluded.

• SITE: Single site 
• SETTING TYPE: Outpatient 
• LOCATION: Physical Medicine and Rehabilitation Department, Atatürk University Faculty of Medicine

• PHASE OF CARE: Late effects and survivorship
• APPLICATIONS: Elder care, palliative care

• Randomized, controlled trial

• Affected and unaffected upper limbs were measured with tape at four sites: metacarpophalangeal joint, wrists, and 10 cm below and above the lateral epicondyles.
• Dermal thickness was measured with ultrasonography at the affected and unaffected limbs.
• Circumferences, dermal thickness, and the volume of affected and unaffected limbs were calculated, and the difference between them was recorded as delta.
• Pain was measured by a visual analog scale of 0–10.
• All measurements were taken by the same physician who was blind to the treatment groups.

Significant correlation (p = 0.001) between dermal thickness with ultrasound and circumference of forearm measurement and water immersion measure method on forearm. Pre- and post-treatment measurements with both groups were significantly reduced, but no statistically significant difference between groups after therapy and one month later were noted.

CDT remains the standard treatment for lymphedema. The addition of the pneumatic pump to CDT yielded no significant improvement in lymphedema. Limitations included small sample size and no long-term follow-up. More prospective randomized studies are needed to evaluate potential efficacy of pneumatic pump and to correlate ultrasound measurement of dermal thickness with water immersion method on forearms.

• Small sample (< 30)
• Measurement/methods not well described

Nurses should continue to focus on education for prevention and early intervention for lymphedema.