Skall H,HaedersdalC,Winkel A Gilberg L.Sanderhoff J,NielsenH Mogensen H
Manual lymphdrainage compared with sequential pneumatic compression,
evaluated by volumetrical and scientigraphical techniques and by health survery SF-36
XIX.International Congress of Lymphology 01-06.Sept.2003 Freiburg/Germany

    weiter zur übersetzte Vollversion

Manual lymphdrainage compared with sequential pneumatic compression, evaluated volumetrical and scientigraphical techniques and by health survey SF-36 Purpose:

The aim of this study was to compare the effects of manual lymph drainage therapy versus sequential pneumatic compression therapy and to identify the prevalence of lymphedema according to the study definition of lymphedema, following breast cancer surgery.

Mainly two different physiotherapy treatment modalities are prescribed in the attempt to minimize lymphedema following breast cancer surgery. The two modalities require a different amount of physiotherapy resources and therefore the results of this trial are important to decision makers when planning and dimensioning health care programs.

30 women with lymphedema after breast carcinoma surgery in the period of 1990-1997 were included in the study.

Methods and Materials:
The study was done as a randomized, clinically controlled trial. The women were treated for 5 weeks with either (group A) Manual Lymph Drainage (MLD) or (group B) Sequential Pneumatic Compression (SPC). Edema reduction and self-reported health status (SF-36) was measured 4 times: at baseline and followed up at 1, 3 and 12 months.

Following non-parametric statistical tests were used: Mann Whitney, Wilcoxon, Onesample T-test, Qui-square test and regression analysis, level of significance was set to 5%.

Group A showed 22,2% edema reduction after 1 month (p=0,03) and 35,8% after 3 months (p=9,003) while group B had no significant reduction (18,14% (p=0,14) and 3,6% (p=0,43)). After 3 months the edema reduction in group A was significantly greater than in group B (p=0,012). Looking for the difference between basline values and end point values at the self reported health status we found a difference between group A and group B in 4 out of 8 domains (GH: p=0.02; VT: p=0,04; RE: p=0,02; MH: p=0,03). In the main domain, Role Physical, group A matched an age-related control group after 12 months, while group B remained significantly worse than its age-related control group (p=0,04). The prevalence of lymphedema in 1300 women having had surgery for breast carcinoma was 7,25.

MLD is an efficient physiotherapy technique in reducing arm lymphedema. After 1 year there is a trend in favor of MLD, but no statistically significant difference between MLD and SPC. Lymphedema is relatively common negative sideeffect to breast cancer surgery.