Rodrick JR, Poage E, Wanchai A, Stewart BR, Cormier JN, Armer JM, et al.
PM & R : the journal of injury, function, and rehabilitation. Date of publication 2014 Mar 1;volume 6(3):250-74; quiz 274.
1. PM R. 2014 Mar;6(3):250-74; quiz 274. doi: 10.1016/j.pmrj.2013.09.008. Epub 2013
Sep 18.
Complementary, alternative, and other noncomplete decongestive therapy treatment
methods in the management of lymphedema: a systematic search and review.
Rodrick JR(1), Poage E(2), Wanchai A(3), Stewart BR(4), Cormier JN(5), Armer
JM(6).
Author information:
(1)St. John's Hospital, Rehab South Outpatient Therapies, Springfield, IL(∗).
(2)Rehabilitation Associates of Naples, Naples, FL(†).
(3)University of Missouri Sinclair School of Nursing, Columbia, MO;
Boromarajonani College of Nursing, Buddhachinaraj, Thailand(‡).
(4)University of Missouri Sinclair School of Nursing, Columbia, MO(§).
(5)Departments of Surgical Oncology and Biostatistics, University of Texas MD
Anderson Cancer Center, Houston, TX(‖).
(6)University of Missouri Sinclair School of Nursing, Mizzou North 408 DC 116.05,
Columbia, MO, 65212(¶). Electronic address: armer@missouri.edu.
OBJECTIVES: (1) 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 (2) to provide
practical applications of that evidence to improve care of patients with or at
risk for LE. TYPE: This study meets the defining criteria as a systematic search
and review because it includes varied study types. All studies that met the
inclusion criteria were evaluated for weight of evidence and value.
LITERATURE SURVEY: The systematic search and review includes articles published
in the contemporary literature (2004-2012). Publications published from 2004-2011
were retrieved from 11 major medical indices by using search terms for LE and
management approaches. Literature archives were examined through 2012. Data
extraction included study design, objectives pertaining to LE, number and
characteristics of participants, interventions, and outcomes. Study strengths and
weaknesses were summarized. Study evidence was categorized according to the
Oncology Nursing Society Putting Evidence into Practice level-of-evidence
guidelines after achieving consensus among the authors. No authors participated
in development of nor benefitted from the review of these modality methods or
devices.
METHODOLOGY: Extracted data from 85 studies were reviewed in 4 subcategories:
botanical, pharmaceutical, physical agent modality, and modalities of
contemporary value. After review, 47 articles were excluded, which left 16
articles on botanicals and pharmaceuticals and 22 articles for physical agent
modality and/or modalities of contemporary value. Pharmaceuticals were later
excluded. The authors concluded that botanicals had generated sufficient studies
to support a second, more specific systematic review; thus, botanicals are
reported elsewhere.
SYNTHESIS: It was found that limited high-level evidence was available for all
categories. Well-constructed randomized controlled trials related specifically to
LE 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 LE, was often anecdotal. Subject numbers were fewer than 50 for most
studies.
CONCLUSIONS: No interventions were ranked as "recommended for practice" based on
the Putting Evidence into Practice guidelines. Two treatment modalities in 3
studies were ranked as "likely to be effective" in reducing LE or in managing
secondary LE complications. Consideration should be given that many of the PAMs
demonstrate long-standing support within the literature, with broad parameters
for therapeutic application and benefit for secondary conditions associated with
LE. However, further investigation as to their individual contributory value and
the factors that contribute to their efficacy, specific to LE, has not been done.
It also is significant to mention that the majority of these studies focused on
breast cancer-related LE. Studies that explored treatment interventions for
LE-related vascular disorders (eg, chronic venous insufficiency, congenital
dysphasia, trauma) were sparse. Limitations of the literature support the
recommendations for future research to further examine the level of evidence in
these modalities for LE management.
Copyright © 2014 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.
DOI: 10.1016/j.pmrj.2013.09.008
PMID: 24056160 [Indexed for MEDLINE]
