BackgroundBreast cancer related lymphedema (BCRL) is a prevalent complication secondary to cancer treatments which significantly impacts the physical and psychological health of breast cancer survivors. Previous research shows increasing use of low level laser therapy (LLLT), now commonly referred to as photobiomodulation (PBM) therapy, for BCRL. This systematic review evaluated the effectiveness of LLLT (PBM) in the management of BCRL.MethodsClinical trials were searched in PubMed, AMED, Web of Science, and China National Knowledge Infrastructure up to November 2016. Two reviewers independently assessed the methodological quality and adequacy of LLLT (PBM) in these clinical trials. Primary outcome measures were limb circumference/volume, and secondary outcomes included pain intensity and range of motion. Because data were clinically heterogeneous, best evidence synthesis was performed.ResultsEleven clinical trials were identified, of which seven randomized controlled trials (RCTs) were chosen for analysis. Overall, the methodological quality of included RCTs was high, whereas the reporting of treatment parameters was poor. Results indicated that there is strong evidence (three high quality trials) showing LLLT (PBM) was more effective than sham treatment for limb circumference/volume reduction at a short-term follow-up. There is moderate evidence (one high quality trial) indicating that LLLT (PBM) was more effective than sham laser for short-term pain relief, and limited evidence (one low quality trial) that LLLT (PBM) was more effective than no treatment for decreasing limb swelling at short-term follow-up.ConclusionsBased upon the current systematic review, LLLT (PBM) may be considered an effective treatment approach for women with BCRL. Due to the limited numbers of published trials available, there is a clear need for well-designed high-quality trials in this area. The optimal treatment parameters for clinical application have yet to be elucidated.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3852-x) contains supplementary material, which is available to authorized users.

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This study aimed to comprehensively investigate the reliability of multiple heart rate variability (HRV) parameters, and to explore the influence of artefact removal and breathing condition on HRV reliability. Resting HRV was collected using Polar Team monitors on forty-one participants (age: 19.9±1.2 years; 28 females, 13 males) during two separate days. Within each session, participants performed 10 minutes each of spontaneous and controlled breathing (randomized order). Kubios HRV analysis software was used to analyze 180s data epochs using "low" or "strong" artefact removal. Relative reliability was assessed using intraclass correlation coefficients (ICC2,1) and absolute reliability was quantified using mean-normalized standard error of measurement (SEM%). Time domain and nonlinear parameters produced poor to good inter-session agreement (ICC:0.34-0.68; SEM%: 11.0-39.0) with "low" artefact removal, regardless of breathing condition. Frequency domain parameters demonstrated fair inter-session agreement during controlled breathing (ICC:0.40-0.45; SEM%: 26.0-70.0), but poor agreement during spontaneous breathing (ICC:0.07-0.13; SEM%: 32.0-81.0). Minimal differences in ICCs were observed between "low" and "strong" artefact removal. Thus, this study provides three practical applications: 1) HRV monitoring is most reliable when using time domain and nonlinear parameters, regardless of breathing or filtering condition, but no single parameter is especially reliable. The large variation and poor inter-session reliability of frequency indices during spontaneous breathing are improved by controlling breathing rate; 2) "Low" artefact removal appears superior to more aggressive artefact removal; and 3) Inter-session differences in HRV measurements <30% may be indicative of normal daily variation rather than true physiologic changes.