A randomized clinical trial comparing advanced pneumatic truncal, chest, and arm treatment to arm treatment only in self-care of arm lymphedema

Abstract

Treatment of the truncal lymphatics prior to treatment of the lymphedematous arm is an accepted, although not empirically tested, therapeutic intervention delivered during decongestive lymphatic therapy (DLT). Breast cancer survivors with arm lymphedema are encouraged to use these techniques when performing simple lymphatic drainage as part of their life-long lymphedema self-care. Self-massage is at times difficult and pneumatic compression devices are used by many patients to assist with self-care. One such device, the Flexitouch(®) System, replicates the techniques used during DLT; however, the need for application of pneumatic compression in unaffected truncal areas to improve self-care outcomes in arm only lymphedema is not established. The objective of this study was to compare the therapeutic benefit of truncal/chest/arm advanced pneumatic compression therapy (experimental group) verses arm only pneumatic compression (control group) in self-care for arm lymphedema without truncal involvement using the Flexitouch(®) System. Outcomes of interest were self-reported symptoms, function, arm impedance ratios, circumference, volume, and trunk circumference. Forty-two breast cancer survivors, (21 per group), with Stage II lymphedema completed 30 days of home self-care using the Flexitouch(®) System. Findings revealed a statistically significant reduction in both the number of symptoms and overall symptom burden within each group; however, there were no statistically significant differences in these outcomes between the groups. There was no statistically significant overall change or differential pattern of change between the groups in function. A statistically significant reduction in bioelectrical impedance and arm circumference within both of the groups was achieved; however, there was no statistically significant difference in reduction between groups. These findings indicate that both configurations are effective, but that there may be no added benefit to advanced pneumatic treatment of the truncal lymphatics prior to arm massage when the trunk is not also affected. Further research is indicated in a larger sample.

Normative Volume Difference Between the Dominant and Nondominant Upper Limbs in Healthy Older Women

“…The effect of dominance has previously been found for other tools used in the diagnosis of lymphedema such as bioimpedance spectroscopy which has necessitated different cut-offs depending on which limb was at risk. 24,25,28 It is therefore logical that circumference and volume cut-offs should also take into account limb dominance.…”

Development and validation of the Lymphedema Symptom and Intensity Survey-Arm

“…The revised 36-item tool was subsequently validated [3,8,11,12,19,20]. (Figure 1) Breast cancer survivors with previously diagnosed lymphedema completed the LSIDS-A using the 1-10 scale in addition to other measures used to evaluate validity and reliability.…”

Putting Evidence Into Practice: Cancer-Related Lymphedema

“…In a small pre-and post-test study of 21 breast cancer survivors with lymphedema, Moattari et al (2012) reported a significant effect of combined CDT and pneumatic compression device on arm volume reduction (p < 0.05). A small RCT in the United States assigned 42 breast cancer survivors with lymphedema into an experimental group receiving truncal, chest, and arm pneumatic compression to treat lymphedema and a control group of arm compression only (Ridner, Murphy, et al, 2012). Findings demonstrated no significant effect of the pneumatic compression device on lymphedema symptoms, bioimpedance ratio, and physical functioning.…”