Manual lymphatic drainage improves the quality of life in patients with chronic venous disease: a randomized controlled trial

Abstract

IntroductionManual lymphatic drainage (MLD) is an adjunctive method of chronic venous disease (CVD) therapy. Evaluation of the change at the clinical stage, hemodynamic parameters and quality of life (QoL) following venous system surgery in CVD patients undergoing MLD preoperatively are the most interesting aspects of the study.Material and methodsThe CVD patients qualified for elective surgery of the venous system were randomly divided into 2 groups: the MLD group (n = 38) and the control group (n = 32). In the preoperative period, the MLD group underwent a series of MLD through a period of 2 weeks. The control group did not undergo MLD preoperatively. Both groups were evaluated for CVD staging on the day of qualification for surgery and between 25 and 30 days post-operatively. Additionally, the MLD group was evaluated after the series of MLD. The CVD staging was evaluated in both groups with a QoL questionnaire (CIVIQ), CEAP classification, foot volumetry (FV) and venous refilling time (VRT).ResultsParameter values obtained in the MLD group (before treatment/after MLD/after surgery): CEAP 2.23/2.15/2.10, VRT 15/13/15.6, FV 3625/3472/3418, CIVIQ-complaints: 54.4/43.8/38.2 and CIVIQ-meaning: 57.3/49.3/43.1. Parameter values obtained in control group (before surgery/after surgery): CEAP 2.4/2.12, VRT 13/14.9, FV 3581/3559, CIVIQ-complaints: 51.9/38.7 and CIVIQ-meaning: 53.7/40.6. The CVD patients statistically improved in CEAP staging, FV and QoL in both groups (p < 0.05).ConclusionsThe MLD alone significantly reduced FV in patients with CVD, also improving their QoL. The MLD applied in CVD patients at the preoperative stage results in better surgical outcome, which is demonstrated by reduced disease progression, FV reduction and improvement in the QoL.

Manual Lymphatic Drainage in the Treatment of Chronic Venous Disease

“…Nevertheless, based on research [21][22][23], the hands of the physical therapist must do the maneuvers producing a low pressures form of skin stretching. The pressure applied by the hands onto the skin and underlying soft tissues should be carefully adjusted to remain soft and just enough to stretch the skin for at least 4 s. When both legs are treated, the whole session take approximately 40-45 min [17,18,21]. The duration and the number of sessions at the studies assessing the role MLD in CVD patients [17,18] are similar, during 2-5 weeks, patients should complete 10-14 sessions of MLD.…”

“…MLD applied before surgery in patients with CVD improves the clinical class of CEAP classification, HRQL, depression, anxiety, edema, and symptoms [17,18,21]. Nevertheless, foot volumetry and reflux volume index only improve when MLD is associated to surgery and compression stockings [17,18].…”

“…Previous studies show that MLD (10 sessions in 2 weeks) used in CVD patients who were referred to vascular surgery is effective in diminishing pain and edema and in improving HRQL [17]. When employed for a longer period of time (14 sessions in 5 weeks), MLD also seems to effectively contribute, together with surgery, to improve CVD severity [18].…”

“…Some studies refer the importance of wearing compression stocking during the application of MLD [17,18]. In one study, 23 out of the 41 patients did not wear compression stockings and only four participants fully adhere to this treatment, with no influence on MLD efficacy.…”

Conservative Management of Chronic Venous Insufficiency

“…the Unna boot), multilayer elastic wraps, dressings, elastic and non-elastic bandages and non-elastic garments. Pneumatic compression devices are also used in patients with refractory edema and venous ulcers [58].…”