Systematic Review on Lymphedema Management

Some practitioners may think they'll never encounter a patient with lymphedema based on the setting. With the fragility of the lymphatic system, a patient can develop lymphedema with surgery, treatment, trauma, and more, relatively easily. With the impedance it can place on the patient's rehabilitation, it is imperative we are aware of the best treatment methods regarding lymphedema so that we can acceleration the patient's healing process. This study reviews the evidence behind Complete Decongestive Therapy (CDT). CDT is performed daily until tissue normalization occurs. It consists of:

    - ~60 minutes daily of Manual Lymph Drainage (MLD)
   
    - Multi-layer, short-stretch compression bandaging with foam or layers of fabric padding of the affected limbs

    - Exercises to enhance lymphatic pumping

    - Skin care of affected areas

    - Compression garments for maintenance following reductions

The lymphatic system is made up of a collection of lymph vessels and nodes that transport a protein rich fluid known as lymph. After undergoing trauma, the lymphatic system has the potential to become overwhelmed. Either there is too much lymph on the body or the lymphatic system can no longer support the load. This leads to the pathology known as lymphedema. The increase in fluid impairs mobility, increases limb weight, and puts the integumentary system at risk for infection. As physical therapists, we have the tools to facilitate the rehabilitation of our patients.

CDT as a whole has been shown to improve quality of life and decrease limb girth. When looking at each component of CDT, however, the evidence is lacking in determining the level of effectiveness, due to poor study design and the ethical issue of withholding care. One of the most important factors is patient adherence. CDT can be extremely effective early on, but in order to maintain the results the patient must be compliant with compression garments and exercises for maintenance. While CDT has been shown to be beneficial in treating lymphedema, there is definitely room for research to improve upon the effectiveness and efficiency of our care by developing better protocols and separating the effective components of CDT from the non-effective ones.

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Reference:
Lasinski BB, McKillip Thrift K, Squire D, Austin MK, Smith KM, Wanchai A, Green JM, Stewart BR, Cormier JN, Armer JM. (2012). A Systematic Review of the Evidence for Complete Decongestive Therapy in the Treatment of Lymphedema from 2004 to 2011. PM&R: The Journal of Injury, Function and Rehabilitation, 4(8), 580-599.