Complex Decongestive Lymphatic Therapy With or Without Vodder II Manual Lymph Drainage in More Severe Chronic Postmastectomy Upper Limb Lymphedema: A Randomized Noninferiority Prospective Study

摘要

Context: Complex decongestive lymphatic therapy (CDT) has been the method of choice in conservative management of lymphedema. Although effective, it is time consuming and manual lymph drainage (MLD) usually requires skilled therapists. Objectives: The purpose of this study was to compare the reduction in edema volume in more advanced (>=20% limb volume difference) postmastectomy arm lymphedema achieved by compression bandaging (CB) and physical exercises vs. the same management augmented by an additional 30 minutes of MLD (Vodder II method). Methods: Sixty postmastectomy women were randomly assigned to either the CB group or the CDT group. Of those, 51 women (26 within the CB group) completed 26 weeks of therapy (two weeks of the intensive phase and six months of the maintenance phase). Results: A decrease of limb volume (15.6% in the CB group and 13.8% in the CDT group), edema volume (47.2% and 47.4%, respectively), and limb-related volume change (14.7% and 12.5%) during the intensive phase were observed. This improvement remained constant in both groups after six months of maintenance therapy. The health-related quality of life (measured by the Lymphedema Questionnaire) similarly showed improvement in both groups, with a high level of treatment satisfaction. Conclusion: These results indicate that parallel (immediate and delayed) results may be obtained by CDT without the use of Vodder MLD and CB may be an essential part of lymphedema management.