Five-year assessment of maintenance combined physical therapy in postmastectomy lymphedema.

Abstract

Combined physical therapy (CPT) is the treatment of choice for patients with lymphedema. Intensive stage CPT (I-CPT) results in a substantial reduction of the size of lymphedema, while the second stage CPT (M-CPT) maintains the achieved result for many years. The article analyses the outcome M-CPT for 5 years in patients with lymphedema after mastectomy. Forty patients had regularly been attending follow-up appointments every six months for five years (Group A). Out of the group of patients who had not been reporting for follow-up, twenty women accepted an invitation for assessment (Group B); none of them complied with the prescribed compression therapy. All patients were submitted to I-CPT and patients from group A completed M-CPT comprising compression garments and an individual program of physical exercises. During five-year M-CPT, the difference in limb volumes (Vo), relative size of edema (Vor) reduction achieved after I-CPT was maintained in Group A, while in Group B a considerable increase of Vo by 14% was noted. Ultimately lymphedema in these patients was more pronounced than before their physical therapy had commenced. For 40 women using compression sleeves the mean Suitability Score System was 8.3 points on maximum 11-point scale, for 15 patients wearing additional compression gloves, the mean score was 4.3 points on maximum 5 points. The reduction of lymphedema achieved during I-CPT can be retained during M-CPT when the patient systematically attends follow-up examinations, applies compression therapy, and follows the therapy instructions. Non-compliance is followed by a worsening of lymphedema.