Abstract
PurposeTo assess the impact of manual lymphatic drainage (MLD) on the health-related quality of life (HRQoL) of adults with lymphoedema or mixed oedema, through a systematic review of randomised controlled trials (RCTs).MethodsMEDLINE, EMBASE, PsycINFO, CENTRAL, the Cochrane Database of Systematic Reviews and ClinicalTrials.gov were searched to identify RCTs evaluating HRQoL after a MLD intervention compared to non-MLD interventions (PROSPERO 2016:CRD42016042255). We extracted the effect of the interventions on the HRQoL (primary outcome) as well as data on volume and functional changes, and adverse events when available (secondary outcomes).ResultsEight studies were eligible. The studies were heterogeneous in the aetiology of oedema, schemes of MLD applied, additional treatments offered with MLD, length of follow-up, instruments used to assess HRQoL and interventions offered to the control group. Five studies included patients with breast cancer-related arm lymphoedema; one study reported increased HRQoL among patients randomised to the MLD group. The two RCTs that involved patients with leg mixed oedema due to chronic venous insufficiency did not find between-group differences in the overall HRQoL. One trial included patients with hand oedema from systemic sclerosis and showed higher HRQoL in the group that received MLD. No studies reported reductions in HRQoL, or severe adverse events after MLD. The small numbers of patients analysed in all studies may have resulted in lack of power to detect between-group differences in HRQoL.ConclusionsThe effect of MLD on the HRQoL of patients with chronic oedema is unclear.
Highlights
Lymphoedema is a chronic abnormal swelling of a limb or quadrant of the trunk due to accumulation of protein-rich fluids in the interstitial tissue, caused by incapacity of the lymphatic system to effectively distribute lymph [1, 2]
We aimed to evaluate the impact of manual lymphatic drainage (MLD) on the healthrelated quality of life (HRQoL) of adult patients with lymphoedema or mixed oedema, irrespective of the oedema aetiology or location, through a systematic review of randomised controlled trials (RCTs)
RCTs including patients with lymphoedema or mixed oedema, in which MLD or complete decongestive therapy (CDT) was the primary intervention given to the intervention group (IG) and not to the control group (CG), and providing results for HRQoL, were eligible
Summary
Lymphoedema is a chronic abnormal swelling of a limb or quadrant of the trunk due to accumulation of protein-rich fluids in the interstitial tissue, caused by incapacity of the lymphatic system to effectively distribute lymph [1, 2]. Chronic oedema may have severe physical and psychological consequences for patients, including impaired. Guidelines for the management of breast cancer-related lymphoedema (BCRL) recommend the use of complete decongestive therapy (CDT) [1, 2], which includes manual lymphatic drainage (MLD), self-care (e.g. healthy diet, skin care), physical exercise and compression therapy with bandaging or garments [14]. MLD consists of special massage techniques with gentle tissue pressure to promote lymph flow [14]. It is considered effective in reducing lymphoedema [17]. Besides understanding the impact of MLD on clinical endpoints (e.g. changes in volume or appearance of ulceration), understanding the MLD impact on patients’ perception, including the healthrelated quality of life (HRQoL) is essential to develop comprehensive therapy concepts
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