A Cochrane review [Abstract] 2 included 6 trials with a total of 208 patients to assess the efficacy and safety of manual lymphatic drainage (MLD) for breast-cancer related lymphedema (BCRL). MLD + compression bandaging versus compression bandaging alone showed reductions of 30% to 38.6% for compression bandaging alone, and an additional 7.11% reduction for MLD (MD 7.11%, 95% CI 1.75% to 12.47%; 2 RCTs; n=83, P=0.06).
MLD + standard physiotherapy versus standard physiotherapy showed improvements in both groups from baseline but no significant between-groups differences (1 trial, n = 42).
Three trials compared MLD + compression therapy to non-MLD treatment + compression therapy. In a study comparing compression sleeve + MLD to compression sleeve + pneumatic pump, volume reduction was larger in MLD group (MD 47.00 mL, 95% CI 15.25 mL to 78.75 mL; 1 RCT; n = 24). Edema volume was smaller in the MLD group in another trial comparing compression sleeve plus MLD to compression sleeve plus self-administered simple lymphatic drainage (MD -230.00 mL, 95% CI -450.84 mL to -9.16 mL; 1 RCT; n = 31). A third trial compared MLD + compression bandaging versus self-administered drainage + compression bandaging; no difference in volume reduction was detected (MD 11.80%, 95% CI -2.47% to 26.07%, n = 28).
A systematic review and meta-analysis 3 included 10 RCTs assessing manual lymphatic drainage (MLD) in breast cancer-related lymphedema (BCRL) patients. Statistically significant improvements were found on the incidence of lymphedema (RR = 0.58, 95% CI 0.37 to 0.93, P =.02) and pain intensity (SMD = -0.72, 95% CI -1.34 to -0.09, P = .02). The effects of MLD on volumetric changes of lymphedema and quality of life were not statistically significant.
Comment: The quality of evidence is downgraded by study quality (poor methodological quality in original studies) and and by imprecise results (limited study size).
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