title: A randomized, controlled, parallel-group clinical trial comparing multilayer bandaging followed by hosiery versus hosiery alone in the treatment of patients with lymphedema of the limb.
abstract: BACKGROUND
  Multilayered, low stretch bandages (MLB) combined with exercises, skin care, and manual lymphatic drainage therapy are recommended as an intensive phase of treatment for lymphedema patients. The relative efficacy of each of the components of this comprehensive treatment program have not been determined. This study aimed to compare the effect of multilayer bandaging as an initial phase of lymphedema treatment followed by elastic hosiery versus hosiery alone.
  
  
  METHODS
  A randomized, controlled, parallel-group trial was undertaken in the setting of the Lymphedema Clinic, The Royal Marsden Hospital, London. Ninety women with unilateral lymphedema (of the upper or lower limbs) were enrolled in the study. The interventions consisted of 18 days of multilayer bandaging followed by elastic hosiery or hosiery alone, each for a total period of 24 weeks. The main outcome measure was the percentage reduction in excess limb volume.
  
  
  RESULTS
  The reduction in limb volume by MLB followed by hosiery was approximately double that from hosiery alone and was sustained over the 24-week period. The mean overall percentage reduction at 24 weeks was 31% (n = 32) for MLB versus 15.8% (n = 46) for hosiery alone, for a mean difference of 15. 2% (95% confidence interval, 6.2-24.2) (P = 0.001).
  
  
  CONCLUSIONS
  Multilayer bandaging as an initial phase of treatment for lymphedema patients, followed by hosiery, achieves greater and more sustained limb volume reduction than hosiery alone.
authors.affiliation: Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom.
authors.forename: C M
authors.initials: CM
authors.lastname: Badger
authors.forename: J L
authors.initials: JL
authors.lastname: Peacock
authors.forename: P S
authors.initials: PS
authors.lastname: Mortimer
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm / Q000473:pathology; D001458:Bandages; D003020:Clothing; D005260:Female; D006801:Humans; D007866:Leg / Q000473:pathology; D008209:Lymphedema / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D016896:Treatment Outcome