title: Lymphoedema therapy in breast cancer patients: a systematic review on effectiveness and a survey of current practices and costs in Finland.
abstract: BACKGROUND
  This study systematically evaluates the effects and harms of physiotherapy methods and explores current treatment practices and costs in relation to lymphoedema in breast cancer patients in Finland.
  
  
  METHODS
  A systematic review of randomized controlled trials (RCTs) on physiotherapy interventions for breast cancer patients with lymphoedema. A postal survey to lymph therapists, a telephone and register survey for therapy costs.
  
  
  RESULTS
  We identified 14 RCTs, of which two had moderate and the others high risk of bias. There was moderate evidence that compression bandages decreased lymphoedema, and that pneumatic pumps had no effect on lymphoedema. In Finland lymph therapy practice is a combination of manual lymph drainage (MLD), compression bandages, therapeutic exercises and guidance for self-treatment, with an annual average cost of EUR 799 per patient.
  
  
  CONCLUSIONS
  Compression bandages are likely to reduce upper limb lymphoedema in breast cancer patients. Evidence on other physiotherapy methods and their combinations is limited due to the poor quality of the trials. No evidence was found on any outcomes other than upper limb volume. We call for well-designed trials with patient-related outcomes on the effectiveness of MLD, guidance and therapeutic exercises.
authors.affiliation: Satakunta University of Applied Sciences, Research and Development, Pori, Finland. anne.karki@samk.fi
authors.forename: Anne
authors.initials: A
authors.lastname: Kärki
authors.forename: Heidi
authors.initials: H
authors.lastname: Anttila
authors.forename: Tiina
authors.initials: T
authors.lastname: Tasmuth
authors.forename: Ulla-Maija
authors.initials: UM
authors.lastname: Rautakorpi
mesh_terms: D001943:Breast Neoplasms / Q000191:economics* / Q000628:therapy*; D005260:Female; D005387:Finland; D006306:Health Surveys; D006801:Humans; D008209:Lymphedema / Q000191:economics* / Q000628:therapy*; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome