title: Manual lymph drainage improving upper extremity edema and hand function in patients with systemic sclerosis in edematous phase.
abstract: OBJECTIVE
  In systemic sclerosis (SSc; scleroderma) patients in edematous phase, hand edema is often present. Manual lymph drainage (MLD) stimulates the lymphatic system and reduces edema. Our aim was to evaluate the efficacy of MLD in reducing edema and in improving functionality of the hands and perceived quality of life (QOL) in SSc patients in edematous phase.
  
  
  METHODS
  Of 35 SSc patients with edematous hands, 20 were treated with MLD according to the Vodder technique once a week for 5 weeks (intervention group), and 15 served as the observation group. Patients were evaluated at enrollment, at the end of treatment (T1), and after 9 weeks of followup (T2) by volumetric test (assessing hand volume), the Hand Mobility in Scleroderma (HAMIS) test, and 4 visual analog scales (VAS; scored 0-10) evaluating the perception of hand edema and pain and their interference on daily activities. QOL and disability were assessed by the physical synthetic index (PSI) and mental synthetic index (MSI) of the Short Form 36 (SF-36) and by the Health Assessment Questionnaire (HAQ).
  
  
  RESULTS
  In the intervention group, hand volume, the HAMIS test, and the 4 VAS were improved significantly at the end of treatment (P < 0.001). The results were maintained at T2 (P < 0.001). The HAQ and the PSI and MSI of the SF-36 also improved significantly at T1 (P < 0.001), but only PSI improvement was maintained at T2 (P < 0.001). In the observation group, no improvement at T1 and at T2 was observed.
  
  
  CONCLUSIONS
  In SSc, MLD significantly reduces hand edema and improves hand function and perceived QOL.
authors.affiliation: Careggi Hospital (Azienda Ospedaliero-Universitaria Careggi), University of Florence, Florence, Italy.
authors.forename: Susanna Maddali
authors.initials: SM
authors.lastname: Bongi
authors.forename: Angela
authors.initials: A
authors.lastname: Del Rosso
authors.forename: Mauro
authors.initials: M
authors.lastname: Passalacqua
authors.forename: Sara
authors.initials: S
authors.lastname: Miccio
authors.forename: Marco Matucci
authors.initials: MM
authors.lastname: Cerinic
mesh_terms: D000328:Adult; D004322:Drainage / Q000379:methods*; D004487:Edema / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006225:Hand; D006801:Humans; D008196:Lymph; D008405:Massage; D008875:Middle Aged; D009048:Motor Skills; D011788:Quality of Life; D012595:Scleroderma, Systemic / Q000150:complications* / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy; D016896:Treatment Outcome; D034941:Upper Extremity