title: Effect of manual lymph drainage in addition to guidelines and exercise therapy on arm lymphoedema related to breast cancer: randomised controlled trial.
abstract: OBJECTIVE
  To determine the preventive effect of manual lymph drainage on the development of lymphoedema related to breast cancer.
  
  
  METHODS
  Randomised single blinded controlled trial.
  
  
  METHODS
  University Hospitals Leuven, Leuven, Belgium.
  
  
  METHODS
  160 consecutive patients with breast cancer and unilateral axillary lymph node dissection. The randomisation was stratified for body mass index (BMI) and axillary irradiation and treatment allocation was concealed. Randomisation was done independently from recruitment and treatment. Baseline characteristics were comparable between the groups.
  
  
  METHODS
  For six months the intervention group (n = 79) performed a treatment programme consisting of guidelines about the prevention of lymphoedema, exercise therapy, and manual lymph drainage. The control group (n = 81) performed the same programme without manual lymph drainage.
  
  
  METHODS
  Cumulative incidence of arm lymphoedema and time to develop arm lymphoedema, defined as an increase in arm volume of 200 mL or more in the value before surgery.
  
  
  RESULTS
  Four patients in the intervention group and two in the control group were lost to follow-up. At 12 months after surgery, the cumulative incidence rate for arm lymphoedema was comparable between the intervention group (24%) and control group (19%) (odds ratio 1.3, 95% confidence interval 0.6 to 2.9; P = 0.45). The time to develop arm lymphoedema was comparable between the two group during the first year after surgery (hazard ratio 1.3, 0.6 to 2.5; P = 0.49). The sample size calculation was based on a presumed odds ratio of 0.3, which is not included in the 95% confidence interval. This odds ratio was calculated as (presumed cumulative incidence of lymphoedema in intervention group/presumed cumulative incidence of no lymphoedema in intervention group)×(presumed cumulative incidence of no lymphoedema in control group/presumed cumulative incidence of lymphoedema in control group) or (10/90)×(70/30).
  
  
  CONCLUSIONS
  Manual lymph drainage in addition to guidelines and exercise therapy after axillary lymph node dissection for breast cancer is unlikely to have a medium to large effect in reducing the incidence of arm lymphoedema in the short term. Trial registration Netherlands Trial Register No NTR 1055.
authors: Department of Rehabilitation Sciences, Katholieke Universiteit Leuven and Department of Physiotherapy, University Hospitals Leuven, Leuven, Belgium. nele.devoogdt@uzleuven.be
authors: Nele
authors: N
authors: Devoogdt
authors: Marie-Rose
authors: MR
authors: Christiaens
authors: Inge
authors: I
authors: Geraerts
authors: Steven
authors: S
authors: Truijen
authors: Ann
authors: A
authors: Smeets
authors: Karin
authors: K
authors: Leunen
authors: Patrick
authors: P
authors: Neven
authors: Marijke
authors: M
authors: Van Kampen
mesh_terms: D000328:Adult; D000368:Aged; D001530:Belgium / Q000453:epidemiology; D001943:Breast Neoplasms / Q000150:complications / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008196:Lymph; D008198:Lymph Nodes / Q000601:surgery*; D008209:Lymphedema / Q000453:epidemiology / Q000517:prevention & control*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016037:Single-Blind Method