title: A systematic review of the evidence for complete decongestive therapy in the treatment of lymphedema from 2004 to 2011.
abstract: OBJECTIVE
  To critically analyze the contemporary published research that pertains to the individual components of complete decongestive therapy (CDT), as well as CDT as a bundled intervention in the treatment of lymphedema.
  
  
  METHODS
  Publications were retrieved from 11 major medical indices for articles published from 2004-2010 by using search terms for lymphedema and management approaches. Literature archives of the authors and reference lists were examined through 2011.
  
  
  METHODS
  A research librarian assisted with initial literature searches by using search terms used in the Best Practice for the Management of Lymphoedema, plus expanded terms, for literature related to lymphedema. Authors sorted relevant literature for inclusion and exclusion; included articles were sorted into topical areas for data extraction and assessment of level of evidence by using a published grading system and consensus process. The authors reviewed 99 articles, of which 26 met inclusion criteria for individual studies and 1 case study did not meet strict inclusion criteria. In addition, 14 review articles and 2 consensus articles were reviewed.
  
  
  METHODS
  Information on study design and/or objectives, participants, outcomes, intervention, results, and study strengths and weaknesses was extracted from each article. Study evidence was categorized according to the Oncology Nursing Society Putting Evidence into Practice level of evidence guidelines after achieving consensus among authors.
  
  
  RESULTS
  Levels of evidence were only moderately strong, because there were few randomized controlled trials with control groups, well-controlled interventions, and precise measurements of volume, mobility and/or function, and quality of life. Treatment interventions were often bundled, which makes it difficult to determine the contribution of each individual component of treatment to the outcomes achieved.
  
  
  CONCLUSIONS
  CDT is seen to be effective in reducing lymphedema. This review focuses on original research about CDT as a bundled intervention and 2 individual components, manual lymph drainage and compression bandages. Additional studies are needed to determine the value and efficacy of the other individual components of CDT.
authors.affiliation: Lymphedema Therapy and The Boris-Lasinski School, Woodbury, NY(⁎).
authors.forename: Bonnie B
authors.initials: BB
authors.lastname: Lasinski
authors.forename: Kathryn
authors.initials: K
authors.lastname: McKillip Thrift
authors.forename: Decourcy
authors.initials: D
authors.lastname: Squire
authors.forename: Melanie K
authors.initials: MK
authors.lastname: Austin
authors.forename: Kandis M
authors.initials: KM
authors.lastname: Smith
authors.forename: Ausanee
authors.initials: A
authors.lastname: Wanchai
authors.forename: Jason M
authors.initials: JM
authors.lastname: Green
authors.forename: Bob R
authors.initials: BR
authors.lastname: Stewart
authors.forename: Janice N
authors.initials: JN
authors.lastname: Cormier
authors.forename: Jane M
authors.initials: JM
authors.lastname: Armer
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D008209:Lymphedema / Q000628:therapy*; D026741:Physical Therapy Modalities