Randomized, Controlled, Crossover Trial Comparing Immediate Effects of Components of Complex Decongestive Therapy in Lower-limb Lymphedema Patients

Abstract

Objectives: Complex decongestive therapy is recommended as a standard treatment for lymphedema. It comprises skin care, manual lymphatic drainage (MLD), multilayered compression bandaging, and active exercise with compression therapy (AECT). Lower-limb elevation (LLE) is also widely used for adjunct treatment of lower-limb lymphedema (LLL). This study compared the immediate effects of each treatment component (MLD, AECT, and LLE) on LLL.

Methods: Of the 24 participants who had developed LLL after a gynecological cancer surgery, 22 completed MLD, AECT, and LLE interventions, each performed for 30 min in a randomized crossover design. The main outcome was lower-limb volume as assessed by perometry. Other outcome measures included skin symptoms (stiffness and pitting, observed through palpation) and pain and heaviness (rated using a visual analog scale). Relaxation and improvement of lower-limb discomfort were evaluated quantitatively after the interventions. Statistical analyses of the main outcome used analysis of variance with a linear mixed-effects model. Subanalysis was performed on cases where the volume difference between the affected and unaffected limb exceeded 10% (severe cases).

Results : Lower-limb volume decreased significantly after all interventions (P <0.001). There was no significant difference between the three interventions across all cases (n = 22). In the subanalysis of severe cases (n = 19), lower-limb volume was significantly reduced after AECT relative to LLE.

Conclusions: Our results showed that lower-limb volume significantly improved after each intervention. AECT was more effective than LLE for patients with more severe edema.