Adjustable Compression Wraps (ACW) vs. Compression Bandaging (CB) in the Acute Phase of Breast Cancer-Related Arm Lymphedema Management-A Prospective Randomized Study.

The objective of this study is to compare the effectiveness, comfort and possibilities of the self-application of adjustable compression wraps (ACW) with compression bandaging (CB) in the acute phase of treatment in advanced upper-limb lymphedema. In total, 36 patients who fulfilled the admission criteria were randomly assigned into ACW-Group (18 patients), or CB-Group (18 patients). Treatment in both groups lasted for two weeks. In the first, all patients were educated in applying adjustable compression wraps (ACW-Group) or self-bandaging (CB-Group) and treated by experienced physiotherapists. In the second week, the use of ACW and CB was continued by the patients themselves at home. In both groups, a clinically significant reduction in the affected limb volume was found after the first week (p < 0.001). A further decrease in the affected limb volume within the second week was noted only in the CB-Group (p = 0.02). A parallel trend was found in the percentage reduction in the excess volume after one and two weeks of compression therapy. Within two weeks, both groups achieved a significant improvement in decreasing lymphedema-related symptoms, but women from the ACW-Group reported complications related to carrying out compression more frequently (p = 0.002). ACW can reduce lymphedema and disease-related symptoms, but based on the results it is difficult to recommend this method as an alternative option in the acute phase of CPT among women with advanced arm lymphedema.

Early Detection of Breast Cancer-Related Lymphedema in COVID-19 Pandemic.

Background: This study aimed at presenting a prospective surveillance model of care delivered at home for women qualified for surgery due to breast cancer under the epidemic-related restrictions. Methods and Results: Women (age ≥18 years, diagnosed with breast cancer, no clinical features of upper limbs lymphedema, and a volume difference between the limbs <5%, not using any prophylactic compression products) will be provided with comprehensive education in the field of self-measurements and lymphedema prevention. The outcome measures include limb volume (circumferential measurements with a tape at 4 cm intervals), simplified protocol of three measurement points combined with the symptoms monitoring (according to the physical section of Lymphedema Quality of Life Inventory [LyQLI]). We propose a new calculation method as the RACI (relative arm circumference increase) in accordance with previous research-RAVI (relative arm volume increase) and the new proposal-the RACD (relative arm circumference difference). According to cylinder formula it can be calculated that 5% increase in limb volume results in ∼2% change in RACI. Regular appointments will be planned at 3, 6, 9, and 12 months after the enrollment. Additional urgent appointments will be arranged after the home or phone "red flags" (an increase circumference by ≥2%, positive pitting test, and any new symptoms) detection. We hypothesize that performing only three measurements combined with the typical symptoms monitoring would be accurate for lymphedema diagnosis based on the RAVI of ≥5%. Moreover, RACI/RACD increments combined with positive symptoms would correlate with RAVI. Conclusions: The new proposal of protocol can be the optimal solution in COVID-19 pandemic.

Three-year follow-up of the compression use in lower limb edema during pregnancy: A case report.

Lower limb edema with its accompanying subjective ailments has been increasingly frequent in gravid women and in the postpartum period. The management is essentially non-interventional based on compression therapy (CT) with physical exercise adapted to the severity of venous disease and edema. A case of lower limb edema in a woman in the thirty third week of pregnancy was described. CT including compressive bandaging (CB) by short-stretch bandage and compression garments (CG) with physical activity was applied. Edema volume reduction, changes in consistency from hard to mild in palpation and reduction of accompanying ailments by use of CB after two weeks were observed. Further improvement by use of CG before and after delivery, and 3 years later was confirmed. Compression and physical exercise have a positive impact on edema reduction and leg symptoms intensity during pregnancy and should be recommended.

Lay Caregivers Education in Multicomponent Compression Bandaging in Obese Patients with Lower Limb Edema: A Case-Control Pilot Study.

Background: A report on the usefulness of the instruction of lay carers in multilayer short-stretch compression bandaging within the initial intensive phase physical treatment of mixed-etiology chronic lower limb edema. Methods and Results: In a group of adult obese patients (including 24 females) with venous insufficiency and chronic bilateral lower limb edema, and without a history of physical therapy, 20 (ambulatory managed) were bandaged once daily (four layers, short stretch with cotton tube, and foam padding underneath) for 3 weeks (Monday-Friday) by skilled physiotherapists, and in 20 cases (education group, EG), the patients' lay carers were educated by these physiotherapists according to the same regime during one session. The outcome measures included limb volume (the method of circumference measurement with a tape at 4 cm intervals) after 1, 3, and 6 months, the time to reach the maintenance phase, the frequency of complementary bandaging during this phase, and the sense of self-efficacy (General Self-Efficacy scale, GSEs). No significant differences were noted between the two groups in the baseline measurements of age, body mass, and limb volume. The carers were able to apply compression bandages in all cases during the observation period. The time to reach the maintenance phase was longer in EG (6 vs. 1 weeks; p < 0.001). A similar median reduction in edema volume was observed at the end of the bandaging period, which continued for 3 and 6 months. It was only in EG that further improvement between 1 and 3 months was observed (p = 0.008). All participants represented an equally high optimistic sense of personal competence (GSEs). Conclusions: The instruction of lay carers in bandaging may provide a simple clinically effective solution for lower limb edema management, thus lowering its costs.

Do Compression Sleeves Reduce the Incidence of Arm Lymphedema and Improve Quality of Life? Two-Year Results from a Prospective Randomized Trial in Breast Cancer Survivors.

BACKGROUND: In a previous randomized controlled trial it has been demonstrated that arm compression sleeves worn immediately after breast cancer surgery, including axillary lymph node removal in addition to physical therapy are able to reduce the occurrence of early postoperative swelling and of arm lymphedema up to 1 year and to improve quality of life. The aim of the present investigation was to check the further development of the arm swelling in patients using compression sleeves or not, and to compare the quality of life in women treated due to breast cancer 2 years after surgery. MATERIALS AND METHODS: Twenty from originally 23 patients who still wore their compression sleeves (15 mmHg) and 21 from 22 patients who had been randomized into the control group without compression could be seen after one more year. Arm volume measurements were performed and quality of life (QLQ-C30 and QLQ-BR23 questionnaires) was assessed. RESULTS: Three from 20 patients in the compression group (CG) and 6 from 21 without compression showed arm lymphedema, defined by an increase of the arm volume exceeding 10% compared with the preoperative values. Significant improvement of several quality of life parameters were found in the CG. CONCLUSION: Light compression sleeves worn for 2 years are not only able to reduce the incidence of early postoperative edema and of lymphedema, but also lead to a significant improvement of important quality-of-life parameters like physical functioning, fatigue, pain, arm and breast symptoms, and future perspectives.

Physical Activity With and Without Arm Sleeves: Compliance and Quality of Life After Breast Cancer Surgery-A Randomized Controlled Trial.

BACKGROUND: After breast cancer surgery patients are at higher risk of lymphedema development and decreasing physical activity (PA), as well as decreasing health-related quality of life (HRQOL). The aim of the study was to compare the level of PA and HRQOL in women after breast cancer surgery using light arm compression with women not using compression 1 year after oncological treatment. METHODS AND RESULTS: Forty-five women were preoperatively randomly assigned to a compression group (CG, n = 23) or to no compression group (NCG, n = 22). Arm volumes were measured before surgery and 12 months thereafter. The CG received circular-knit sleeves in compression class 1 for daily wearing in the postoperative period up to 1 year. Both groups underwent a standardized physical exercise program. PA with the short version of International Physical Activity Questionnaire (IPAQ), compliance, and HRQOL by EORTC QLQ-C30 and QLQ-BR23 questionnaires was assessed in both groups 1 year after surgery. After 1 year observation the CG showed significantly lower mean affected arm volume compared to NCG. The total PA (calculated as the sum of vigorous moderate exercises and walking) was markedly higher within the CG, with no difference in particular IPAQ items. There were no correlations between reported PA items and observed arm/edema volume or body mass index changes. The QLQ-BR23 revealed only better sexual functioning (p = 0.014) and greater upset by hair loss in NCG (p = 0.01). CONCLUSIONS: The available data indicate that wearing compression sleeves neither interfere with the level of PA nor decrease quality of life 1 year after breast cancer surgery.

Preventing Early Postoperative Arm Swelling and Lymphedema Manifestation by Compression Sleeves After Axillary Lymph Node Interventions in Breast Cancer Patients: A Randomized Controlled Trial.

CONTEXT: Breast cancer-related lymphedema (LE) remains one of the major long-term complications after surgery. Many reports showed the effectiveness of compression in breast cancer-related LE treatment, but randomized controlled trials evaluating compression garments for postoperative prevention are lacking. OBJECTIVES: The aim of the study was to evaluate the potential role of light arm compression sleeves for reducing the incidence of early postoperative swelling and of breast cancer-related arm LE. METHODS: A total of 45 women were pre-operatively randomly assigned to a group with compression of circular-knit sleeves in compression class I (15-21 mm Hg) for daily wearing (compression group [CG]; n = 23) or to a control group without compression (no CG, n = 22). Both groups underwent a standardized physical exercise program. Arm volumes were measured before surgery and one, three, six, nine, and 12 months thereafter. RESULTS: At one month, postoperative swelling was reduced only in CG. After 12 months, the average change of excess volumes (edema) reached -67.6 mL in the CG vs. +114.5 mL in the no CG (P < 0.001). Significantly less edema was seen in the CG after three, six, nine, and 12 months. No significant difference between groups in health-related quality of life (measured by EORTC QLQ-C30) was observed. CONCLUSION: Fifteen to 21 mm Hg compression sleeves in combination with physical activity may be a safe and efficient option to prevent postsurgical arm swelling and development of LE.

Risk Factors Related to Lower Limb Edema, Compression, and Physical Activity During Pregnancy: A Retrospective Study.

OBJECTIVE: The aim of the article was to assess risk factors and to analyze methods applied in the prevention and treatment of lower limb edema in pregnant women with a particular focus on compression therapy and exercise. MATERIALS AND METHODS: Fifty-four women during the early 24-hour period following delivery were assigned to two groups-either to a group with swellings of lower limbs during pregnancy, located mostly in the region of feet and lower legs (Group A, n = 42), or to a group without edema (Group B, n = 12). Two subgroups, namely A1 and A2, were additionally distinguished in Group A. Compression therapy that consisted in wearing circular-knit compression garments, usually at compression level 1 (ccl1), with three cases of compression level 2 (ccl2) was applied only in Group A1 (n = 18 women). RESULTS: The analysis has led to a conclusion that there is a link between the occurrence of edema during pregnancy on the one hand and the pregravidity episodes of venous conditions (vascular insufficiency and thrombosis, p < 0.05) and the lack of physical exercise during pregnancy (p = 0.01) on the other hand. However, interdependence between the occurrence of edema and the number of times a female had been pregnant, physical activity before gravidity, or body mass index before gravidity has not been identified. Only 33% of the analyzed women applied compression therapy during pregnancy; a half of them continued to apply compression during the postpartum period. CONCLUSIONS: Compression therapy in combination with proper physical exercises appears to be an effective means to prevent and treat venous thrombosis and lower limb edema in pregnant women, yet further research in line with the principles of evidence-based medicine is required.

Effects of kinesio taping on anaerobic power recovery after eccentric exercise.

The aim of the study was to evaluate the effectiveness of kinesio taping (KT) in anaerobic power recovery after eccentric exercise. The study was carried out on 10 healthy men. The participants performed two 60-min downhill runs with a constant intensity. Peak anaerobic power (PP) and mean power (MP) were measured before and five times after eccentric exercise. Anaerobic power was evaluated with the Maximal Cycling Sprint Test. After the downhill run, passive recovery (PR) and KT (lymphatic application) were applied in random order. A significant decrease in PP and MP was observed at least for 24 h after PR, compared to baseline. After the KT application 24 h after eccentric exercises, anaerobic power was already similar to the baseline measurement. The application of KT significantly improved anaerobic power recovery time after eccentric exercise compared to the period of passive rest immediately prior to testing.

Complex Decongestive Lymphatic Therapy With or Without Vodder II Manual Lymph Drainage in More Severe Chronic Postmastectomy Upper Limb Lymphedema: A Randomized Noninferiority Prospective Study.

CONTEXT: Complex decongestive lymphatic therapy (CDT) has been the method of choice in conservative management of lymphedema. Although effective, it is time consuming and manual lymph drainage (MLD) usually requires skilled therapists. OBJECTIVES: The purpose of this study was to compare the reduction in edema volume in more advanced (≥20% limb volume difference) postmastectomy arm lymphedema achieved by compression bandaging (CB) and physical exercises vs. the same management augmented by an additional 30 minutes of MLD (Vodder II method). METHODS: Sixty postmastectomy women were randomly assigned to either the CB group or the CDT group. Of those, 51 women (26 within the CB group) completed 26 weeks of therapy (two weeks of the intensive phase and six months of the maintenance phase). RESULTS: A decrease of limb volume (15.6% in the CB group and 13.8% in the CDT group), edema volume (47.2% and 47.4%, respectively), and limb-related volume change (14.7% and 12.5%) during the intensive phase were observed. This improvement remained constant in both groups after six months of maintenance therapy. The health-related quality of life (measured by the Lymphedema Questionnaire) similarly showed improvement in both groups, with a high level of treatment satisfaction. CONCLUSION: These results indicate that parallel (immediate and delayed) results may be obtained by CDT without the use of Vodder MLD and CB may be an essential part of lymphedema management.

Five-year assessment of maintenance combined physical therapy in postmastectomy lymphedema.

BACKGROUND: Combined physical therapy (CPT) is the treatment of choice for patients with lymphedema. Intensive stage CPT (I-CPT) results in a substantial reduction of the size of lymphedema, while the second stage CPT (M-CPT) maintains the achieved result for many years. AIM: The article analyses the outcome M-CPT for 5 years in patients with lymphedema after mastectomy. METHODS: Forty patients had regularly been attending follow-up appointments every six months for five years (Group A). Out of the group of patients who had not been reporting for follow-up, twenty women accepted an invitation for assessment (Group B); none of them complied with the prescribed compression therapy. All patients were submitted to I-CPT and patients from group A completed M-CPT comprising compression garments and an individual program of physical exercises. RESULTS: During five-year M-CPT, the difference in limb volumes (Vo), relative size of edema (Vor) reduction achieved after I-CPT was maintained in Group A, while in Group B a considerable increase of Vo by 14% was noted. Ultimately lymphedema in these patients was more pronounced than before their physical therapy had commenced. For 40 women using compression sleeves the mean Suitability Score System was 8.3 points on maximum 11-point scale, for 15 patients wearing additional compression gloves, the mean score was 4.3 points on maximum 5 points. CONCLUSIONS: The reduction of lymphedema achieved during I-CPT can be retained during M-CPT when the patient systematically attends follow-up examinations, applies compression therapy, and follows the therapy instructions. Non-compliance is followed by a worsening of lymphedema.

Assessment of knowledge of cancer and lymphoedema among breast cancer survivors.

AIM: To evaluate the knowledge of breast cancer and lymphoedema symptoms among mastectomy survivors. MATERIAL AND METHODS: The research was carried out in the Centre of Oncology Branch in Cracow. The survey comprised 60 hospitalized patients as well as 30 healthy subjects from the Malopolska region. The scientific method used was a specially designed questionnaire. RESULTS: Women with a history of cancer demonstrate a health-oriented approach. The subjects known as the experimental group perform breast self-examinations, regularly visit a gynaecologist, are aware of the most severe mastectomy complication - lymphoedema, and recognize the impact of physical activity on it. Breast cancer operation survivors have a good knowledge of breast cancer and lymphoedema, however, existing shortcomings in practical issues are worrying. On the contrary, the control group neglects regular check-ups, evaluates its own knowledge as negligible and, most surprisingly, is not interested in the subject of breast cancer and lymphoedema, even though the subjects of the group believe that arm swelling is connected to all types of breast cancer surgeries. CONCLUSIONS: Breast cancer survivors have a good knowledge of their disorder but are still lacking some essential information. Respondents from the control group have a limited knowledge in the field of cancer and lymphoedema, are not interested in breast cancer matters and are not encouraged by gynaecologists to perform breast self-examinations. Educational prevention programs should develop a health-oriented approach among all women and emphasize their basic role in therapy.