Intermittent Pneumatic Compression Dosage for Adults and Children with Lymphedema: A Systematic Review.

BACKGROUND: Pneumatic compression has been used for more than 40 years in the management of lymphedema (LE). Modes of application have evolved with little consensus regarding optimal treatment parameters or dosage. The aim of this systematic review was to report the evidence for dosage of intermittent pneumatic compression (IPC) for people with LE and, particularly, that for upper versus lower limbs or child versus adult dosage. METHODS: Medline, Embase, CINAHL, PubMed, and Scopus were searched with terms, including LE and IPC devices, with no restriction on time. Other materials searched included reference lists of included articles. STUDY SELECTIONS: Systematic review registration: PROSPERO ID: CRD42017054338. Studies were assessed according to PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines and were excluded if they were not in English, not human, had physiological outcomes, or studied IPC in combination with other therapies. Quality appraisal, using the McMaster University Critical Review Tool, was undertaken by two researchers with differences resolved by a third. One hundred twenty-two full-text studies were screened for eligibility. RESULTS: Sixteen met inclusion criteria for final analysis. Of these, four were reported separately due to concurrent use of compression garments during the study period. One randomized controlled trial met the requirements for a level II (National Health and Medical Research Council) rating; the remainder were level III-2 and below. Devices applying compression via multichamber sleeves were more commonly used in the past 20 years, with a trend toward lower pressures and shorter treatment times compared with earlier studies. Little evidence exists for application of specific dosage of IPC for children or a particular limb. New devices utilizing lower pressures support home use and self-management of LE. CONCLUSION: Low-level evidence of moderate quality shows significant outcomes achieved with dosage times of 45-60 minutes, applying pressures between 30 and 60 mmHg in sequential IPC programs. Methodological limitations in most studies suggest caution in drawing conclusions.

Conservative management of lymphoedema in children: a systematic review.

PURPOSE: A systematic literature review was conducted to determine best practice conservative management of pediatric lymphoedema. METHOD: The PRISMA protocol was followed; a search of Ovid Medline, Cinahl and Scopus was conducted using the search terms children OR pediatric OR adolescent AND lymphoedema OR lymphedema. Studies about management or treatment of lymphoedema in children were included while studies about filariasis, imaging, pathology, secondary lymphoedema, surgical techniques, central lymphoedema and those with participants with a median age greater than 18 years were excluded. RESULTS: Of 738 possible studies identified, eight studies were eligible for inclusion in the review: four case reports, two retrospective service reviews and two prospective studies investigating different interventions. All studies were rated using the NHMRC hierarchy of evidence and appraised by both authors using the McMaster University Critical Review Form. Studies were of low quality with poor descriptions of management, small sample size, unclear and inconsistent methodology and irreproducible outcome measures. CONCLUSION: This review identified low level evidence to support the use of pneumatic compression in the management of pediatric lymphoedema. Further research is required to identify optimal parameters for application of pneumatic compression and to investigate the use of other interventions for conservative management of pediatric lymphoedema.