Advanced pneumatic compression device with simulated manual lymphatic drainage in rehabilitation of patients with breast cancer related lymphedema: a review

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Abstract

Introduction. Improvements in oncological treatment strategies have led to improved survival rates for breast cancer patients, which is responsible for the increasing number of patients with Breast Cancer Related Lymphedema (BCRL). The search for effective complementary interventions, such as modified Intermittent Pneumatic Compression (IPC) programmes, that can be incorporated into stand-alone treatment programmes for patients with BCRL, including for use at home, is relevant.

Aim. To study the efficacy of different modern intermittent pneumatic compression techniques in BCRL based on the analysis of systematic reviews and meta-analyses of randomized controlled trials (RCTs).

Materials and methods. The search was conducted in the databases eLIBRARY.RU, Scopus, PubMed, Web of Science, and PEDro using the keywords “lymphedema”, “upper extremities”, “breast cancer”, and “variable pneumocompression” from 1998 to 2024. A total of 53 sources were selected for March 2024, of which 17 were systematic reviews, one was a Cochrane review, four were practice guidelines and 31 were RCTs (58.49 %).

Results and discussion. The systematic reviews analyzed were unable to demonstrate convincingly the added value of manual lymphatic drainage (MLD) as part of a Complex Decongestive Therapy (CDT). Therefore, we analyzed the results of RCTs on the use of standard and modified IPC programmes that can be included in stand-alone patient treatment programmes, including those for home use. The efficacy of IPC is supported by the results of a large number of publications evaluating the efficacy of IPC in BCRL. The studies included the following interventions: a combination of CDT and IPC or IPC alone, with the pressure used for IPC ranging from 40 to 60 mmHg and the duration of the IPC procedure varying from 30 minutes to 2 hours. The results showed that the adjunctive use of IPC to CDT could alleviate lymphedema, but there was no significant difference between conventional treatment of lymphedema with and without pneumatic pump. It was found that during the intensive phase (phase I) of treatment, CDT combined with IPC provided significantly greater mean volume reduction than CDT alone (43.1 % vs. 37.5 %; p = 0.036). In the few studies conducted, the use of the Advanced Pneumatic Compression Device (APCD) technique with simulated MLD was found to be superior to the standard ADPC technique and more adaptable to long-term home use in patients with BCRL.

Conclusion. Thus, analysis of published sources showed that CDT combined with IPC is more effective in reducing excess volume and excess circumference of the upper limb with lymphedema during a relatively short follow-up period (up to 8 weeks after the end of physiotherapy). In addition, the combined application of CDT + IPC can improve the shoulder mobility in four functional positions: extension, extension, flexion and external rotation, which can be the basis for periodic continuous supportive lymphatic drainage treatment to maintain the anti-edema effect. It has also been shown that the use of the APCD technique with simulated MLD is superior to IPC and more adapted to long-term home use in patients with BCRL.

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About the authors

Tatiana V. Apkhanova

National Medical Research Center for Rehabilitation and Balneology

Author for correspondence.
Email: apkhanovatv@nmicrk.ru
ORCID iD: 0000-0003-3852-2050

D.Sc. (Med.), Chief Researcher, Department of Physiotherapy and Reflexotherapy

Russian Federation, Moscow

Tatiana V. Konchugova

National Medical Research Center for Rehabilitation and Balneology

Email: apkhanovatv@nmicrk.ru
ORCID iD: 0000-0003-0991-8988

D.Sc. (Med.), Professor, Chief Researcher of the Department of Physiotherapy and Reflexotherapy

Russian Federation, Moscow

Olga M. Musaeva

National Medical Research Center for Rehabilitation and Balneology

Email: apkhanovatv@nmicrk.ru
ORCID iD: 0000-0001-9146-0966

Senior Researcher, Somatic Rehabilitation, Active Longevity and Reproductive Health Department

Russian Federation, Moscow

Valentina A. Morgunova

National Medical Research Center for Rehabilitation and Balneology

Email: apkhanovatv@nmicrk.ru
ORCID iD: 0000-0001-5791-2770

Ph.D. (Med.), Researcher of the Department of Physiotherapy and Reflexotherapy

Russian Federation, Moscow

Valeriia A. Vasileva

National Medical Research Center for Rehabilitation and Balneology

Email: apkhanovatv@nmicrk.ru
ORCID iD: 0000-0002-6526-4512

Ph.D. (Med.), Senior Researcher, Somatic Rehabilitation, Active Longevity and Reproductive Health Department

Russian Federation, Moscow

Olesya A. Shcherbakova

National Medical Research Center for Rehabilitation and Balneolog

Email: apkhanovatv@nmicrk.ru
ORCID iD: 0009-0003-2831-8192

Ph.D. (Med.), Deputy Chief Physician for Medical Affairs

Russian Federation, Moscow

Lev G. Agasarov

National Medical Research Center for Rehabilitation and Balneology

Email: apkhanovatv@nmicrk.ru
ORCID iD: 0000-0001-5218-1163

D.Sc. (Med.), Professor, Chief Researcher

Russian Federation, Moscow

Kristina M. Nazarova

National Medical Research Center for Rehabilitation and Balneology

Email: apkhanovatv@nmicrk.ru
ORCID iD: 0009-0000-2590-6755

Ph.D. (Med.), Researcher, Somatic Rehabilitation, Active Longevity and Reproductive Health Department

Russian Federation, Moscow

Larisa A. Marchenkova

National Medical Research Center for Rehabilitation and Balneology

Email: apkhanovatv@nmicrk.ru
ORCID iD: 0000-0003-1886-124X

D.Sc. (Med.), Docent, Head of the Research Department, Head of the Department of Somatic Rehabilitation, Reproductive Health and Active Longevity, Professor at the Department of Restorative Medicine, Physical Therapy and Medical Rehabilitation, National Medical Research Center for Rehabilitation and Balneology

Russian Federation, Moscow

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