Listed in Issue 199


BONGI and COLLEAGUES, Careggi Hospital (Azienda Ospedaliero-Universitaria Careggi), University of Florence, Florence, Italy evaluated the efficacy of manual lymph drainage (MLD) in the treatment and quality of life in patients with systemic sclerosis (SSc; scleroderma).


In systemic sclerosis (SSc; scleroderma) patients in oedematous phase, hand oedema is often present. Manual lymph drainage (MLD) stimulates the lymphatic system and reduces oedema. Our aim was to evaluate the efficacy of MLD in reducing oedema and in improving functionality of the hands and perceived quality of life (QOL) in SSc patients in oedematous phase.


Of 35 SSc patients with oedematous hands, 20 were treated with MLD according to the Vodder technique once a week for 5 weeks (intervention group), and 15 served as the observation group. Patients were evaluated at enrolment, at the end of treatment (T1), and after 9 weeks of followup (T2) by volumetric test (assessing hand volume), the Hand Mobility in Scleroderma (HAMIS) test, and 4 visual analog scales (VAS; scored 0-10) evaluating the perception of hand oedema and pain and their interference on daily activities. QOL and disability were assessed by the physical synthetic index (PSI) and mental synthetic index (MSI) of the Short Form 36 (SF-36) and by the Health Assessment Questionnaire (HAQ).


In the intervention group, hand volume, the HAMIS test, and the 4 VAS were improved significantly at the end of treatment (P < 0.001). The results were maintained at T2 (P < 0.001). The HAQ and the PSI and MSI of the SF-36 also improved significantly at T1 (P < 0.001), but only PSI improvement was maintained at T2 (P < 0.001). In the observation group, no improvement at T1 and at T2 was observed.


In SSc, MLD significantly reduces hand oedema and improves hand function and perceived QOL.


Bongi SM, Del Rosso A, Passalacqua M, Miccio S and Cerinic MM. Manual lymph drainage improving upper extremity edema and hand function in patients with systemic sclerosis in edematous phase. Source Arthritis care & research. 63(8):1134-41. Aug 2011.


The above review indicated that manual lymph drainage (MLD) significantly reduces hand oedema, improves hand function and quality of life in sufferers of systemic sclerosis (SSc).

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