Positive Health Online

Abstract

FREIRE DE OLIVEIRA and COLLEAGUES, 1. Physical Therapy Sector, Women's Integrated Healthcare Center, University of Campinas, Campinas, SP, Brazil. marimfo@yahoo.com.br ; 2. Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Campinas, SP, Brazil; 3. Management and Health Care Department, Physical Therapy Sector, Federal University of São Paulo, São Paulo, SP, Brazil; 4. Nuclear Medicine and Radiology Department, School of Medicine, University of Campinas, Campinas, SP, Brazil; 5. University Center of Associated Teaching Colleges, São Paulo, SP, Brazil conducted a clinical trial in 105 women undergoing radical breast cancer surgery and who underwent either manual lymphatic drainage (MLD)  or upper limb (UL) active exercises for 1 month.

Background

To evaluate manual lymphatic drainage (MLD) and active exercise effects on lymphatic alterations of the upper limb (UL), range of motion (ROM) of shoulder, and scar complications after breast cancer surgery.

Methodology

Clinical trial. Setting: Health care center. Participants: Women (N=105) undergoing radical breast cancer surgery who were matched for staging, age, and body mass index. Interventions: Women (n=52) were submitted to MLD and 53 to active exercises for UL for 1 month and followed up. Main Outcome Measures: Shoulder ROM, surgical wound inspection and palpation, UL circumference measurements, and lymphoscintigraphy were performed in preoperative and postoperative periods.

Results

There was no significant difference between groups with regard to wound healing complications, ROM, and UL circumferences. After surgery, 25 (48.1%) of the MLD group and 19 (35.8%) of the active exercise group showed worsening in radiopharmaceutical uptake velocity, whereas 9 (17.3%) of the MLD group and 11 (20.8%) of the active exercise group showed improved velocity (P=.445). With regard to uptake intensity, 27 (51.9%) of the MLD group and 21 (39.6%) of the active exercise group showed worsening whereas 7 (13.5%) of the MLD group and 7 (13.2%) of the active exercise group showed some improvement (P=.391). The presence of collateral circulation was similar in both groups at both time points evaluated. The active exercise group had a significant increase in postoperative liver absorption (P=.005), and the MLD group had a significant increase in postoperative dermal backflow (P=.024).

Conclusion

MLD and active exercise effects are equivalent with regard to morbidity. Minor changes in lymphatic function associated with either MLD or active exercises were not related to patients' symptoms or signs.

References

Freire de Oliveira MM1, Costa Gurgel MS2, Pace do Amaral MT3, Amorim BJ4, Ramos CD4, Almeida Filho JG4, de Rezende LF5, Zanatta Sarian LO2. Manual Lymphatic Drainage and Active Exercise Effects on Lymphatic Function Do Not Translate Into Morbidities in Women Who Underwent Breast Cancer Surgery. Arch Phys Med Rehabil. 98(2):256-263. Feb 2017. DOI: 10.1016/j.apmr.2016.06.024. Epub Aug 9 201