BELLARMINE UNIVERSITY, LOUISVILLE, KY

In patients with lymphedema, are alternative

or traditional treatments more effective at removing fluid from the extremities?Megan Davis, Kristin Hamrick, Bret Ramsey, Briana

Ulanowski

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Objective

• Define lymphedema• Describe traditional treatment• Describe and discuss multiple

alternative treatments.• Discuss results, conclusion, and

clinical significance.

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Lymphedema

• Lymphatic System– Sanitation System– Waste Disposal– Fluid Check– One-way system Lymphede

maProgression- Stage 0- Stage 1- Stage 2- Stage 3

http://www.calhounnaturalmedicine.com/health/lymphatic-detoxification

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Complete Decongestive Therapy

• Systematic Order of Treatment (Lasinski 2012)

– Manual Lymphatic Draining– Compression

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Might Look Like This…http://sowhereisshenow.blogspot.com/2010/08/lymphedema-here-we-go-again.html

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Complete Decongestive Therapy

• Systematic Order of Treatment– Manual Lymphatic Draining– Compression– Exercise– Proper Self-Care

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Why use alternate techniques?

(Rodrick et al 2013)

• Qualifications• Time• Money• Resources• Reimbursement• Compliance

http://www.mayoclinic.com/images/image_popup/r7_lymphedema.jpg

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Alternative Treatments

• Kinesio Tex Tape – Tsai et al 2009 – Morris et al 2013– Rodrick et al 2013

• Acupuncture & Moxibustion – Wanchai et al 2012– Rodrick et al 2013

• Low-level laser therapy – Rodrick et al 2013

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Kinesio Tex Tape

• Compression bandage used in CDT replaced with Kinesio Tex Tape– Mimics skin– Aid systems– Provide mechanical support– Lift skin from tissue beneath– Releases pressure

http://i1.ytimg.com/vi/DNo2EurDQ34/maxresdefault.jpg

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Kinesio Tex Tap Literature

• Patients with unilateral breast-cancer lymphedema for at least 3 months (Tsai et al 2009)

– N=41 randomly assigned– CDT or Modified with Kinesio Tex Tape

• Systematic Review of the Literature (Morris et al 2013)

– Includes Tsai et al Support Care Cancer 2009

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Literature (Cont.)

• Systematic Review Literature (Rodrick et al 2013)

– Better after 1 month treatment– Unaware of long-term management

with tape– Likely to be effective with CDT

Article Tsai et al 2009

Morris et al 2013

Rodrick et al 2013

Significant Findings

None None None

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Acupuncture & Moxibustion

• Traditional Chinese Medicines– Acupuncture– Moxibustion

• Side Effects• Preventative Measure• Treatment for patients that acquired

lymphedema

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Wanchai et al 2012

• Systematic Review of 4 Studies– Decrease hardness and swelling– Increase Body Temperature

• Significant Findings– Measure Yourself Medical Outcome Profile– SF-36 bodily pain and vitality subscales– ROM, degree of lymphedema– 30% Reduction lymphedema by

circumference

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Rodrick et al 2013

• Acupuncture stimulate anatomical locations on skin– Pressure or needle with/without electrical

stimulation

• Significant Findings– Increased shoulder ROM– Improved altered sensory issues– Less density perceived

http://www.aaomed.org/AAOM/files/ccLibraryFiles/Filename/000000000015/Acupuncture-Picture.jpg

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Low-Level Laser Therapy

• Softening scar tissue by increasing– Lymphatic motoricity,

Lymphangiogenesis, macrophage activity

• Unblock lymphatic system– Not associated with CDT

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Rodrick et al 2013

• Likely to be effective– Limb-volume reduction– Shoulder mobility– Grip strength – Self-reported symptoms

https://encryptedtbn2.gstatic.com/images?q=tbn:ANd9GcQRiQfWLrawIz4OBfQxn9JfxzlpvtdD0MOZX_jgazkmOKafDv0QS88ToAky

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Conclusion

• Most effective treatment– Complete Decongestive Therapy

http://www.youtube.com/watch?v=rJ-gjui1Z_c

• More literature on alternative treatments is needed.

BELLARMINE UNIVERSITY, LOUISVILLE, KY

References• Lasinski BB. Complete decongestive therapy for treatment of lymphedema.

Seminars in oncology nursing. 2013;29(1):20–7. doi:10.1016/j.soncn.2012.11.004.

• Morris D, Jones D, Ryan H, Ryan CG. The clinical effects of Kinesio® Tex taping: A systematic review. Physiotherapy theory and practice. 2013;29(4):259–70. doi:10.3109/09593985.2012.731675.

• Rodrick JR, Poage E, Wanchai A, Stewart BR, Cormier JN, Armer JM. Complementary, Alternative, and Other Non-Complete Decongestive Therapy (CDT) Treatment Methods in the Management of Lymphedema: A Systematic Search and Review. PM & R : the journal of injury, function, and rehabilitation. 2013. doi:10.1016/j.pmrj.2013.09.008.

• Tsai H-J, Hung H-C, Yang J-L, Huang C-S, Tsauo J-Y. Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related lymphedema? A pilot study. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2009;17(11):1353–60. doi:10.1007/s00520-009-0592-8.

• Wanchai A, Armer JM, Stewart BR. Complementary and alternative medicine and lymphedema. Seminars in oncology nursing. 2013;29(1):41–9. doi:10.1016/j.soncn.2012.11.006.