Moattari, M., Jaafari, B., Talei, A., Piroozi, S., Tahmasebi, S., & Zakeri, Z. (2012). The effect of combined decongestive therapy and pneumatic compression pump on lymphedema indicators in patients with breast cancer related lymphedema. Iranian Red Crescent Medical Journal, 14(4), 210–217.

To investigate the effect of combined decongestive therapy (CDT) and pneumatic compression pump on upper-limb lymphedema indicators (circumference, volume, and shoulder range of motions) in patients with breast cancer-related lymphedema

The intervention was completed in two phases. In the first phase, the therapeutic phase, CDT and compression pumping was performed by the one researcher at the clinic. Each session included manual lymphatic drainage for 30–40 minutes. The affected upper limb was then placed in the compression pump for 15 minutes and bandaged with multilayer compression bandages, followed by remedial exercises. Also during the first phase, written and verbal information were given regarding skin and nail care, care of the bandaging and practical training in manual lymphatic drainage, how to bandage the upper limb, and remedial exercises. In the second phase, the maintenance phase, patients performed CDT daily at home. The first phase included three weekly sessions for four weeks; each session lasted 60–90 minutes. The second phase included daily CDT for four weeks. Patients were evaluated at baseline and four and eight weeks after the intervention.

• The study sample (N = 21) was comprised of 100 femal patients with breast cancer-related upper-limb lymphedema.
• Mean age ranged from 35–70 years.
• All patients were at least one year since axillary node dissection and had not received CDT.

The study took place at the Shahid Mottahari Therapeutic Center in Shiraz, Iran.

The study has clinical applicability for late effects and survivorship.

The study used a pre-post design.

• Measuring tape was used to measure circumference.
• Volume was measured using water displacement.
• Range of shoulder joint motions was measured using a goniometer.

The mean difference in circumference of the two upper limbs in all areas at different phases of study decreased significantly (p < 0.05). The difference in mean volume between the two upper limbs four and eight weeks after the intervention were smaller than before the intervention (p < 0.001). Mean range of flexion (p < 0.001), extension (p < 0.004), abduction (p < 0.001), and external rotation (p < 0.001) increased four and eight weeks after the intervention.

Combined CDT and pneumatic compression pump reduce mean volume and mean circumference of the breast cancer-related upper-limb lymphedema and increase shoulder joint range of motion.

• The sample size was small, with less than 30 participants.
• The study had a risk of bias because of no control group or random assignment.
• Unintended interventions or applicable interventions were not described and would influence results.
• The author did not provide the time (how many minutes) of daily CDT performed by patients in the second phase.
• No information is provided regarding the compression pump.  

Nurses can play a key role in providing rapid and timely interventions to reduce the severity of lymphedema (e.g., CDT skills and use of compression pump) and patient education regarding self-care and self-management of lymphedema.