Preston, N.J., Seers, K., & Mortimer, P.S. (2008). Physical therapies for reducing and controlling lymphoedema of the limbs. Cochrane Database of Systematic Reviews (Online), Issue 4, CD003141.

To assess the effect of physical treatment programs on the volume, shape, condition, and long-term (six months) control of oedema in lymphoedematous limbs and to assess the psycho-social benefits of physical treatment

Databases included in the review were the Cochrane Breast Cancer Group Trials Register, The Cochrane Central Register of Controlled Trials, MEDLINE^©, EMBASE, CINAHL^©, the National Research Register and UnCover, PASCAL, SIGLE, reference lists produced by The British Lymphology Society, and The International Society of Lymphology Congress Proceedings. Keywords were lymphoedema, lymphedema, lymphodema, or elephantiasis; exercise; physical therapy; bandage; hosiery or hose; compression; bandages and dressings; compression garments; physical therapy modalities; intermittent pneumatic compression devices; physiotherapy; kinesiotherapy; compression stocking; pneumatic compression; limb volume; limb size; excess (limb) volume; oedema or edema volume; and quality of life measure or tool. Studies were included in the review if they were randomized controlled trials that tested physical therapies with a follow-up period of at least six months. Studies were excluded if they had a follow-up  less than six months or the trial did not use limb volume as the method of assessing change in size.

The total number of studies reviewed initially was 185. Two blinded reviewers independently assessed trial quality and extracted data. Meta-analysis was not performed because of the poor quality of the trials.

• Three studies were included in the report.
• The total sample size was 150.
• The sample range across studies was 25–33.
• All types of lymphedema were included, non cancer-related and cancer- related.
• Patients with cancer had to have completed their cancer treatment at least six months before entering the trial and could not have evidence of recurrent malignant disease when going into the trial.

Wearing a compression sleeve is beneficial. The bandage plus hosiery results in a greater reduction in excess limb volume than hosiery alone and this difference in reduction was maintained long term.

All three trials have their limitations and have yet to be replicated, so their results must be viewed with caution.

There is a clear need for well-designed, randomised trials of the whole range of physical therapies if the best approach to managing lymphedema is to be determined.