Ridner, S.H., Murphy, B., Deng, J., Kidd, N., Galford, E., & Dietrich, M.S. (2010). Advanced pneumatic therapy in self-care of chronic lymphedema of the trunk. Lymphatic Research and Biology, 8(4), 209–215.

To examine potential efficacy of the Flexitouch system (compression garment) for self-care home use in patients with breast cancer who had truncal lymphedema

The system examined includes compression garments for the trunk, chest, and arm and applies variable dynamic pressure to affected areas, controlled by software programming. It uses multi-chambered inflatable and stretchable fabric garments. Patients were fitted for the garments. Patients completed one-hour daily treatments for 10 days. Patient symptoms and cirumferential measurements were done at baseline, after the fifth treatment, and at the end of the study. Patients were trained in use and, after the initial treatment, were instructed in use for home treatment. Research staff observed the first home treatment, then patients completed the rest on their own at home.

• The study sample (N = 12) was comprised of female patients with breast cancer.
• Mean age was 55.3 years, with a range of 43–79 years.
• Patients had an average of 5.4 years since diagnosis and an average of 52.6 months duration of lymphedema.
• Of patients in the study, 75% were married or partnered and 50% were employed full-time.

The study took place in home settings in the United States.

The study has clinical applicability for late effects and survivorship.

The study used a quasi-experimental pre-post design.

• Patients took the Lymphedema Symptom Intensity and Distress Survey-Arm and Trunk (LSIDS-AT).
• Patients took the Functional Assessment Screening Questionnaire.
• Trunk circumference was measured using Gulick II tape.

There were significant reductions in symptoms of truncal heaviness (x² = 15.07, p = 0.0001), swelling (x²=14.73, p = 0.0001), tightness (x² = 12.63, p = 0.0002) and itchiness (x²= 12.0, p = 0.0002). There were no significant changes in truncal measurements; however, there was a general non-significant trend of reduced circumference in all areas measured. There was also significant reduction in difficulty sleeping (p = 0.008).  All significant changes occurred after the fifth treatment and then remained stable at the end of the study. There was a general trend of increasing reports of skin conditions over the course of the study.

The system may be an effective device to relieve lymphedema symptoms with home self-care treatment.

• The sample size was small, with less than 30 participants.
• The study design had a risk of bias because of no control group, no blinding, no random assignment, and no appropriate attentional control condition. Risk of bias (no control group) 
• The study duration was short, and it is not clear what the longer-term effects would be, particularly given the trend of increasing skin condition reporting.

The device may be helpful to reduce symptoms of lymphedema with an approach that patients can use at home for self-care. Larger controlled studies are warranted and longer term use should be evaluated.