Torres Lacomba, M., Yuste Sanchez, M.J., Zapico Goni, A., Prieto Merino, D., Mayoral del Moral, O., Cerezo Tellez, E., & Minayo Mogollon, E. (2010). Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: Randomised, single blinded, clinical trial. BMJ (Clinical Research Ed.), 340, b5396.

To determine effectiveness of an early physiotherapy program in reducing the risk of secondary lymphedema in women after surgery for breast cancer

Early therapy included manual lymph drainage, stretching exercises for key muscle groups, progressive active and assisted shoulder exercises, proprioceptive facilitation exercises without resistance along with education consisting of instruction with printed materials. All patients were followed up 4 weeks after surgery and at 3, 6 and 12 months. Follow-up time points were somewhat flexible by design; however, actual differences in follow-up are not described. If secondary lymphedema occurred, complex decongestive therapy was carried out.

• The study sample (N = 116)  was comprised of female patients with breast cancer postoperatively.
• Mean age was 52.9 years.
• Patients were excluded if they were receiving adjuvant therapies.

The study took place in an outpatient setting in Spain.

The study used a randomized, single-blinded, controlled trial design.

• Arm circumference was measured at 5 cm intervals on both arms.
• Demographic data was collected.
• Computed volume ratio was compared between arms.

Incidence of secondary lymphedema was 25% in the control group compared to 7% in the intervention group (p = 0.01). In both groups the volume of the affected arm increased over time. In the control group, the volume was an average of 5.1% greater in the affected arm compared to 1.6% greater in the intervention group (p = 0.0065). Survival analysis showed that secondary lymphedema developed more rapidly in the control group and the protective effect of early physiotherapy remained for a longer time.

Early physiotherapy can be an effective intervention for prevention or mitigation of secondary lymphedema after surgery for breast cancer within one year after surgery.

• Actual exercise done by the control group is not known.
• Adherence of any patients to educational guidance is not discussed.
• Methods state that complex decongestion would be done in any case of lymphedema; however, these findings or differences between groups are not mentioned.
• One-year follow-up does not make it clear if early physiotherapy remains effective over the longer term.

Early physiotherapy and related exercises are helpful in preventing or mitigating lymphedema in the short term for patients who have had surgery for breast cancer involving axillary lymph node dissection. Ongoing research in this area is needed to determine effective strategies in the longer term for this chronic problem.