Echometer Model D Manual Lymphatic Drainage

• Model M Echometer For Sale
• Echometer Model D Manual Lymphatic Drainage Techniques
• Echometer Model D Manual Lymphatic Drainage Benefits

Manual Lymphatic Drainage in Lymph edema. There are several indications for the use of MLD other than lymphedema, like CVD, postthrombotic syndrome, chronic wounds, traumatic edema (iatrogenic, postsurgical, and musculoskeletal injury), complex regional pain syndrome, and lymphedema.

BackgroundLymphedema is a common complication of axillary dissection for breast cancer. We investigated whether manual lymphatic drainage (MLD) could prevent or manage limb edema in women after breast-cancer surgery.

MethodsWe performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) to evaluate the effectiveness of MLD in the prevention and treatment of breast-cancer-related lymphedema. The PubMed, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro), SCOPUS, and Cochrane Central Register of Controlled Trials electronic databases were searched for articles on MLD published before December 2012, with no language restrictions. The primary outcome for prevention was the incidence of postoperative lymphedema. The outcome for management of lymphedema was a reduction in edema volume. ResultsIn total, 10 RCTs with 566 patients were identified. Two studies evaluating the preventive outcome of MLD found no significant difference in the incidence of lymphedema between the MLD and standard treatment groups, with a risk ratio of 0.63 and a 95% confidence interval (CI) of 0.14 to 2.82. Seven studies assessed the reduction in arm volume, and found no significant difference between the MLD and standard treatment groups, with a weighted mean difference of 75.12 (95% CI, −9.34 to 159.58).

ConclusionsThe current evidence from RCTs does not support the use of MLD in preventing or treating lymphedema. However, clinical and statistical inconsistencies between the various studies confounded our evaluation of the effect of MLD on breast-cancer-related lymphedema. Lymphedema is defined as persistent tissue swelling caused by the blockage or absence of lymph drainage. Lymphedema is a major concern for patients undergoing axillary lymph-node dissection for the treatment of breast cancer. The incidence of lymphedema at 12 months after breast surgery ranges from 12% to 26% ,. Lymphedema may result in cosmetic deformity, loss of function, physical discomfort, recurrent episodes of erysipelas,and psychological distress ,. Thus, an effective treatment for lymphedema is necessary.Previous surgical techniques for the treatment of lymphedema aimed to reduce limb volume using a debulking resection approach.

With the advent of microsurgery, use of multiple lymphatic-venous anastomoses has become the most common surgical treatment. However, convincing evidence of the success of lymphatic-venous anastomoses has not been demonstrated.

Thus, most patients with lymphedema choose non-surgical treatments, such as the use of elastic stockings, especially in early stages of lymphedema.Complex decongestive physiotherapy (CDP) is likely to reduce upper limb lymphedema in patients with breast cancer. Evidence of the efficacy of other physiotherapy methods is limited –. Compression bandaging, manual lymphatic drainage (MLD), physical exercise to maintain lymphatic flow, and skin care are combined in CDP ,. In MLD, specialized rhythmic pumping techniques are used to massage the affected area and enhance the lymph flow. Gentle skin massage is thought to cause superficial lymphatic contraction, thereby increasing lymph drainage.Vodder originally suggested the use of range-of-motion exercises to relieve various types of chronic edema, such as sinus congestion and catarrh , and the use of MLD has become a common treatment for lymphedema worldwide, especially in European hospitals and clinics.To date, several studies have been published investigating the effects of MLD in preventing and treating lymphedema after breast-cancer surgery –. However, these studies have been inconclusive, probably because of small sample sizes. Therefore, we conducted a systematic literature review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effectiveness of MLD in the prevention and treatment of breast-cancer-related lymphedema.

Selection criteriaWe reviewed RCTs or quasi-RCTs from the literature that evaluated the outcome of MLD in preventing and treating breast-cancer-related lymphedema. For inclusion in our study, the trials were required to describe: 1) the inclusion and exclusion criteria used for patient selection, 2) the MLD technique used, 3) the compression strategy used, 4) the definition of lymphedema, and 5) the evaluation of lymphedema severity. We excluded trials that met as least one of the following criteria: 1) patients had not received axillary lymph-node dissection (such as in studies in which only sentinel node sampling was used), 2) the clinical outcomes had not been clearly stated, or 3) duplicate reporting of patient cohorts had occurred. Search strategy and study selectionStudies were identified by keyword searches of the following electronic databases: PubMed, EMBASE, CINAHL, PEDro (Physiotherapy Evidence Database), SCOPUS, Cochrane Central Register of Controlled Trials, and the ClinicalTrials.gov registry. The following terms and Boolean operator were used in MeSH and free-text searches: ‘manual lymph drainage’, ‘breast cancer OR neoplasm’, ‘lymphoedema OR lymphedema’.

The ‘related articles’ facility in PubMed was used to broaden the search. No language restrictions were applied. The final search was performed in December 2012. We attempted to identify additional studies by searching the reference sections of any relevant papers and contacting known experts in the field. Data extraction and methodological quality appraisalTwo authors (K-WT and T-WH) independently extracted details of the RCTs pertaining to the participants, inclusion and exclusion criteria, manual lymph-drainage techniques used, arm lymphedema parameters, and complications. The individually recorded decisions of the two reviewers were compared, and any disagreements were resolved based on the evaluation of a third reviewer (S-HT).The two authors independently appraised the methodological quality of each study based on: 1) adequacy of the randomization, 2) allocation concealment, 3) blinding, 4) duration of follow-up, 5) number of drop-outs, and 6) performance of an intention-to-treat (ITT) analysis. Outcomes assessmentsThe efficacy of MLD was evaluated by the incidence of lymphedema and the reduction in the volume of the patient’s arm at 1, 3, 6, 9 and 12 months after MLD treatment.

Model M Echometer For Sale

The arm volume was assessed by submerging each arm in a container filled with water, and measuring the volume (ml) displaced. The absolute edema volume was defined as the difference in volume between the arm with lymphedema and the contralateral arm. The following various definitions for lymphedema were used in the studies analyzed: a difference in volume of greater than 10% between the affected arm and contralateral arm , ; an increase of 200 ml or more in the volume of the affected arm compared with the pre-surgery volume of the same arm ; and an increase of 20 mm or more in the circumference of the affected arm compared with the pre-surgery circumference of the same arm ,. Statistical analysisStatistical analysis was conducted using Review Manager software (version 5.1;Cochrane Collaboration, Oxford, UK). The meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. When necessary, standard deviations (SDs) were estimated based on the reported confidence interval (CI) limits, standard error, or range values.

The effect sizes of dichotomous outcomes were calculated as risk ratios (RR), and the mean difference was calculated for continuous outcomes. The precision of an effect size was calculated as the 95% CI. A pooled estimate of the RR was calculated using the DerSimonian and Laird random-effects model. This provided relatively wide CIs and an appropriate estimate of the average treatment effect for trials that were statistically heterogeneous, resulting in a conservative statistical claim.

The data were pooled only for studies that exhibited adequate clinical and methodological similarity. Statistical heterogeneity was assessed using the I 2 test, with I 2 quantifying the proportion of the total outcome variability that was attributable to variability among the studies. Characteristics of the trialsThe process by which we screened and selected the trials is shown in a flow chart (Figure ). Our initial search yielded 170 studies, of which 29 were deemed ineligible after screening of titles and abstracts.

Echometer Model D Manual Lymphatic Drainage Techniques

Another 141 reports were excluded from our final analysis for the following reasons: 58 were review articles, 3 were animal studies, 18 had used different comparisons, 33 discussed different topics, and 19 were not randomized trials. The remaining 10 eligible RCTs –, – were included in our analysis. Most of the trials had assessed MLD treatment using the Vodder method. MLD was performed by specially trained physiotherapists, and was followed by skin care with moisturizers, multilayered short-stretch bandaging with appropriate padding, and exercise. The MLD extended to the neck, the anterior and posterior trunk, and the swollen arm.

One study did not fully describe the MLD method that was used. In addition to the use of sleeve or glove compression, standard therapies also included educational information and recommendations on lymphedema, instructions for physical exercises to enhance lymph flow, education in skin care, and safety precautions. Across all ten studies, the two treatment groups were comparable for patient age and the duration of MLD (Table ). Most of the included trials had investigated whether the addition of MLD to the standard therapy after breast-cancer treatment improved clinical outcomes in women with lymphedema. Two trials investigated the preventive effect of MLD on the development of lymphedema in women after breast-cancer surgery ,. Two trials measured the effects of simple lymphatic drainage (SLD) versus MLD on lymphedema of the arm ,.

Echometer Model D Manual Lymphatic Drainage Benefits

One trial compared the outcomes of MLD with or without sequential pneumatic compression (SPC).We assessed the methodological quality of the included trials (Table ). Five studies reported acceptable methods of randomization , –, four trials described the method of allocation concealment.