Megan Davis, Kristin Hamrick, Bret Ramsey, Briana Ulanowski In patients with lymphedema, are alternative or traditional treatments more effective at removing fluid from the extremities? Megan Davis, Kristin Hamrick, Bret Ramsey, Briana Ulanowski

Objective Define lymphedema Describe traditional treatment Describe and discuss multiple alternative treatments. Discuss results, conclusion, and clinical significance.

Lymphedema Lymphatic System Lymphedema Progression Stage 0 Stage 1 Sanitation System Waste Disposal Fluid Check One-way system http://www.calhounnaturalmedicine.com/health/lymphatic-detoxification Lymphedema Progression Stage 0 Stage 1 Stage 2 Stage 3 Bodies immune system defender. In that it transports and drains excess fluids, proteins, and cellular debris from the interstitial spaces that are not reabsorbed by venous system. Maintains proper fluid balance Drains into the venous system does not go the other direction like that of the heart.

Complete Decongestive Therapy Systematic Order of Treatment (Lasinski 2012) Manual Lymphatic Draining Compression Systematic Literature Review complete decongestive therapy is effective and has a positive impact on quality of life in patients with varying severities of lymphedema continued compression of the affected area is required to maintain treatment results.

Might Look Like This… http://sowhereisshenow. blogspot

Complete Decongestive Therapy Systematic Order of Treatment Manual Lymphatic Draining Compression Exercise Proper Self-Care

Why use alternate techniques? (Rodrick et al 2013) Qualifications Time Money Resources Reimbursement Compliance http://www.mayoclinic.com/images/image_popup/r7_lymphedema.jpg

Alternative Treatments Kinesio Tex Tape Tsai et al 2009 Morris et al 2013 Rodrick et al 2013 Acupuncture & Moxibustion Wanchai et al 2012 Low-level laser therapy

Kinesio Tex Tape Compression bandage used in CDT replaced with Kinesio Tex Tape Mimics skin Aid systems Provide mechanical support Lift skin from tissue beneath Releases pressure http://i1.ytimg.com/vi/DNo2EurDQ34/maxresdefault.jpg Thickness and Flexibility Muscle and Lymphatic Systems Without restricting movement Provides space for lymphatic fluid movement

Kinesio Tex Tap Literature Patients with unilateral breast-cancer lymphedema for at least 3 months (Tsai et al 2009) N=41 randomly assigned CDT or Modified with Kinesio Tex Tape Systematic Review of the Literature (Morris et al 2013) Includes Tsai et al Support Care Cancer 2009 No significant differences between groups for outcome measures [including side effects] KTT is no more effective than usual care SSB [ in breast cancer related lymphedema outcomes] KTT had increased wound development than SSB SSB is more cost effective over an extended treatment period

Literature (Cont.) Systematic Review Literature (Rodrick et al 2013) Better after 1 month treatment Unaware of long-term management with tape Likely to be effective with CDT Article Tsai et al 2009 Morris et al 2013 Rodrick et al 2013 Significant Findings None

Acupuncture & Moxibustion Traditional Chinese Medicines Acupuncture Moxibustion Side Effects Preventative Measure Treatment for patients that acquired lymphedema Fine, solid, stainless steel needle inserted under skin for stimulation Body stimulation using heat from the smoldering herb mugwort Bruising, bleeding, pain and fatigue

Wanchai et al 2012 Systematic Review of 4 Studies Significant Findings Decrease hardness and swelling Increase Body Temperature Significant Findings Measure Yourself Medical Outcome Profile SF-36 bodily pain and vitality subscales ROM, degree of lymphedema 30% Reduction lymphedema by circumference

Rodrick et al 2013 Acupuncture stimulate anatomical locations on skin Pressure or needle with/without electrical stimulation Significant Findings Increased shoulder ROM Improved altered sensory issues Less density perceived http://www.aaomed.org/AAOM/files/ccLibraryFiles/Filename/000000000015/Acupuncture-Picture.jpg

Low-Level Laser Therapy Softening scar tissue by increasing Lymphatic motoricity, Lymphangiogenesis, macrophage activity Unblock lymphatic system Not associated with CDT

Rodrick et al 2013 Likely to be effective Limb-volume reduction Shoulder mobility Grip strength Self-reported symptoms https://encryptedtbn2.gstatic.com/images?q=tbn:ANd9GcQRiQfWLrawIz4OBfQxn9JfxzlpvtdD0MOZX_jgazkmOKafDv0QS88ToAky 1) Independent of compression and CDT 2) Pain, function, QOL, and softening tissue

Conclusion Most effective treatment Complete Decongestive Therapy http://www.youtube.com/watch?v=rJ-gjui1Z_c More literature on alternative treatments is needed.

References Lasinski BB. Complete decongestive therapy for treatment of lymphedema. Seminars in oncology nursing. 2013;29(1):20–7. doi:10.1016/j.soncn.2012.11.004. Morris D, Jones D, Ryan H, Ryan CG. The clinical effects of Kinesio® Tex taping: A systematic review. Physiotherapy theory and practice. 2013;29(4):259–70. doi:10.3109/09593985.2012.731675. Rodrick JR, Poage E, Wanchai A, Stewart BR, Cormier JN, Armer JM. Complementary, Alternative, and Other Non-Complete Decongestive Therapy (CDT) Treatment Methods in the Management of Lymphedema: A Systematic Search and Review. PM & R : the journal of injury, function, and rehabilitation. 2013. doi:10.1016/j.pmrj.2013.09.008. Tsai H-J, Hung H-C, Yang J-L, Huang C-S, Tsauo J-Y. Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related lymphedema? A pilot study. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2009;17(11):1353–60. doi:10.1007/s00520-009-0592-8. Wanchai A, Armer JM, Stewart BR. Complementary and alternative medicine and lymphedema. Seminars in oncology nursing. 2013;29(1):41–9. doi:10.1016/j.soncn.2012.11.006.