The Randomized Controlled Study of Low-Level Laser Therapy, Kinesio-Taping and Manual Lymphatic Drainage in Patients With Stage II Breast Cancer-Related Lymphedema.

Original Article Eur J Breast Health 2023; 19(1): 34-44 DOI: 10.4274/ejbh.galenos.2022.2022-6-4 The Randomized Controlled Study of Low-Level Laser Therapy, Kinesio-Taping and Manual Lymphatic Drainage in Patients With Stage II Breast Cancer-Related Lymphedema Sedef Selcuk Yilmaz1, Fikriye Figen Ayhan2 Department of Physical Medicine and Rehabilitation, Ankara Mamak State Hospital, Ministry of Health, Ankara, Turkey Department of Physical Medicine and Rehabilitation, Medicana International Ankara Hospital, Atilim University Faculty of Medicine, Ankara, Turkey 1 2 ABSTRACT Objective: To compare the effects of low-level laser therapy, kinesio-taping and manual lymphatic drainage (MLD) on the affected arm volume, quality of life, arm function, neuropathic pain and shoulder mobility in patients with stage II breast cancer-related lymphedema. Materials and Methods: Forty-five breast cancer patients with stage II lymphedema were included. The patients were randomized to three groups and treated with MLD, kinesio-taping or low-level laser therapy. After these different therapeutic modalities, all patients received multilayer compression bandaging, lymphedema remedial exercises, skin care, and a patient education program by the same lymphedema therapist. All treatments were applied 5-days a week for three weeks. The lymphedema compression garments were prescribed to all patients and follow-up visits were planned at the end of the treatment, and at four and 12 weeks. The efficacy of the treatments was evaluated by volumetric calculations based on circumferential measurements using the formula for a truncated cone, in addition to goniometric assessments for shoulder joint ROM, and questionnaires: Quick-disability of arm, shoulder and hand for arm disability; pain-detect for neuropathic pain; and quality of life for arm lymphedema (LYMQOL-arm). Results: The baseline patient and disease characteristics, and outcome measures were similar between groups. All treatment modalities were found to be effective in decreasing arm volume, and improving quality of life, upper extremity disability and neuropathic pain. The percentage of decreased arm volume or treatment success was better in kinesio-taping group than in the MLD group at the end of the treatment, and at four and 12 weeks after treatment (p = 0.009, p = 0.039, and p = 0.042, respectively). Conclusion: Kinesio-taping led to better results than MLD and was similarly effective compared with low-level laser in stage II breast cancer-related lymphedema at the twelfth week of follow-up. Kinesio-taping and low-level laser should be considered as alternative treatments in early-moderate stages of lymphedema. After these modalities, multi-layer compression and compression bandaging remain cornerstones of lymphedema treatment. Keywords: Lymphedema; breast cancer; low level laser therapy; kinesio-taping; manual lymphatic drainage; complex decongestive treatment Cite this article as: Selcuk Yilmaz S, Ayhan FF. The Randomized Controlled Study of Low-Level Laser Therapy, Kinesio-Taping and Manual Lymphatic Drainage in Patients With Stage II Breast Cancer-Related Lymphedema. Eur J Breast Health 2023; 19(1): 34-44 Key Points • 34 Lymphedema is chronic, progressive and disabling disease needed self-management including skin care, self-manual lymphatic drainage massage, compressive garments, and exercises. Since manual lymphatic drain age is time-consuming and tiresome technique, alternative treatments such as kinesio-taping and LLLT should be considered because of similar effectivity in early stage of lymphedema. Corresponding Author: Sedef Selcuk Yilmaz; ©Copyright Received: 07.08.2022 Accepted: 17.09.2022 Available Online Date: 01.01.2023 2023 by the Turkish Federation of Breast Diseases Societies / European Journal of Breast Health published by Galenos Publishing House. Selcuk Yilmaz and Ayhan. Stage II Breast Cancer-Related Lymphedema Introduction Lymphedema is a chronic, progressive and sometimes disabling disease if it has been not treated until end stage. Breast cancer (BC) related lymphedema (BCRL) is the most common cause of lymphedema in developed countries with an incidence ranging from 6–30% (1-4). The main risk factors for BCRL are the number of removed axillary lymph nodes, the number of metastatic lymph nodes, axillary radiotherapy, taxane type chemotherapy, obesity, advanced age, lack of physical activity, and the presence of hematoma, seroma or infection in the affected quadrant (4-6). Lymphedema patients need life-long care, medical and psychosocial support (2). For optimal benefits, it is important to diagnose early, start treatment early and customize the treatment (2). Complex decongestive therapy (CDT) is the internationally accepted gold standard treatment method consisting of two-phases (2). The first phase of CDT is intensive and is performed by health professionals; this phase includes skin care, manual lymphatic drainage (MLD), compression therapies, such as multi-layer low-stretch bandaging, and specialized exercises (2). The second phase is for maintenance and is performed by the patient, caregiver, or family and consists of the same components, and compression garments. MLD is a unique gentle massage technique intended to increase lymphatic circulation using lymphatic anastomoses and territories in addition to diaphragmatic breathing. MLD can be applied by health professionals or by patients themselves (self MLD). Since MLD is a time-consuming technique and costly to implement, there were some recent studies that investigated the effectiveness of combining alternative techniques. However, there were a limited number of randomized controlled studies investigating the efficacies of MLD (7, 8), low-level laser therapy (LLLT) (9-11), and kinesio-taping (12-14). Moreover, there was no direct comparative study of these treatment modalities. There were also some controlled studies including intermittent pneumatic compression devices (15), low-level laser treatment (911), electrotherapy (16), extra-corporal shock wave therapy (17), and kinesio-taping (2, 7). The aim of this study was to compare the effectiveness and tolerability of LLLT, and kinesio-taping, as alternative treatment options for MLD, in patients with stage II BCRL. Materials and Methods Patients with BCRL attending the University of Health Sciences Turkey, Ankara Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Division of Oncological Rehabilitation and Lymphedema were evaluated in this study. Ethical approval was obtained to conduct this study from the Institutional Review Board for Human Subjects (approval number: E-18-2025, date: 26.06.2018). Patients were eligible if they had unilateral, stage I-III BC, unilateral stage II arm lymphedema and arm volume difference of 5–20% on the affected side after BC surgery. Exclusion criteria were: Patients with stage IV BC; bilateral BC; bilateral lymphedema; stage (...truncated)