Thirteen studies met the inclusion criteria (920 participants). One study (74 participants) was Level II (small randomised controlled trial with high false-positive or false-negative errors). Five studies (393 participants) were Level III (nonrandomised, pre- test/post-test with comparison group or cross-over design). Seven studies (453 participants) were Level V (one-group pre-test/post- test).
Based on the levels of evidence extracted from the included studies, 1 Grade B (single-level II study) and 6 Grade C (level of evidence grade III to V) recommendations were generated by the results of the individual studies.
The Grade B recommendation was that compression garments appear to reduce limb size after 6 months of use, and the addition of electrical stimulation does not improve the results.
The Grade C recommendations were:
1. Elevation alone is not effective in controlling lymphedema.
2. Microwave treatment, in combination with compression garment use, can reduce limb size.
3. Compression garments alone reduce limb size. Pneumatic pumps or electrical stimulation devices, in combination with compression garments, do not improve the results.
4. Complex physical therapy (CPT) was supported by 2 level V studies, but modified CPT was found to be just as effective as regular CPT in one of the studies.
5. Combinations of treatments including massage, pneumatic pump, and compression garments show positive results in the treatment of people with lymphedema (2 studies).
6. The Wright linear pump and the uniform pressure pump are effective in reducing limb size when followed by the use of compression garments.