Study designs of evaluations included in the review
Prospective randomised, quasi-experimental, uncontrolled, or single-subject experimental (repeated measures) clinical studies were included.
Specific interventions included in the review
Post-operative therapy, therapy methods used with late symptoms, or therapeutic exercise or training were eligible.
The included lymphoedema therapy methods were ultrasound therapy, elastic sleeve, mechanical pressure therapy, electrically-stimulated lymphatic drainage, pneumatic compression, lymph massage by Foldi, bandaging, microwave heating, skin care, self-massage, mechanical massage vibrator, manual lymph drainage, massage with aromatherapy, low-level laser therapy, isometrics, and pneumatic massage with uniform or differentiated pressure. The included post-operative shoulder exercises were hand-squeezing, wall climbing, pendulum and pulley, arm use, spontaneous movements, and isometrics. The included exercise therapies involved head and neck, arm-shoulder, arm-leg, on-floor abdominal, back-leg, stretching, active assisted shoulder exercise, functional activities, and instruction in self-care. The included aerobic exercises were pedalling or walking, or were self-chosen. There were wide variations in the introduction, timing, intensity and duration of the interventions, and combinations of interventions were seen in all categories.
Participants included in the review
Female patients who had undergone breast cancer surgery were included. There was considerable heterogeneity among the populations in terms of age, severity of conditions, time elapsed since breast cancer operations, and prior or concurrent use of medication and therapies for oedema.
Outcomes assessed in the review
The outcomes assessed were oedema (measures such as volume or circumference difference, body-weight); shoulder mobility (e.g. goniometric range of motion and circumference measurement); and functional capacity (e.g. oxygen uptake, respiratory values, arm and shoulder function). Several studies also measured the subjective feelings of patients using a variety of tools.
How were decisions on the relevance of primary studies made?
The authors do not state how the papers were selected for the review, or how many of the reviewers performed the selection.