A PILOT RANDOMIZED TRIAL EVALUATING LOW-LEVEL LASER THERAPY AS AN ALTERNATIVE TREATMENT TO MANUAL LYMPHATIC DRAINAGE FOR BREAST CANCER-RELATED LYMPHEDEMA
Ridner SH, Poage-Hooper E, Kanar C, Doersam JK, Bond SM, Dietrich MS
PURPOSE/OBJECTIVES: To examine the impact of advanced practice nurse (APN) administered low level laser therapy (LLLT) as both a stand-alone and complementary treatment for arm volume, symptoms, and quality of life (QOL) in women with breast cancer related lymphedema.
DESIGN: A three-group, pilot, randomized clinical trial.
SETTING: A private rehabilitation practice with two locations in the southwestern United States.
SAMPLE: 46 breast cancer survivors with treatment related lymphedema.
METHODS: Patients were screened for eligibility and then randomized to either manual lymphatic drainage (MLD) for 40 minutes, LLLT for 20 minutes, or, 20 minutes of MLD followed by 20 minutes of LLLT. Compression bandaging was applied after each treatment. Data were collected pre-treatment, daily, weekly, and at the end of treatment.
MAIN RESEARCH VARIABLES: Independent variables consisted of three types of APN administered lymphedema treatment. Outcome variables included limb volume, extracellular fluid, psychological and physical symptoms, and QOL.
FINDINGS: No statistically significant between group differences were found in volume reduction; however, all groups had clinically and statistically significant reduction in volume. No group differences were noted in psychological and physical symptoms, or QOL; however, treatment related improvements were noted in symptom burden within all groups. Skin improvement was noted in each group that received LLLT.
CONCLUSIONS: LLLT with bandaging may offer a time saving therapeutic option to conventional MLD. Alternatively compression bandaging alone could account for the demonstrated volume reduction.
Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/23803270
Full Article in PDF format: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3887507/pdf/nihms-534360.pdf
EFFECT OF LOW-LEVEL LASER THERAPY ON PAIN AND SWELLING IN WOMEN WITH BREAST CANCER-RELATED LYMPHEDEMA: A SYSTEMATIC REVIEW AND META-ANALYSIS
Smoot B, Chiavola-Larson L, Lee J, Manibusan H, Allen DD
PURPOSE: This study aims to examine literature on effectiveness of low-level laser therapy (LLLT) in reducing limb volume and pain in adults with breast cancer-related lymphedema (BCRL).
METHODS: PubMed, PEDro, CINAHL, and Cochrane databases were searched using (lymphedema OR edema OR swelling) AND (breast cancer OR mastectomy) AND (laser OR low-level laser therapy OR LLLT OR cold laser). Intervention studies or meta-analyses reporting LLLT for BCRL were included in the search. Pooled effect sizes (ES) and 95 % confidence intervals (CI) were calculated for volume and pain. No limitations were placed on length of follow-up, publication year, or language. Final search was conducted on October 16, 2014.
RESULTS: Nine studies met criteria for inclusion. Within-group pooled ES for volume (six studies) was -0.52 (-0.78, -0.25), representing a 75.7-ml reduction in limb volume after LLLT. Between-group pooled ES for volume (four studies) was -0.62 (-0.97, -0.28), representing a 90.9-ml greater reduction in volume with treatment including LLLT versus not including LLLT. Within-group pooled ES for pain reduction (three studies) was -0.62 (-1.06, -0.19), pain reduction of 13.5 mm (0-100 mm VAS). Between-group pooled ES for pain reduction (two studies) was non-significant at -1.21 (-4.51, 2.10).
CONCLUSION: Moderate-strength evidence supports LLLT in the management of BCRL, with clinically relevant within-group reductions in volume and pain immediately after conclusion of LLLT treatments. Greater reductions in volume were found with the use of LLLT than in treatments without it.
IMPLICATIONS FOR CANCER SURVIVORS: LLLT confers clinically meaningful reductions in arm volume and pain in women with BCRL.
Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/25432632