A comparison of two treatment programs in treating secondary upper limb lymphoedema : a preliminary study

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A comparison of two treatment programs in treating secondary upper limb lymphoedema : a preliminary study


Author: Fong, Pui-yee Pauline
Title: A comparison of two treatment programs in treating secondary upper limb lymphoedema : a preliminary study
Degree: M.Sc.
Year: 2005
Subject: Hong Kong Polytechnic University -- Dissertations
Arm -- Diseases -- Treatment
Lymphatics -- Diseases -- Treatment
Department: Dept. of Rehabilitation Sciences
Pages: xi, 126 leaves : ill. (some col.) ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1818214
URI: http://theses.lib.polyu.edu.hk/handle/200/3616
Abstract: Secondary upper limb lymphoedema has been recognized as a major complication to breast cancer survivors. The aim of a lymphoedema management is to enhance the lymphatic transport capacity so as to alleviate the patients' physical and psychological morbidities. At present, there are two major lymphoedema management namely, the Combined Decongestive Therapy (CDT) and the Sequential Pneumatic Compression (SPC) therapy. They are commonly practiced in western countries and in Hong Kong respectively but they lack local evidence proof. This preliminary study aimed to compare the effectiveness of a modified Combined Decongestive Therapy (mCDT) program and that of a Sequential Pneumatic Compression (SPC) program to Hong Kong Chinese women with secondary upper limb lymphoedema after breast cancer treatments. The study was a randomised two-group pretest-posttest trial. Twenty Hong Kong Chinese female who met the inclusion criteria participated in the study. They were required to wear compression arm sleeves and to do remedial exercises daily for two weeks in Phase I study. In the two-week Phase II study, they were randomly allocated into either the mCDT program with Manual Lymph Drainage (MLD) (n=10) or the SPC program with Sequential Pneumatic Compression (SPC) (n10). Outcome measures included % volume excess of the lymphoedematous upper limb, upper limb dexterity measured by the Minnesota Manual Dexterity Tests (MMDT), subjective perception on symptoms, and the quality of life measure using the Traditional Chinese version of the FACT-B+4v.4 scale. Two-way repeated measures ANOVAs were used to compare the two treatment programs over time. All subjects showed significant improvements in almost all outcomes in Phase I study. When the two treatment programs were compared in Phase II study, significant differences were demonstrated on the % volume excess of the lymphoedematous upper limb (p=0.025), the MMDT turning subtest (p=0.035) and the physical domains in the quality of life measure. The mCDT program showed relatively favourable results in the objective outcomes while the SPC program was relatively better in the quality of measure. Almost all significant changes happened after the 10 treatment sessions. When the two treatment programs were individually studied, the mCDT program showed significant improvements in the objective outcomes (p=0.000 to 0.003), subjective perception on tenderness, heaviness and soft tissue hardness (p=0.001 to 0.041) after the two-week program. Subjects in the SPC program showed significant improvements in the tenderness, the arm subscale, trial outcome index and the FACT-general score in the QOL measure (p=0.003 to 0.022). At the follow-up assessment in one month post-treatment, the two treatment programs showed significant differences on the MMDT placing subtest (p=0.039) and many physical domains in the quality of life measure (p=0.001 to 0.033) and it was the mCDT program which gave continuing improvements on these outcomes at the follow-up assessment, while the SPC program did not. These might indicate that MLD generated better lasting effect than SPC. A more stringent clinical study is warranted to prove the efficacy of both treatment programs with higher scientific values.

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