Pilot study to evaluate an apparatus for mechanical lymph drainage

Introduction

Lymphedema is characterized by an abnormal accumulation of fluids and other substances in the tissues due to a failure of the lymphatic system [1, 2].

An association of therapies is recommended to treat lymphedema that include manual and mechanical lymph drainage, myolymphokinetic exercises, compression garments and bandages, hygienic care and care during day-to-day life, psychological support and lymphokinetic drugs [2].

Exercising, associated with compression mechanisms and lymph drainage, is one of the three cornerstones in the treatment of lymphedema [3, 4]. However, there are few studies evaluating mechanical lymph drainage of the upper limbs [5, 6].

The aim of this study was to evaluate a new method of mechanical lymph drainage over a three-hour session using the RAGodoy® apparatus.

Material and methods

Thirteen patients with breast cancer treatment-related arm lymphedema aged 42-76 years old (average – 56.7) were randomly selected. All patients underwent mastectomy with axillary dissection, but without evidence of tumor activity at the time of the study. The inclusion criterion was the presence of lymphedema and exclusion was limitation of joint mobility and infection. Lymphedema was defined as a difference in volume of more than 200 ml between arms. Patients were subjected to mechanical lymph drainage using an electromechanical device (RAGodoy®, Sã o Jose do Rio Preto, Brazil), to perform passive movements with flexion and extension of the elbow (fig. 1A, B). Mechanical lymph drainage was performed for three hours and water displacement volumetry using calibrated digital scales was performed to evaluate the size of the lymphedematous arm before the start of the session and at hourly intervals. Neither compression mechanisms nor any other associated treatment was used in this study.

The paired t-test was used for statistical analysis with an alpha error of 5% being considered acceptable. The study was approved by the Research Ethics Committee of the Medicine School in São José do Rio Preto (237/2004).

Pilot study to evaluate an apparatus for mechanical lymph drainage

Figure 1A, BThe RAGodoy® apparatus

Results

Volume was lost in the first hour; during the second and third hour there were increases in volume when compared to the first hour. The mean decrease was significant at the end of the first hour (p-value = 0.000) and at the end of three hours (p-value = 0.014) compared to the initial values. Table 1 shows the volumes before the start of the session and then at hourly intervals. No statistical difference was seen between the second and third hour (Bonferroni alpha correction = 0.008; p-value = 0.01; tab. 2).

Table 1. Volume of the arm before starting mechanical lymph drainage using the RAGodoy® apparatus and at the end of the first, second and third hour

Patient

Initial volume of the arm (ml)

Volume at the end of 1st hour (ml)

Volume at the end of 2nd hour (ml)

Volume at the end of 3rd hour (ml)

Difference between the initial and final volumes (ml)

1

2291

2210

2242

2202

-89

2

1439

1376

1423

1426

-13

3

1698

1532

1536

1619

-79

4

1917

1864

1903

1932

15

5

1993

1896

2009

1998

5

6

1552

1487

1476

1483

-69

7

2649

2536

2561

2596

-53

8

2236

2179

2064

2096

-140

9

2843

2735

2692

2714

-129

10

1657

1562

1598

1662

5

11

1342

1268

1267

1425

83

12

2680

2647

2701

2560

-120

13

2166

2086

2078

2040

-126

Table 2. Statistical analysis of the variations in the arm volume obtained with mechanical lymph drainage employing the RAGodoy® apparatus after applying t-test with a Bonferroni alpha correction of 0.008

Period (hours)

n

Mean

SD

SE

95% CI

T

p-value

0–1

13

83.46

33.72

9.35

(63.08; 103.84)

8.92

0.000*

0–2

13

70.2

63.5

17.6

(31.8; 108.6)

3.99

0.002

0–3

13

54.6

68.8

19.1

(13.0; 96.2)

2.86

0.014

SD — standard deviation, SE — standard error, CI — confidence interval

Conclusion

This study evaluated the use of mechanical lymph drainage using passive flexion and extension movements of the arm to treat lymphedema. A previous pilot study showed that its use reduces the volume of the arm [6], however the objective of this study was to evaluate its continuous intensive use. The results do not suggest that its continuous use for more than one hour is beneficial to the treatment of lymphedema.

An intensive approach using mechanical lymph drainage for 6 to 8 hours per day has been evaluated to treat lymphedema of the lower limbs; this showed that there is a continued reduction of the leg lymphedema during all the treatment session [7, 8]. In an ongoing study, the synergistic effect of the use of a compression mechanism with mechanical drainage is being evaluated with promising preliminary results. However, for arm lymphedema, the continuous use of mechanical lymph drainage for more than one hour is not recommended, however by associating this with manual lymph drainage and compression a continuous reduction can be achieved.

During this study patients reported tiredness after one hour of exercising, perhaps due to sitting for a long time. However, patients have also reported becoming tired while exercising, lying on an exercise mat. These observations are important because they help to define the best way to use the mechanical lymph drainage device. One idea is to have breaks during exercising; this is possible with an intensive association of therapies (active and passive exercises, manual lymph drainage, and compression mechanisms).

Lymphedema of the arms causes a series of complications such as tendonitis and limitations in joint mobility. Therefore, intensive lymphedema treatment should be considered and proposed to these patients. Manual lymph drainage both in isolation and as part of intensive treatment enables rapid reduction in the volume of limbs but becomes very tiring for both the professional and patient. In this way, an association of therapies is an alternative to be considered.

Conclusion

Mechanical lymph drainage of the upper limbs using the RAGodoy® apparatus is more effective in reducing volume during the first hour than in subsequent hours and thus it is not recommended to perform mechanical lymph drainage continuously for periods of more than one hour.

References

  1. Lee B, Andrade M, Bergan J et al (2010) International Union of Phlebology. Diagnosis and treatment of primary lymphedema. Consensus document of the International Union of Phlebology (IUP) ¾ 2009. Int Angiol; 29: 454–470.

  2. de Godoy JM, de Godoy M de F (2010) Godoy & Godoy technique in the treatment of lymphedema for under-pri­vileged populations. Int J Med Sci; 15; 7: 68–71.

  3. Godoy JMP, Godoy MFG (2007) Assessment of inelastic sleeves in patients with upper limb lymphoedema. Indian J Physiotherapy Occup Therapy; 1: 3–5.

  4. Partsch H, Damstra RJ, Mosti G (2011) Dose finding for an optimal compression pressure to reduce chronic edema of the extremities. Int Angiol; 30: 527–533.

  5. Leduc O, Leduc A (2002)Rehabilitation protocol in upper limb lymphedema. Ann Ital Chir; 73: 479–484.

  6. Bordin NA, Guerreiro Godoy M de F, Pereira de Godoy JM (2009) Mechanical lymphatic drainage in the treatment of arm lymphedema. Indian J Cancer; 46: 337–339.

  7. Pereira de Godoy JM, Azoubel LM, Guerreiro de Godoy M de F (2010) Intensive treatment of leg lymphedema. Indian J Dermatol; 55: 144–147.

  8. Pereira de Godoy JM, Amador Franco Brigidio P, Buzato E, Guerreiro de Godoy M de F (2012) Intensive outpatient treatment of elephantiasis. Int Angiol; 31: 494–499.

Adres do korespondencji:

Maria de Fatima Guerreiro Godoy OT, PhD

Avenida Constituição, 1306 São Jose do Rio Preto, SP – Brazil CEP: 15025-120

e-mail: mfggodoy@gmail.com

Acta Angiol Vol. 19, No. 3 pp. 118–120

Copyright © 2013 Via Medica

ISSN 1234–950X

>www.angiologia.pl

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl