A comparison of manual lymphatic drainage to conventional physiotherapy in the management of axillary web syndrome

Abstract

Background: Axillary web syndrome (AWS) is among the most prevalent and unrecognised conditions affecting breast cancer (BC) patients post-operatively. Conventional treatment does not include manual lymphatic drainage (MLD) despite emerging evidence suggesting existing associated benefits. Therefore, an evidence-based study on this subject was considered relevant due to AWS's debilitating effects. The research question: Does MLD in addition to physiotherapy interventions (exercise, stretching and soft tissue techniques) decrease symptoms for BC patients with AWS when compared to physiotherapy interventions only? The PICO elements: Population (P): patients suffering from AWS, Intervention (I): Physiotherapy and MLD, Comparison (C): Physiotherapy only; soft tissue techniques, exercise and stretching, Outcome (O): Decrease in symptoms of AWS. Methods: The PICO framework aided in extracting relevant keywords for an accurate search strategy. Boolean operators, limiters, wild cards and truncations were utilised. The searched databases include EBSCOhost (CINAHL and MEDLINE Complete), PubMed, PEDro, Hydi, Cochrane Library and Scopus. The PRISMA flow diagram provided an auditable trail for the study selection, resulting in five studies for appraisal. Results: Three systematic reviews (SRs) and two randomised controlled trials (RCTs) were critically appraised by the CASP tool (2020) for RCTs and SRs. A significant improvement in AWS symptoms was observed when MLD was included in the intervention in four of the five selected studies. Conclusion: The research question could not be answered accurately due to limitations in available research and their methodologies. Despite this, the findings suggest that MLD can positively affect AWS symptoms. Recommendations and implications: Further research efforts include local studies, larger sample sizes, follow-ups and advanced statistical analysis. The use of MLD may be considered in AWS management. Guidelines including MLD as a possible treatment modality for AWS need to be developed. Healthcare professionals and physiotherapy students require continuous education in AWS management and MLD techniques.