Revisão Produção Nacional Revisado por pares

Effects of Complex Physical Therapy and Multimodal Approaches on Lymphedema Secondary to Breast Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials

2021; Elsevier BV; Volume: 103; Issue: 2 Linguagem: Inglês

10.1016/j.apmr.2021.06.027

ISSN

1532-821X

Autores

Flávia Belavenuto Rangon, Jéssica Daniel Martins da Silva, Almir Vieira Dibai‐Filho, Rinaldo Roberto de Jesus Guirro, Elaine Caldeira de Oliveira Guirro,

Tópico(s)

Myofascial pain diagnosis and treatment

Resumo

Abstract Objective What are the immediate, short-term, and long-term effects of complex physical therapy and multimodal approaches on lymphedema secondary to breast cancer? Data Sources Four electronic databases (MEDLINE, Embase, Cochrane Library, Physiotherapy Evidence Database) were searched from inception up to August 2020. Study Selection Randomized controlled trials comparing complex physical therapy and multimodal approaches to the conservative treatment of lymphedema secondary to breast cancer. Data Extraction Two independent researchers performed data extraction and assessed the risk of bias, respectively, using the predefined form and Cochrane Collaboration of Risk of Bias. The determination of evidence quality was carried out using the Grading of Recommendations Assessment, Development, and Evaluation tools. Data Synthesis Fourteen studies were identified for the systematic review and 11 studies for the meta-analysis with standardized mean difference (SMD), 95% CI, and random-effect model. The common outcomes involved total volume, pain, and physical function of the upper limb. Complex physical therapy has shown a favorable tendency to control outcomes in the short- and long-term. The meta-analysis indicated a small effect for volume reduction (SMD, −0.18; 95% confidence interval [CI], −0.35 to 0.00) and a moderate effect for short-term pain reduction (SMD, −0.61; 95% CI, −1.19 to –0.02). Conclusions High-quality evidence suggests a more significant effect of complex physical therapy on multimodal approaches to the control of the upper limb total volume, substantiating the absence of changes in the current clinical practice in the management of lymphedema secondary to breast cancer. Future research should aim to identify concrete effect of therapeutic modalities in the immediate-, short-, and long-term.

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