Marijke Van Kampen

Effect of manual lymph drainage in addition to guidelines and exercise therapy on arm lymphoedema related to breast cancer: randomised controlled trial.

Objective To determine the preventive effect of manual lymph drainage on the development of lymphoedema related to breast cancer. Design Randomised single blinded controlled trial. Setting University Hospitals Leuven, Leuven, Belgium. Participants 160 consecutive patients with breast cancer and unilateral axillary lymph node dissection. The randomisation was stratified for body mass index (BMI) and axillary irradiation and treatment allocation was concealed. Randomisation was done independently from recruitment and treatment. Baseline characteristics were comparable between the groups. Intervention For six months the intervention group (n=79) performed a treatment programme consisting of guidelines about the prevention of lymphoedema, exercise therapy, and manual lymph drainage. The control group (n=81) performed the same programme without manual lymph drainage. Main outcome measures Cumulative incidence of arm lymphoedema and time to develop arm lymphoedema, defined as an increase in arm volume of 200 mL or more in the value before surgery. Results Four patients in the intervention group and two in the control group were lost to follow-up. At 12 months after surgery, the cumulative incidence rate for arm lymphoedema was comparable between the intervention group (24%) and control group (19%) (odds ratio 1.3, 95% confidence interval 0.6 to 2.9; P=0.45). The time to develop arm lymphoedema was comparable between the two group during the first year after surgery (hazard ratio 1.3, 0.6 to 2.5; P=0.49). The sample size calculation was based on a presumed odds ratio of 0.3, which is not included in the 95% confidence interval. This odds ratio was calculated as (presumed cumulative incidence of lymphoedema in intervention group/presumed cumulative incidence of no lymphoedema in intervention group)×(presumed cumulative incidence of no lymphoedema in control group/presumed cumulative incidence of lymphoedema in control group) or (10/90)×(70/30). Conclusion Manual lymph drainage in addition to guidelines and exercise therapy after axillary lymph node dissection for breast cancer is unlikely to have a medium to large effect in reducing the incidence of arm lymphoedema in the short term. Trial registration Netherlands Trial Register No NTR 1055.

Effectiveness of Postoperative Physical Therapy for Upper-Limb Impairments After Breast Cancer Treatment: A Systematic Review

OBJECTIVE To systematically review the effectiveness of various postoperative physical therapy modalities and timing of physical therapy after treatment of breast cancer on pain and impaired range of motion (ROM) of the upper limb. DATA SOURCES We searched the following databases: PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Physiotherapy Evidence Database, and Cochrane. Articles published until October 2012 were included. STUDY SELECTION Only (pseudo) randomized controlled trials and nonrandomized experimental trials investigating the effectiveness of passive mobilization, manual stretching, myofascial therapy, and/or exercise therapy and timing of physical therapy after treatment for breast cancer are reviewed. Primary outcomes are pain of the upper limb and/or ROM of the shoulder. Secondary outcomes are decreased shoulder strength, arm lymphedema, limitations in activities of daily living, decreased quality of life, and wound drainage volume. Physical therapy modalities had to be started in the first 6 weeks after surgery. DATA EXTRACTION Articles were selected by 2 independent researchers in 3 phases and compared for consensus. First the titles were analyzed, and then the selected abstracts and finally the full texts were reviewed. DATA SYNTHESIS Eighteen randomized controlled trials were included in the review. Three studies investigated the effect of multifactorial therapy: 2 studies confirmed that the combination of general exercises and stretching is effective for the treatment of impaired ROM another study showed that passive mobilization combined with massage had no beneficial effects on pain and impaired ROM. Fifteen studies investigated the effectiveness of a single physical therapy modality. One study of poor quality found evidence supporting the beneficial effects of passive mobilization. The only study investigating the effect of stretching did not find any beneficial effects. No studies were found about the effectiveness of myofascial therapy in the postoperative phase. Five studies found that active exercises were more effective than no therapy or information on the treatment of impairments of the upper limb. Three studies supported the early start of exercises for recovery of shoulder ROM, whereas 4 studies supported the delay of exercises to avoid prolonged wound healing. CONCLUSIONS Multifactorial physical therapy (ie, stretching, exercises) and active exercises were effective to treat postoperative pain and impaired ROM after treatment for breast cancer. High-quality studies are necessary to determine the effectiveness of passive mobilization, stretching, and myofascial therapy as part of the multifactorial treatment. In addition, the appropriate timing and content of the exercise programs need to be further investigated.

Different physical treatment modalities for lymphoedema developing after axillary lymph node dissection for breast cancer: A review

The purpose of this article is to provide a systematic review of Combined Physical Therapy, Intermittent Pneumatic Compression and arm elevation for the treatment of lymphoedema secondary to an axillary dissection for breast cancer. Combined Physical Therapy starts with an intensive phase consisting of skin care, Manual Lymphatic Drainage, exercises and bandaging and continues with a maintenance phase consisting of skin care, exercises, wearing a compression sleeve and Manual Lymphatic Drainage if needed. We have searched the following databases: PubMed/MEDLINE, CINAHL, EMBASE, PEDro and Cochrane. Only (pseudo-) randomised controlled trials and non-randomised experimental trials investigating the effectiveness of Combined Physical Therapy and its different parts, of Intermittent Pneumatic Compression and of arm elevation were included. These physical treatments had to be applied to patients with arm lymphoedema which developed after axillary dissection for breast cancer. Ten randomised controlled trials, one pseudo-randomised controlled trial and four non-randomised experimental trials were found and analysed. Combined Physical Therapy can be considered as an effective treatment modality for lymphoedema. Bandaging the arm is effective, whether its effectiveness is investigated on a heterogeneous group consisting of patients with upper and lower limb lymphoedema from different causes. There is no consensus on the effectiveness of Manual Lymphatic Drainage. The effectiveness of skin care, exercises, wearing a compression sleeve and arm elevation is not investigated by a controlled trial. Intermittent Pneumatic Compression is effective, but once the treatment is interrupted, the lymphoedema volume increases. In conclusion, Combined Physical Therapy is an effective therapy for lymphoedema. However, the effectiveness of its different components remains uncertain. Furthermore, high-quality studies are warranted. The long-term effect of Intermittent Pneumatic Compression and the effect of elevation on lymphoedema are not yet proven.

Prospective evaluation of urinary incontinence, voiding symptoms and quality of life after open and robot-assisted radical prostatectomy.

To compare functional outcomes, i.e. urinary incontinence (UI), voiding symptoms and quality of life, after open (ORP) and robot‐assisted radical prostatectomy (RARP).

Lymphoedema Functioning, Disability and Health Questionnaire (Lymph-ICF): Reliability and Validity

Background Lymphedema occurs frequently after axillary dissection for breast cancer and causes significant physical and psychosocial problems. To plan the treatment for lymphedema and monitor the patients progress, arm swelling and arm function need to be assessed. Objective The purpose of this study was to investigate the reliability (test-retest, internal consistency, measurement variability) and validity (content and construct) of data obtained with the Lymphoedema Functioning, Disability and Health questionnaire (Lymph-ICF). Methods The Lymph-ICF is a descriptive and evaluative tool and consists of 29 questions about impairments in function, activity limitations, and participation restrictions of patients with breast cancer and arm lymphedema. The questionnaire is divided into 5 domains: physical function, mental function, household activities, mobility activities, and life and social activities. Reliability and validity were examined on 60 patients with lymphedema and 30 patients without lymphedema. Results Intraclass correlation coefficients for test-retest reliability ranged from .65 to .93. Cronbach alpha coefficients for internal consistency were higher than .70. There were no systematic changes from the first test to the second test, and measurement variability was acceptable (standard errors of measurement=4.8–12.5). Content validity was good because all questions were understandable for all participants, the scoring system (visual analog scale) was clear for 88% of the participants, and all complaints due to arm lymphedema were mentioned by 85% of the participants. Construct validity was good. There was good convergent validity because 5 expected domains of the Lymph-ICF had the strongest correlation with 5 expected domains of the 36-Item Short-Form Health Survey questionnaire (SF-36). Thus, the 5 hypotheses assessing convergent validity were accepted. There was acceptable divergent validity because 3 of 5 hypotheses assessing divergent validity were accepted. There was good known-groups validity because patients with lymphedema had a higher total score on the Lymph-ICF and had a higher score on each domain and on each question (except one) compared with patients without lymphedema. Conclusion The Lymph-ICF is a reliable and valid questionnaire to assess impairments in function, activity limitations, and participation restrictions of patients with arm lymphedema after axillary dissection for breast cancer.

2014 consensus statement on improving pelvic floor muscle training adherence: International Continence Society 2011 State-of-the-Science Seminar.

To summarize the findings and “expert‐panel” consensus of the State‐of‐the‐Science Seminar on pelvic floor muscle training (PFMT) adherence held prior to the 41st International Continence Society scientific meeting, Glasgow, 2011.

The efficacy of a wetting alarm diaper for toilet training of young healthy children in a day‐care center: A randomized control trial

To evaluate, in a randomized controlled way, the use of a daytime wetting alarm in a day‐care center during three consecutive weeks in healthy children.

Pelvic‐Floor‐Muscle Training Adherence: Tools, Measurements and Strategies—2011 ICS State‐of‐the‐Science Seminar Research Paper II of IV

This paper on pelvic‐floor‐muscle training (PFMT) adherence, the second of four from the International Continence Societys 2011 State‐of‐the‐Science Conference, aims to (1) identify and collate current adherence outcome measures, (2) report the determinants of adherence, (3) report on PFMT adherence strategies, and (4) make actionable clinical and research recommendations.

Influence of Pelvic Floor Muscle Exercises on Full Spectrum Therapy for Nocturnal Enuresis

PURPOSE We investigated the effect of pelvic floor muscle training on the efficacy of full spectrum therapy and maximal voided volume in children with nocturnal enuresis. We also determined factors predicting treatment outcome, full spectrum therapy duration and the relapse rate. Full spectrum therapy is a combination of alarm, reward, timed voiding and drinking, over learning and pelvic floor muscle training. MATERIALS AND METHODS A total of 63 consecutive children were referred to the physiotherapy department for full spectrum therapy to resolve nocturnal enuresis, including 32 in the experimental group who underwent full spectrum therapy with pelvic floor muscle training and 31 in the control group who underwent full spectrum therapy without training. RESULTS There was no significant difference in treatment outcome, duration, maximal voided volume and relapse between the 2 groups. Of all children 89% became dry within 6 months. During the year after treatment 33.3% and 37.9% of the experimental and control groups relapsed, while the relapse rate at 1 year was 7.4% and 20.7%, respectively. Age and child motivation were associated with the duration of success (p = 0.04 and <0.01, respectively). Secondary enuresis and psychosocial problems were factors significantly related to relapse (each p <0.01). CONCLUSIONS There is no beneficial effect of including pelvic floor muscle training in full spectrum therapy. Older children and those with better motivation experienced more rapid success. Factors predicting relapse were secondary enuresis and psychosocial problems.

Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL): Reliability and Validity

Background Patients may develop primary (congenital) or secondary (acquired) lymphedema, causing significant physical and psychosocial problems. To plan treatment for lymphedema and monitor a patients progress, swelling, and problems in functioning associated with lymphedema development should be assessed at baseline and follow-up. Objective The purpose of this study was to investigate the reliability (test-retest, internal consistency, and measurement variability) and validity (content and construct) of data obtained with the Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL). Design This was a multicenter, cross-sectional study. Methods The Lymph-ICF-LL is a descriptive, evaluative tool containing 28 questions about impairments in function, activity limitations, and participation restrictions in patients with lower limb lymphedema. The questionnaire has 5 domains: physical function, mental function, general tasks/household activities, mobility activities, and life domains/social life. The reliability and validity of the Lymph-ICF-LL were examined in 30 participants with objective lower limb lymphedema. Results Intraclass correlation coefficients for test-retest reliability ranged from .69 to .94, and Cronbach alpha coefficients for internal consistency ranged from .82 to .97. Measurement variability was acceptable (standard error of measurement=5.9–12.6). Content validity was good because all questions were understandable for 93% of participants, the scoring system (visual analog scale) was clear, and the questionnaire was comprehensive for 90% of participants. Construct validity was good. All hypotheses for assessing convergent validity and divergent validity were accepted. Limitations The known-groups validity and responsiveness of the Dutch Lymph-ICF-LL and the cross-cultural validity of the English version of the Lymph-ICF-LL were not investigated. Conclusions The Lymph-ICF-LL is a Dutch questionnaire with evidence of reliability and validity for assessing impairments in function, activity limitations, and participation restrictions in people with primary or secondary lower limb lymphedema.