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      Conservative treatment of lymphedema: the state of the art Translated title: Tratamento conservador do linfedema: estado da arte

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          Abstract

          This article aims to discuss the possibilities of conservative and non-pharmacological treatments for lymphedema. A non-systematic review of the literature was carried out, including studies involving human subjects with different types of lymphedema. Several approaches to lymphedema treatment have been reported and Complex Decongestive Therapy (CDT) has been considered the most effective treatment for limb lymphedema. Other conservative treatments have been proposed such as Taping, Extracorporeal Shock Wave Therapy, Acupuncture, Photobiomodulation Therapy, Endermologie, Intermittent Pneumatic Compression, and Low-frequency, Low-intensity Electrotherapy. The choice of the therapeutic approach to be employed should consider lymphedema characteristics, the therapist's experience, and the patient's wishes. In addition, since this is a chronic condition, the patient must adhere to the treatment. To this end, the therapeutic proposal may be the key to better control of limb volume.

          Resumo

          Este artigo tem como objetivo discutir as possibilidades de tratamentos conservadores e não medicamentosos para o linfedema. Foi realizada uma revisão não sistemática da literatura, com a inclusão de estudos realizados em humanos com diferentes tipos de linfedema. Várias abordagens de tratamento foram relatadas, sendo a terapia descongestiva complexa considerada o tratamento mais eficaz para o linfedema de membros. Outros tratamentos conservadores foram propostos, como taping, terapia por ondas de choque extracorpórea, acupuntura, fotobiomodulação, endermologia, compressão pneumática intermitente e eletroterapia de baixa intensidade e baixa frequência. A escolha da abordagem terapêutica a ser empregada deve considerar as características do linfedema, a experiência do terapeuta e os desejos do paciente. Além disso, como é uma condição crônica, o paciente deve aderir ao tratamento. Para isso, a proposta terapêutica pode ser a chave para um melhor controle do volume do membro.

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          Most cited references95

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          Lymphedema after Breast Cancer Treatment

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            The Diagnosis and Treatment of Peripheral Lymphedema: 2016 Consensus Document of the International Society of Lymphology.

            (2016)
            This International Society of Lymphology (ISL) Consensus Document is the latest revision of the 1995 Document for the evaluation and management of peripheral lymphedema (1). It is based upon modifications: [A] suggested and published following the 1997 XVI International Congress of Lymphology (ICL) in Madrid, Spain (2), discussed at the 1999 XVII ICL in Chennai, India (3), and considered/ confirmed at the 2000 (ISL) Executive Committee meeting in Hinterzarten, Germany (4); [B] derived from integration of discussions and written comments obtained during and following the 2001 XVIII ICL in Genoa, Italy as modified at the 2003 ISL Executive Committee meeting in Cordoba, Argentina (5); [C] suggested from comments, criticisms, and rebuttals as published in the December 2004 issue of Lymphology (6); [D] discussed in both the 2005 XX ICL in Salvador, Brazil and the 2007 XXI ICL in Shanghai, China and modified at the 2008 Executive Committee meeting in Naples, Italy (7,8);[E] modified from discussions and written comments from the 2009 XXII ICL in Sydney, Australia, the 2011 XXIII ICL in Malmö, Sweden, the 2012 Executive Committee Meetings (9),and [F] from discussions at the 2013 XXIV ICL in Rome, Italy, and the 2015 XXV ICL in San Francisco, USA, as well as multiple written comments and feedback from Executive Committee and other ISL members during the 2016 drafting. The document attempts to amalgamate the broad spectrum of protocols and practices advocated worldwide for the diagnosis and treatment of peripheral lymphedema into a coordinated proclamation representing a “Consensus” of the international community based on various levels of evidence. The document is not meant to override individual clinical considerations for complex patients nor to stifle progress. It is also not meant to be a legal formulation from which variations define medical malpractice. The Society understands that in some clinics the method of treatment derives from national standards while in others access to medical equipment and supplies is limited; therefore the suggested treatments might be impractical. Adaptability and inclusiveness does come at the price that members can rightly be critical of what they see as vagueness or imprecision in definitions, qualifiers in the choice of words (e.g., the use of “may... perhaps... unclear”, etc.) and mentions (albeit without endorsement) of treatment options supported by limited hard data. Most members are frustrated by the reality that NO treatment method has really undergone a satisfactory meta-analysis (let alone rigorous, randomized, stratified, long-term, controlled study). With this understanding, the absence of definitive answers and optimally conducted clinical trials, and with emerging technologies and new approaches and discoveries on the horizon, some degree of uncertainty, ambiguity, and flexibility along with dissatisfaction with current lymphedema evaluation and management is appropriate and to be expected. We continue to struggle to keep the document concise while balancing the need for depth and details. With these considerations in mind, we believe that this 2016 version presents a Consensus that embraces the entire ISL membership, rises above national standards, identifies and stimulates promising areas for future research, and represents the best judgment of the ISL membership on how to approach patients with peripheral lymphedema in the light of currently available evidence. Therefore, the document has been, and should continue to be, challenged and debated in the pages of Lymphology (e.g., as Letters to the Editor) and ideally will remain a continued focal point for robust discussion at local, national and international conferences in lymphology and related disciplines. We further anticipate as experience evolves and new ideas and technologies emerge that this “living document” will undergo further periodic revision and refinement as the practice and conceptual foundations of medicine and specifically lymphology change and advance.
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              Manual lymphatic drainage for lymphedema following breast cancer treatment.

              More than one in five patients who undergo treatment for breast cancer will develop breast cancer-related lymphedema (BCRL). BCRL can occur as a result of breast cancer surgery and/or radiation therapy. BCRL can negatively impact comfort, function, and quality of life (QoL). Manual lymphatic drainage (MLD), a type of hands-on therapy, is frequently used for BCRL and often as part of complex decongestive therapy (CDT). CDT is a fourfold conservative treatment which includes MLD, compression therapy (consisting of compression bandages, compression sleeves, or other types of compression garments), skin care, and lymph-reducing exercises (LREs). Phase 1 of CDT is to reduce swelling; Phase 2 is to maintain the reduced swelling.
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                Author and article information

                Journal
                J Vasc Bras
                J Vasc Bras
                jvb
                Jornal Vascular Brasileiro
                Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV)
                1677-5449
                1677-7301
                11 October 2021
                2021
                : 20
                : e20200091
                Affiliations
                [1 ] originalInstituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil.
                [2 ] originalInstituto Oncofisio, São Paulo, SP, Brasil.
                [3 ] originalUniversidade de São Paulo – USP, Faculdade de Medicina, Departamento de Cirurgia, São Paulo, SP, Brasil.
                Author notes

                Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

                Correspondence Anke Bergmann Instituto Nacional de Câncer Rua André Cavalcante, 37, 3º andar anexo, Centro 20231-050 - Rio de Janeiro (RJ), Brazil Tel.: +55 (21) 3207-6551 E-mail: abergmann@ 123456inca.gov.br

                Author information AB - Physical therapist, PhD in Ciências da Saúde from Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (ENSP/ FIOCRUZ); Researcher at Instituto Nacional de Câncer. JMTB - Physical therapist, PhD in Oncologia, Hospital do Cancer A.C.; Head of Instituto Oncofisio. MFCA - Physician, PhD in Clínica Cirúrgica, Faculdade de Medicina da Universidade de São Paulo; Associate professor, Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo.

                Author contributions Conception and design: AB, JMTB, MFCA Analysis and interpretation: AB, JMTB, MFCA Data collection: AB, JMTB, MFCA Writing the article: AB, JMTB, MFCA Critical revision of the article: AB, JMTB, MFCA Final approval of the article*: AB, JMTB, MFCA Statistical analysis: N/A. Overall responsibility: AB, JMTB, MFCA *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

                Author information
                http://orcid.org/0000-0002-1972-8777
                http://orcid.org/0000-0001-5477-1634
                http://orcid.org/0000-0001-9907-3768
                Article
                jvbAR20200091_EN 00416
                10.1590/1677-5449.200091
                8565523
                34777487
                87340561-f7ff-4d06-ab9e-c05e14c67835
                Copyright© 2021 The authors.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 June 2020
                : 08 October 2020
                Page count
                Figures: 5, Tables: 0, Equations: 0, References: 94
                Categories
                Review Article

                lymphedema,combined modality therapy,physical therapy specialty,rehabilitation,treatment,linfedema,terapia combinada,fisioterapia,reabilitação,tratamento

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