Manual Lymphatic Drainage and Active Exercise Effects on Lymphatic Function Do Not Translate Into Morbidities in Women Who Underwent Breast Cancer Surgery

作者：Freire de Oliveira Mariana Maia; Costa Gurgel Maria Salete; Pace do Amaral Maria Teresa; Amorim Barbara Juarez; Ramos Celso Dario; Almeida Filho Jose Geraldo; de Rezende Laura Ferreira; Zanatta Sarian Luis Otavio

来源：Archives of Physical Medicine and Rehabilitation, 2017, 98(2): 256-263.

DOI：10.1016/j.apmr.2016.06.024

• Breast neoplasms
• Lymphatic system
• Physical therapy modalities
• Rehabilitation

Objective: To evaluate manual lymphatic drainage (MLD) and active exercise effects on lymphatic alterations of the upper limb (UL), range of motion (ROM) of shoulder, and scar complications after breast cancer surgery.
Design: Clinical trial.
Setting: Health care center.
Participants: Women (N=105) undergoing radical breast cancer surgery who were matched for staging, age, and body mass index. Interventions: Women (n=52) were submitted to MLD and 53 to active exercises for UL for 1 month and followed up.
Main Outcome Measures: Shoulder ROM, surgical wound inspection and palpation, UL circumference measurements, and lymphoscintigraphy were performed in preoperative and postoperative periods.
Results: There was no significant difference between groups with regard to wound healing complications, ROM, and UL circumferences. After surgery, 25 (48.1%) of the MLD group and 19 (35.8%) of the active exercise group showed worsening in radiopharmaceutical uptake velocity, whereas 9 (17.3%) of the MILD group and 11(20.8%) of the active exercise group showed improved velocity (P=.445). With regard to uptake intensity, 27 (51.9%) of the MLD group and 21(39.6%) of the active exercise group showed worsening whereas 7 (13.5%) of the MLD group and 7 (13.2%) of the active exercise group showed some improvement (P=.391). The presence of collateral circulation was similar in both groups at both time points evaluated. The active exercise group had a significant increase in postoperative liver absorption (P=.005), and the MLD group had a significant increase in postoperative dermal backflow (P=.024).
Conclusions: MLD and active exercise effects are equivalent with regard to morbidity. Minor changes in lymphatic function associated with either MLD or active exercises were not related to patients' symptoms or signs.

• 出版日期2017-2