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Drenaje linfático manual para el linfedema posterior al tratamiento del cáncer de mama

Appendices

Appendix 1. Medline Search Strategy

# ▲

Searches

1

randomised controlled trial.pt.

2

randomized controlled trial.pt.

3

controlled clinical trial.pt.

4

randomized.ti,ab.

5

randomised.ti,ab.

6

placebo.ti,ab.

7

randomly.ti,ab.

8

trial.ti,ab.

9

groups.ti,ab.

10

drug therapy.sh.

11

1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10

12

exp Lymphedema/

13

lymphedema.mp.

14

lymphoedema.mp.

15

exp Edema/ and exp Arm/

16

(arm adj2 edema).mp.

17

(arm adj2 oedema).mp.

18

upper extremity edema.mp.

19

upper extremity oedema.mp.

20

lymphedemic.mp.

21

lymphoedemic.mp.

22

12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21

23

complete decongestive therapy.mp.

24

conservative treatment.mp.

25

complete decongestive physiotherapy.mp.

26

CDP.mp.

27

manual lymphatic drainage.mp.

28

MLD.mp.

29

sequential pneumatic compression.mp.

30

complex decongestive therapy.mp.

31

decongestive lymphatic therapy.mp.

32

Foldi method.mp.

33

Vodder method.mp.

34

exp Drainage/ and exp Lymphedema/

35

((complete or complex) adj5 decongestive therap*).mp.

36

(complete adj5 decongestive physiotherap*).mp.

37

(decongestive adj5 lymphatic therap*).mp.

38

(manual adj2 lymphatic adj2 drain* adj5 therap*).mp.

39

(manual adj2 lymphatic adj2 drain*).mp.

40

exp Massage/

41

massage.mp.

42

exp Compression Bandages/

43

compression garment.mp.

44

compression hosiery.mp.

45

compression bandage*.mp.

46

compression therap*.mp.

47

23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or 45 or 46

48

11 and 22 and 47

49

Animals/

50

Humans/

51

49 not 50

52

48 not 51

Appendix 2. CENTRAL Search Strategy

#1 MeSH descriptor: [Lymphedema] explode all trees

#2 lymphoedema* or lymphedema* or lymphatic oedema* or lymphatic edema* or oedema* or edema* or arm oedema or arm edema or upper extremity oedema or upper extremity edema or lymphoedemic or lymphedemic

#3 #1 and #2

#4 complete decongestive therap* or conservative treatment or complete decongestive physiotherap* or CDP or manual lymphatic drain* or MLD or sequential pneumatic compression or complex decongestive therap* or decongestive lymphatic therap* or Foldi method or Vodder method or massage or compression bandag* or compression garment* or compression hosiery or compression therap*

#5 MeSH descriptor: [Massage] explode all trees

#6 #4 or #5

#7 #3 and #6

Appendix 3. EMBASE Search Strategy

#1

random* OR factorial* OR crossover* OR cross AND over* OR placebo* OR (doubl* AND blind*) OR (singl* AND blind*) OR assign* OR allocat* OR volunteer* OR 'crossover procedure'/exp OR 'double blind procedure'/exp OR 'randomized controlled trial'/exp OR 'single blind procedure'/exp

#2

'lymphoedema'/exp OR lymphoedema

#3

'lymphedema'/exp OR lymphedema

#4

'arm edema'/exp OR 'arm edema'

#5

'arm oedema'

#6

arm NEAR/3 (oedema OR edema)

#7

'upper extremity edema'

#8

'upper extremity oedema'

#9

lymphedemic

#10

lymphoedemic

#11

#2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10

#12

'complete decongestive therapy'

#13

'conservative treatment'/exp OR 'conservative treatment'

#14

'complete decongestive physiotherapy'

#15

'cdp'/exp OR cdp

#16

'manual lymphatic drainage'

#17

mld

#18

'sequential pneumatic compression'

#19

'complex decongestive therapy'

#20

'decongestive lymphatic therapy'

#21

'foldi method'

#22

'vodder method'

#23

'lymphatic drainage'/exp OR 'lymphatic drainage'

#24

(complex OR complete) NEAR/5 'decongestive therapy'

#25

complete NEAR/5 'decongestive physiotherapy'

#26

decongestive NEAR/5 'lymphatic therapy'

#27

'manual lymphatic drainage therapy'

#28

'manual lymphatic drainage'

#29

'massage'/exp OR massage

#30

'compression bandages'/exp OR 'compression bandages'

#31

'compression garment'/exp OR 'compression garment'

#32

'compression hosiery'

#33

'compression bandage'/exp OR 'compression bandage'

#34

'compression therapy'/exp OR 'compression therapy'

#35

#12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34

#36

#1 AND #11 AND #35

#37

#36 AND [humans]/lim AND [embase]/lim

Appendix 4. WHO ICTRP Search Strategy

Basic Searches:

1. Complete decongestive therapy for lymphedema following breast cancer treatment

2. Complete decongestive therapy AND lymphoedema

3. Complete decongestive therapy AND lymphedema

Advanced Searches:

1. Title: complete decongestive therapy for lymphedema following breast cancer treatment

Recruitment Status: ALL

2. Title: complete decongestive therapy for lymphoedema following breast cancer treatment

Recruitment Status: ALL

3. Condition: lymphoedema*

Intervention: complete decongestive therapy OR conservative treatment OR complete decongestive physiotherapy OR CDP OR manual lymphatic drainage OR MLD OR sequential pneumatic compression OR complex decongestive therapy OR decongestive lymphatic therapy OR Foldi method OR Vodder method

Recruitment Status: ALL

4. Condition: lymphedema*

Intervention: complete decongestive therapy OR conservative treatment OR complete decongestive physiotherapy OR CDP OR manual lymphatic drainage OR MLD OR sequential pneumatic compression OR complex decongestive therapy OR decongestive lymphatic therapy OR Foldi method OR Vodder method

Recruitment Status:

ALL

Study flow diagram for review.
Figuras y tablas -
Figure 1

Study flow diagram for review.

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Forest plot of comparison: 1 MLD + Compression bandaging VS Compression bandaging alone for Immediate Follow Up, outcome: 1.1 Lymphedema Volume (Excess volume remaining in limb after treatment).
Figuras y tablas -
Figure 3

Forest plot of comparison: 1 MLD + Compression bandaging VS Compression bandaging alone for Immediate Follow Up, outcome: 1.1 Lymphedema Volume (Excess volume remaining in limb after treatment).

Forest plot of comparison: 1 MLD + Compression bandaging VS Compression bandaging alone for Immediate Follow Up, outcome: 1.2 Volume reduction in mL.
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 MLD + Compression bandaging VS Compression bandaging alone for Immediate Follow Up, outcome: 1.2 Volume reduction in mL.

Forest plot of comparison: 1 MLD + Compression bandaging VS Compression bandaging alone for Immediate Follow Up, outcome: 1.3 Per cent change.
Figuras y tablas -
Figure 5

Forest plot of comparison: 1 MLD + Compression bandaging VS Compression bandaging alone for Immediate Follow Up, outcome: 1.3 Per cent change.

Forest plot of comparison: 2 MLD + Compression therapy vs Other treatment + Compression therapy, outcome: 2.1 Lymphedema volume (excess volume remaining in limb after treatment).
Figuras y tablas -
Figure 6

Forest plot of comparison: 2 MLD + Compression therapy vs Other treatment + Compression therapy, outcome: 2.1 Lymphedema volume (excess volume remaining in limb after treatment).

Forest plot of comparison: 2 MLD + Compression therapy vs Other treatment + Compression therapy, outcome: 2.2 Volume reduction in mL.
Figuras y tablas -
Figure 7

Forest plot of comparison: 2 MLD + Compression therapy vs Other treatment + Compression therapy, outcome: 2.2 Volume reduction in mL.

Forest plot of comparison: 2 MLD + Compression therapy vs Other treatment + Compression therapy, outcome: 2.3 Per cent change.
Figuras y tablas -
Figure 8

Forest plot of comparison: 2 MLD + Compression therapy vs Other treatment + Compression therapy, outcome: 2.3 Per cent change.

Comparison 1 MLD + Compression bandaging VS Compression bandaging alone for Immediate Follow Up, Outcome 1 Lymphedema Volume (Excess volume remaining in limb after treatment).
Figuras y tablas -
Analysis 1.1

Comparison 1 MLD + Compression bandaging VS Compression bandaging alone for Immediate Follow Up, Outcome 1 Lymphedema Volume (Excess volume remaining in limb after treatment).

Comparison 1 MLD + Compression bandaging VS Compression bandaging alone for Immediate Follow Up, Outcome 2 Volume reduction in mL.
Figuras y tablas -
Analysis 1.2

Comparison 1 MLD + Compression bandaging VS Compression bandaging alone for Immediate Follow Up, Outcome 2 Volume reduction in mL.

Comparison 1 MLD + Compression bandaging VS Compression bandaging alone for Immediate Follow Up, Outcome 3 Per cent change.
Figuras y tablas -
Analysis 1.3

Comparison 1 MLD + Compression bandaging VS Compression bandaging alone for Immediate Follow Up, Outcome 3 Per cent change.

Comparison 2 MLD + Compression therapy vs Other treatment + Compression therapy, Outcome 1 Lymphedema volume (excess volume remaining in limb after treatment).
Figuras y tablas -
Analysis 2.1

Comparison 2 MLD + Compression therapy vs Other treatment + Compression therapy, Outcome 1 Lymphedema volume (excess volume remaining in limb after treatment).

Comparison 2 MLD + Compression therapy vs Other treatment + Compression therapy, Outcome 2 Volume reduction in mL.
Figuras y tablas -
Analysis 2.2

Comparison 2 MLD + Compression therapy vs Other treatment + Compression therapy, Outcome 2 Volume reduction in mL.

Comparison 2 MLD + Compression therapy vs Other treatment + Compression therapy, Outcome 3 Per cent change.
Figuras y tablas -
Analysis 2.3

Comparison 2 MLD + Compression therapy vs Other treatment + Compression therapy, Outcome 3 Per cent change.

Table 1. Volumetric Definitions and Formulae

Volumetric Outcome

Definition / Explanation

Formula

Other terms for this outcome in the included studies

Lymphedema Volume

The excess volume in the limb. The volume is measured in milliliters (mL). It is called ‘lymphedema volume’ because it is the amount of the limb volume that is attributed to lymphedema. Lymphedema volume is NOT the total volume of the limb. To calculate the lymphedema volume, you have to compare the affected limb to the unaffected limb by subtracting. In this review, we are interested in the lymphedema volume (or excess volume) that remains in the limb after treatment.

Post‐treatment total volume of the affected arm minus post‐treatment total volume of the unaffected arm.

Lymphedema volume

has also been called absolute lymphedema volume, post‐intervention volume (McNeely 2004), and excess limb volume (Williams 2002)

Volume Reduction

An estimate of how much the limb has been reduced (in ml) presumably from the treatment.

Lymphedema volume at baseline minus the lymphedema volume after treatment.

OR

Excess volume before treatment minus the excess volume after treatment.

Volume reduction

has also been called the mean lymphedema volume reduction (Johansson 1998; Johansson 1999) and mean change lymphedema volume (McNeely 2004)

Per cent Reduction

The decrease in excess volume relative to the amount of excess volume at baseline. Both the lymphedema volume and the volume reduction are considered absolute values not relative values. However, when absolute values are used, a person with a large excess limb volume might get a 2% reduction, but the amount can look large because the beginning volume was large. By contrast, a person with a small beginning volume, can get a 30% reduction, and it can look small in absolute terms. Thus, it is valuable to have a third way to think about lymphedema outcomes, and that is to look at the per cent change because that is a relative value.

Difference Test A – Difference Test B

____________________________________ x 100

Difference Test A

Where difference is the affected arm volume minus the unaffected arm volume (McNeely 2004)

Another way to think of per cent reduction is this formula:

Excess volume at baseline – Excess volume post‐treatment

______________________________________________x100

Excess volume at baseline

Per cent Reduction has also been called the percentage lymphedema reduction (Johansson 1998; Johansson 1999), per cent change, per cent reduction in lymphedema volume (McNeely 2004), percentage change in excess limb volume (Sitzia 2002)

Figuras y tablas -
Table 1. Volumetric Definitions and Formulae
Comparison 1. MLD + Compression bandaging VS Compression bandaging alone for Immediate Follow Up

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Lymphedema Volume (Excess volume remaining in limb after treatment) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 MLD + Compression bandaging vs Compression bandaging alone

2

83

Mean Difference (IV, Fixed, 95% CI)

‐60.73 [‐194.43, 72.96]

2 Volume reduction in mL Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 MLD + Compression bandaging vs Compression bandaging alone

2

83

Mean Difference (IV, Fixed, 95% CI)

26.21 [‐1.04, 53.45]

3 Per cent change Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 MLD + Compression bandaging vs Compression bandaging alone

2

83

Mean Difference (IV, Fixed, 95% CI)

7.11 [1.75, 12.47]

Figuras y tablas -
Comparison 1. MLD + Compression bandaging VS Compression bandaging alone for Immediate Follow Up
Comparison 2. MLD + Compression therapy vs Other treatment + Compression therapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Lymphedema volume (excess volume remaining in limb after treatment) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 MLD + Compression sleeve vs SLD + Compression sleeve

1

31

Mean Difference (IV, Fixed, 95% CI)

‐230.0 [‐450.84, ‐9.16]

1.2 MLD + Compression sleeve vs Intermittent Sequential Pneumatic Pump + Compression sleeve

1

24

Mean Difference (IV, Fixed, 95% CI)

122.0 [‐57.59, 301.59]

2 Volume reduction in mL Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 MLD + Compression sleeve vs SLD + Compression sleeve

1

31

Mean Difference (IV, Fixed, 95% CI)

10.0 [‐90.54, 110.54]

2.2 MLD + Compression sleeve vs Intermittent sequential pneumatic pump + Compression sleeve

1

24

Mean Difference (IV, Fixed, 95% CI)

47.0 [15.25, 78.75]

3 Per cent change Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 MLD + Compression bandaging vs SLD + Compression bandaging

1

28

Mean Difference (IV, Fixed, 95% CI)

11.80 [‐2.47, 26.07]

3.2 MLD + Compression sleeve vs SLD + Compression sleeve

1

31

Mean Difference (IV, Fixed, 95% CI)

‐2.40 [‐14.11, 9.31]

3.3 MLD + Compression sleeve vs. Intermittent Sequential Pneumatic Pump + Compression sleeve

1

24

Mean Difference (IV, Fixed, 95% CI)

8.0 [‐0.75, 16.75]

Figuras y tablas -
Comparison 2. MLD + Compression therapy vs Other treatment + Compression therapy