背景:乳腺癌(BC)是一个主要的公共卫生问题。接受乳腺癌治疗的妇女中,超过五分之一会在上肢出现淋巴水肿。当前证据主张跨学科肿瘤康复。因此,这方面的研究是必要的,因为在这种康复的基本基本组成部分方面已经达成了有限的共识。共识有,然而,使用减充血淋巴水肿治疗(DLT),但是由于缺乏测试,必要的剂量是未知的,其水平是中等强度。本研究试图验证以活动为导向的本体感受性抗水肿治疗(TAPA)的疗效,与DLT或复杂物理治疗(CPT)等常规治疗相比,以及它在成本效益方面的效率,对于受乳腺癌相关手臂淋巴水肿影响的患者。
方法:控制,具有双重分层的随机临床试验,两个平行的臂,纵向和单盲。64名患有乳腺癌相关手臂淋巴水肿的女性将参加这项研究。实验组干预将是相同的阶段I和II,并将包括针对活动的神经动力练习,本体感觉神经肌肉促进活动和本体感觉抗水肿包扎。对照组干预,根据阶段,将包括预防措施,淋巴水肿车间的皮肤护理和运动规定的培训以及压缩服装(第一阶段)或保守的复杂充血疗法治疗(皮肤护理,多层包扎,手动淋巴引流和按摩疗法)(II期)。
结果:将收集社会人口统计学和临床变量,以测量水肿体积和ADL表现。将对意图治疗进行统计分析。
结论:建议将患者培训添加到DLT中,以及重新设计病人的生活方式和促进健康相关方面。此外,应进行临床试验以评估神经动员技术,治疗中应包括本体感觉神经肌肉促进.粘性包扎也将作为压力疗法的早期形式进行。拟议的研究结合了所有这些方面,以增加舒适度并促进个人在日常情况下淋巴水肿的参与。
结论:作者提出了对I期和II期实验治疗的评估。一个可能的限制是缺乏对这种治疗是否对其他阶段有效的认识,以及在使用绷带期间对适当的手部清洁的关注,鉴于目前的COVID-19大流行情况。
背景:该试验已在ClinicalTrials.gov(NCT03762044)中注册。注册日期:2018年11月23日。前瞻性注册。
BACKGROUND: Breast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current evidence advocates transdisciplinary oncological rehabilitation. Therefore, research in this area is necessary since limited consensus having been reached with regard to the basic essential components of this rehabilitation. Consensus has, however, been reached on the use of decongestive lymphedema therapy (DLT), but due to a lack of tests, the necessary dosages are unknown and its level is moderately strong. This study attempts to verify both the efficacy of activity-oriented proprioceptive antiedema therapy (TAPA), as compared to conventional treatments such as DLT or Complex Physical Therapy (CPT), as well as its efficiency in terms of cost-effectiveness, for patients affected by breast cancer-related arm lymphedema.
METHODS: Controlled, randomized clinical trial with dual stratification, two parallel arms, longitudinal and single blind. 64 women with breast cancer-related arm lymphedema will take part in the study. The experimental group intervention will be the same for stage I and II, and will consist of neuro-dynamic exercises oriented to the activity, proprioceptive neuromuscular facilitation activities and proprioceptive anti-edema bandaging. The control group intervention, depending on the stage, will consist of preventive measures, skin care and exercise-prescribed training in the lymphedema workshop as well as compression garments (Stage I) or conservative Complex Decongestive Therapy treatment (skin care, multi-layer bandaging, manual lymphatic drainage and massage therapy) (Stage II).
RESULTS: Sociodemographic and clinical variables will be collected for the measurement of edema volume and ADL performance. Statistical analysis will be performed on intent to treat.
CONCLUSIONS: It has been recommended that patient training be added to DLT, as well as a re-designing of patient lifestyles and the promotion of health-related aspects. In addition, clinical trials should be undertaken to assess neural mobilization techniques and proprioceptive neuromuscular facilitation should be included in the therapy. Cohesive bandaging will also be performed as an early form of pressotherapy. The proposed study combines all of these aspects in order to increased comfort and promote the participation of individuals with lymphedema in everyday situations.
CONCLUSIONS: The authors have proposed the assessment of the experimental treatment for stages I and II. One possible limitation is the lack of awareness of whether or not this treatment would be effective for other stages as well as the concern for proper hand cleansing during use of bandages, given the current COVID-19 pandemic situation.
BACKGROUND: This trial was registered in ClinicalTrials.gov ( NCT03762044 ). Date of registration: 23 November 2018. Prospectively Registered.