The effect of complex decongestive physiotherapy applied with different pressures on skin and subcutaneous tissue thickness, functionality and quality of life in individuals with lymphedema

The aim of this study was to evaluate the effect of compression bandage applied with different pressures on skin and subcutaneous thickness in individuals with breast cancer-related lymphedema. 21 individuals with stage 2 unilateral lymphedema participated in the study. Skin and subcutaneous thicknesses, extremity volumes, circumference measurement of extremities, free extracellular fluid tissue percentage, quality of life, upper extremity function, sleep quality, physical activity levels, treatment benefit, comfort during treatment were evaluated respectively by ultrasound from 6 reference points as dorsum of hand, wrist volar, forearm dorsum, forearm volar, arm dorsum, arm volar, volumetric measurement, dielectric constant, Lymphedema Quality of Life Questionnaire, Q-DASH, Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire Short Form, Patient Benefit Index-Lymphedema, and visual analog scale. Complex decongestive physiotherapy was applied to individuals randomly divided into two groups, low (20-30 mmHg) (n:11) and high bandage pressure (45-55 mmHg) (n:10). Individuals were evaluated before treatment, at 1st, 10th, end of treatment, and at 3 months follow-up. The skin thickness decreased in the volar reference points of the extremity in the high-pressure bandage group and at the dorsal reference points in the low-pressure bandage group (p<0.05). Subcutaneous tissue thickness decreased at all reference points in the high pressure bandage group (p<0.05). Subcutaneous thickness did not decrease in dorsum of the hand and arm in low pressure bandage group (p<0.05). Edema decreased in a shorter time in the high pressure bandage group (p<0.05). Quality of life, upper extremity function, sleep quality, physical activity, treatment benefit and comfort were similar in both groups. As a result of the study, it was observed high pressure was more effective in reducing subcutaneous tissue thickness in the dorsum of the hand and arm, and the effects of high and low bandage pressures were similar at other reference points. We think that the use of 45-55 mmHg pressure can be recommended especially in cases where edema in the dorsum of the hand is difficult to resolve and rapid reduction of edema is desired.