4026c2a342881f785bdbcdde085f67d1 328236.pdf fbe1235b2a37f2a608038fa7fe45aae8d04d8714 328236.pdf 2e87ebf0321e5e85e3be082a9a3f3fc14ff579d74fc71211ed346b7408754a66 328236.pdf Title: Which Physical Therapy Intervention Is Most Effective in Reducing Secondary Lymphedema Associated with Breast Cancer? A Systematic Review and Network Meta-Analysis Subject: Background: Breast cancer-related lymphedema (BCRL) is a common complication that impairs function and quality of life (QoL). The comparative effectiveness of physical therapy interventions (PTIs) remains unclear. This systematic review and network meta-analysis (NMA) was conducted to identify the most effective PTIs for BCRL management. Methods: A systematic search of Medline/PubMed, LILACS, CENTRAL, PEDro, and CINAHL was conducted up to July 2024. Eligible studies were randomized controlled trials (RCTs) involving women with BCRL, evaluating PTIs delivered alone or in combination. Primary outcomes were lymphedema volume, volume reduction, percentage reduction, QoL, and pain. Secondary outcomes included range of motion (ROM), grip strength, and adverse events. A frequentist NMA was performed, and certainty of evidence (CoE) was assessed using the GRADE approach. Results: Eighty-three RCTs were identified, of which twenty-six (1203 participants) were included in the NMA, assessing 23 PTIs. Based on moderate CoE, yoga was among the most effective interventions for improving QoL within 6 months compared to usual standard care (USC). The multimodal approach, with or without a home exercise program, showed intermediate benefits for external rotation and may also improve shoulder abduction (low to moderate CoE). No intervention demonstrated clear superiority over USC for other outcomes. Adverse events were reported with kinesiotaping and compression measures. Conclusions: The evidence supports yoga and multimodal programs as potential short-term strategies for improving QoL and shoulder mobility in women with BCRL. However, the predominance of low-to-very-low CoE underscores the need for individualized clinical decisions and future high-quality RCTs with standardized comparators, larger samples, and longer follow-up. The consistent use of standardized comparators will be crucial in improving network connectivity and enabling more robust and comprehensive comparisons across multiple interventions. Keywords: breast cancer lymphedema; breast cancer treatment-related lymphedema; physical therapy modalities; physical therapy Author: Raúl Alberto Aguilera-Eguía, Pamela Serón, Ruvistay Gutiérrez-Arias, Brenda Herrera-Serna, Víctor Pérez-Galdavini, Gloria Inostroza-Reyes, Cristian Yáñez-Baeza, Héctor Fuentes-Barría, Hellen Belmar Arriagada, Jaqueline Inostroza-Quiroz, Mariana Melo-Lonconao, Miguel Alarcón-Rivera, Mario Muñoz-Bustos, Mónica Pinzón-Bernal, Patricia López-Soto, Ángel Roco-Videla, Lisse Angarita-Dávila, Xavier Bonfill and Carlos Zaror Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Wed Sep 24 15:58:40 2025 CEST ModDate: Wed Sep 24 16:10:49 2025 CEST Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 23 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1120191 bytes Optimized: no PDF version: 1.5 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- BBIFFQ+URWPalladioL-Ital Type 1 Custom yes yes yes 166 0 YVSXPF+URWPalladioL-Bold Type 1 Custom yes yes yes 167 0 BYQXWA+URWPalladioL-Roma Type 1 Custom yes yes yes 168 0 VHXXZC+EURM10 Type 1 Builtin yes yes yes 261 0 JDUPKS+CMSY10 Type 1 Builtin yes yes yes 277 0 ELBHPF+PalatinoLinotype TrueType WinAnsi yes yes no 256 0 ELBHPD+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 257 0 ELBHPF+PalatinoLinotype TrueType WinAnsi yes yes no 398 0 ELBHPF+PalatinoLinotype TrueType WinAnsi yes yes no 409 0 ELBHPG+PalatinoLinotype TrueType MacRoman yes yes no 410 0 HYYHEA+CMBSY10 Type 1 Builtin yes yes yes 433 0 FHMTPE+VnURWPalladioL Type 1 Custom yes yes yes 535 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-05-15 04:30:50 CEST RepresentationInformation: 328236.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-05-14 11:26:00 CEST Size: 1120191 Format: PDF Version: 1.5 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 784 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Materials and Methods Children: Item: Title: Protocol and Registration Item: Title: Eligibility Criteria Item: Title: Treatment Nodes Item: Title: Information and Search Sources Item: Title: Selection Process Item: Title: Data Compiling and Item Processing Item: Title: Risk of Bias and Certainty in the Evaluation of Evidence Item: Title: Data Synthesis Item: Title: Additional Analysis Item: Title: Certainty of Evidence and Conclusions of This Report Item: Title: Results Children: Item: Title: Study Selection Item: Title: Study Characteristics Item: Title: Risk of Bias Within Studies Item: Title: Network Geometry Item: Title: Effects of Interventions Children: Item: Title: Primary Outcomes Item: Title: Secondary Outcomes Item: Title: Results of Additional Analysis Item: Title: Discussion Children: Item: Title: Implications for Practice Item: Title: Strengths and Limitations of This Study Item: Title: Conclusions Item: Title: References Info: Title: Which Physical Therapy Intervention Is Most Effective in Reducing Secondary Lymphedema Associated with Breast Cancer? A Systematic Review and Network Meta-Analysis Author: Raúl Alberto Aguilera-Eguía, Pamela Serón, Ruvistay Gutiérrez-Arias, Brenda Herrera-Serna, Víctor Pérez-Galdavini, Gloria Inostroza-Reyes, Cristian Yáñez-Baeza, Héctor Fuentes-Barría, Hellen Belmar Arriagada, Jaqueline Inostroza-Quiroz, Mariana Melo-Lonconao, Miguel Alarcón-Rivera, Mario Muñoz-Bustos, Mónica Pinzón-Bernal, Patricia López-Soto, Ángel Roco-Videla, Lisse Angarita-Dávila, Xavier Bonfill and Carlos Zaror Subject: Background: Breast cancer-related lymphedema (BCRL) is a common complication that impairs function and quality of life (QoL). The comparative effectiveness of physical therapy interventions (PTIs) remains unclear. This systematic review and network meta-analysis (NMA) was conducted to identify the most effective PTIs for BCRL management. Methods: A systematic search of Medline/PubMed, LILACS, CENTRAL, PEDro, and CINAHL was conducted up to July 2024. Eligible studies were randomized controlled trials (RCTs) involving women with BCRL, evaluating PTIs delivered alone or in combination. Primary outcomes were lymphedema volume, volume reduction, percentage reduction, QoL, and pain. Secondary outcomes included range of motion (ROM), grip strength, and adverse events. A frequentist NMA was performed, and certainty of evidence (CoE) was assessed using the GRADE approach. Results: Eighty-three RCTs were identified, of which twenty-six (1203 participants) were included in the NMA, assessing 23 PTIs. Based on moderate CoE, yoga was among the most effective interventions for improving QoL within 6 months compared to usual standard care (USC). The multimodal approach, with or without a home exercise program, showed intermediate benefits for external rotation and may also improve shoulder abduction (low to moderate CoE). No intervention demonstrated clear superiority over USC for other outcomes. Adverse events were reported with kinesiotaping and compression measures. Conclusions: The evidence supports yoga and multimodal programs as potential short-term strategies for improving QoL and shoulder mobility in women with BCRL. However, the predominance of low-to-very-low CoE underscores the need for individualized clinical decisions and future high-quality RCTs with standardized comparators, larger samples, and longer follow-up. The consistent use of standardized comparators will be crucial in improving network connectivity and enabling more robust and comprehensive comparisons across multiple interventions. Keywords: breast cancer lymphedema; breast cancer treatment-related lymphedema; physical therapy modalities; physical therapy Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Wed Sep 24 15:58:40 CEST 2025 ModDate: Wed Sep 24 16:10:49 CEST 2025 ID: 0x729abd2ac5b6b55d62556dcd7bb75c5f, 0x1671827c02e7190560454a2dcc9106e2 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: HYYHEA+CMBSY10 FontSubset: true FirstChar: 0 LastChar: 0 FontDescriptor: FontName: HYYHEA+CMBSY10 Flags: Symbolic FontBBox: -26, -940, 1332, 825 FontFile: true ToUnicode: true Font: BaseFont: VHXXZC+EURM10 FontSubset: true FirstChar: 28 LastChar: 28 FontDescriptor: FontName: VHXXZC+EURM10 Flags: Symbolic FontBBox: -32, -243, 1060, 720 FontFile: true ToUnicode: true Font: BaseFont: JDUPKS+CMSY10 FontSubset: true FirstChar: 0 LastChar: 6 FontDescriptor: FontName: JDUPKS+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true ToUnicode: true Font: 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