Which Physical Therapy Intervention Is Most Effective in Reducing Secondary Lymphedema Associated with Breast Cancer? A Systematic Review and Network Meta-Analysis
Aguilera, Raúl (Universitat Autònoma de Barcelona. Departament de Medicina)
Seron, Pamela (Universidad de La Frontera (Xile))
Gutierrez-Arias, Ruvistay (Universidad Andres Bello (Xile))
Herrera-Serna, Brenda (Institución Universitaria Visión de las Américas (Colòmbia))
Pérez-Galdavini, Víctor (Universidad Católica de la Santísima Concepción)
Inostroza-Reyes, Gloria (Universidad Católica de la Santísima Concepción)
Yáñez-Baeza, Cristian (Universidad Católica de la Santísima Concepción)
Fuentes-Barría, Héctor (Universidad Andres Bello (Xile))
Arriagada, Hellen Belmar (Universidad Católica de la Santísima Concepción)
Inostroza-Quiroz, Jaqueline (Universidad de la Frontera (Temuco, Xile))
Melo-Lonconao, Mariana (Universidad Católica de la Santísima Concepción)
Alarcón-Rivera, Miguel (Universidad Católica del Maule)
Muñoz-Bustos, Mario (Universidad de Concepción)
Pinzón-Bernal, Mónica (Universidad Autónoma de Manizales (Colòmbia))
López-Soto, Patricia (Universidad Autónoma de Manizales (Colòmbia))
Roco-Videla, Ángel (Universidad Autónoma de Chile)
Angarita-Dávila, Lisse (Universidad Andrés Bello)
Bonfill, X. (Xavier) (Institut de Recerca Sant Pau)
Zaror, Carlos (Universidad de la Frontera (Temuco, Xile))

Date:	2025
Abstract:	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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Breast cancer lymphedema ; Breast cancer treatment-related lymphedema ; Physical therapy modalities ; Physical therapy
Published in:	Journal of clinical medicine, Vol. 14 (September 2025) , art. 6762, ISSN 2077-0383

DOI: 10.3390/jcm14196762
PMID: 41095841

23 p, 1.1 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles