Table 2 Data extraction for key questions

Andersen

IG: standard care + MLD + self-massage

1) Limb volume, self-reported SE symptoms

12 month

NR

2000 [21]

(standard care: compression garment + exercise instruction + skin care)

Denmark

2) NS

CG: standard care

Bertelli

IG: sleeve (6 h/day for 6 mths) + IPC (2 cycles of 2 week spaced by 5 week interval

1) Limb circumference ≥ 25% compared to baseline

6 month

NR

1991 [22]

Italy

CG: sleeve (6 h/day for 6 months)

2) NS

Bialoszewski

IG: Kinesiotaping (10 days) + standard physiotherapy (not described)

1) Limb circumference

10 days

NR

2009 [23]

Poland

CG: Lymphatic drainage (1 × /day × 10 days) + standard physiotherapy (not described)

2) Significant reduction in limb circumference with kinesiotaping

Carati

IG: LLLT (9 sessions, 17 min each, 3 × /week × 3 week; 8-week rest and repeat)

1) Limb circumference and volume

24 month

NR

2003 (11)

Australia

CG: Sham LLLT

2) NS

(9 sessions as above; 8-week rest) + 'active' LLLT (as above)

Damstra

IG: Low-stretch bandage

1) Limb volume, pain and discomfort

24 h

Patients with high pressure bandages reported more pain and discomfort

2009 [24]

Netherlands

CG: High-stretch bandage

2) NS (volume)

Didem

IG: MLD + compression garment + exercise + skin care

1) Limb circumference, range of motion

4 week

NR

2005 [25]

Turkey

CG: Physiotherapy (bandage + limb elevation + exercises) + compression garment + exercise + skin care

2) Greater decrease in circumference in IG (p < 0.05), NS (ROM)

Dini

IG: IPC (2 cycles over 2 week; each cycle separated by 5-week interval)

1) Limb circumference

9 week

No harms

1998 [26]

Italy

CG: Skin care, prophylaxis

2) NS

Hayes

IG: Aerobic and resistance exercise (12 week)

1) Bioimpedance, perometry

12 week

Swelling (n = 1)

2009 [27]

Australia

CG: NR

2) NS

Hou

IG: BMSC + compression garment

1) Limb volume, self-reported pain

52 week

NR

2008 [28]

China

CG:CDT (MLD + compression therapy + exercise)

2) Volume and pain reductions greater in BMSC group at 52 week (p < 0.05)

Irdesel

IG: Exercise + compression garment

1) Limb circumference, shoulder range of motion

6 month

NR

2007 [29]

Turkey

CG: Exercise

2) NS

Jahr

IG: low-intensity electrostatic field (2-3 ×/week × 4 week) + MLD

1) Visual analogue pain scale

8 week

NR

2008 [30]

Germany

CG: MLD

2) NS

Johansson

IG: IPC (2 h/day, 5 days/week for 2 week) + compression garment

1) Limb volume

2.5 year

NR

1998 [31]

Sweden

CG: Vodder MLD + compression garment

2) NS

Kaviani

IG: LLLT (3 × /week × 3 week; 8 week interval, then repeat same protocol × 3 week)

1) Limb circumference, visual analogue pain scale

22 week

NR

2006 [32]

Iran

CG: Sham laser

2) IG more efficacious than CG, but authors report no p-values

Kessler

IG: Daily physiotherapy exercises + MLD

1) Limb volume

NR

NR

2003 [33]

Switzerland

CG: Daily physiotherapy exercises

2)% volume reduction-IG vs. CG (6.4% vs. 0.1%, p = 0.011)

Kozanoglu

IG: Laser (20 min/3 × wk × 4 week) + exercise + skin care

1) Limb circumference, visual analogue pain scale, grip strength

12 month

None

2009 [34]

Turkey

CG: IPC (2 h at 60 mmHg ×

2) IG improved over CG on circumference (p = 0.02), pain and grip strength (NS)

20 sessions over 4 week) + exercise + skin care

Lau

IG: LLLT 3 × /week for 4 week

1) Limb volume, tissue resistance, DASH score

8 week

NR

2009 [35]

China

CG: no Tx

2) Mean volume less in IG (p = 0.04), greater tissue resistance in IG at 3 of 4 sites (p < 0.05), DASH (NS)

Maiya

IG: LLLT (34 min/day for 10 days) + exercise (after laser)

1) Limb circumference, pain scale

10 days

None

2008 [36]

India

CG: Compression garment (10 days) + exercise

2) IG improved over CG on both outcomes (p < 0.05)

McKenzie

IG: Stretching, resistance, and aerobic exercise training (3 × /week for 8 week

1) Arm circumference and volume, quality-of-life (SF-36 scale)

8 week

NR

2003 [37]

Canada

CG: No Tx

2) NS (all outcomes)

McNeely

IG: MLD (5 days/week × 4 week) + bandaging

1) Limb circumference and volume

4 week

Skin reaction (n = 1), bandage discomfort (n = 1)

2004 [38]

Canada

CG: Bandaging

2) NS

Pilch

Different IPC protocols (4 groups):

1) Limb volume

5 week

NR

2009 [39]

-single chamber, 90 s on: 90 sec off

Poland

-3 chamber, 90 sec on: 90 sec off

2) NS

-single chamber, 45 sec on: 15 sec off

-3 chamber, 45 sec on: 15 sec off

Radakovic

IG: IPC (60 min/day × 10 days) + compression bandage

1) Change in arm volume (limb circumference)

10 days

NR

1998 [40]

Yugoslavia

CG: MLD (30 min/day × 10 days) + compression bandage

2) Circumference reduction greater in IG vs. CG (2.24 cm vs. 0.95; p < 0.05)

Schmitz

IG: Weight lifting (supervised for13 week, unsupervised for 39 week) + compression garment during exercise

1) Limb volume

12 month

Authors report no serious harms

2009 [41]

U.S.

CG: 1-year fitness membership and 13 week of supervised instruction (not mandatory)

2) NS

(companion Schmitz [42])

Shaw

IG: Dietary advice for weight loss

1) Limb volume

12 week

NR

2007 [43]

U.K.

CG: Healthy eating booklet + compression garment

2) Significant reduction in SE arm volume IG vs. CG (7% vs. 3% reduction: p < 0.05)

Shaw

IG: Weight reduction-reduced energy intake OR low fat diet-no reduced energy intake (2 groups)

1) Limb volume

24 week

NR

2007 [44]

U.K.

CG: No Tx

2) NS

Sitzia

IG: MLD (40-80 min 5 × wk × 2 week)

1) Limb volume

2 week

NR

2002 [45]

U.K.

CG: SLD (20 mins 5 × wk × 2 week)

2) NS

Szuba

IG: MLD (daily, self-administered) + compression garment

1) Limb volume, tonometry, range of motion

6 month

None

2002 [47]

U.S.

CG: As above + IPC (1 h daily at 40-50 mmHg)

2) Greater mean volume reduction with IPC (p < 0.05); NS (tonometry, range of motion)

Szuba

IG: MLD (daily) + IPC (30 min at 40-50 mmHg) + compression garment

1) Limb volume, tonometry

30 days

Repetitive headache and small blood pressure increase during IPC (n = 1)

2002 [46]

U.S.

CG: MLD (daily) + compression garment

2) NS

(Maintenance therapy-IG & CG: compression garment + self-administered MLD)

Tsai

IG: Kinesiotape bandage

1) Limb volume and circumference, symptom severity on visual analogue scales, QoL

3 month

NR

2009 [48]

China

CG: Short-stretch bandage

2) NS

(IG & CG: MLD + IPC + exercise)

Wilburn

IG: IPC (1 h/day)

1) Limb volume, QoL

42 days

NR

2006 [49]

U.S.

CG: Self-message (1 h/day) + compression garment

2) Mean volume reduction greater in IG (-208 ml vs.

+ 52 ml; p = 0.007), NS (QoL)

Williams

IG: MLD (daily × 3 week)

1) Limb volume, caliper creep, dermal thickness, QoL

12 week

NR

2002 [50]

U.K.

CG: SLD (daily × 3 week)

2) NS (limb volume, caliper creep), no intergroup differences reported in article (dermal thickness, QoL)

Observational

Balzarini

IG: Ultrasound

1) Limb volume

12 month

NR

1993 [51]

(2 cycles at 4 month intervals-one cycle = 10-30 min session)

Italy

2) NS

CG: IPC (6 h/day × 5 days once every 4 month for 12 month)

Berlin

IG 1: IPC (90-120 mmHg for 20-30 min 2 × /day 5 day/week) + compression garment (25-50 mmHg × 4 week)

1) Limb volume

5 year

NR

1999 [52]

Sweden

IG 2: IPC (80 mmHg ≥ 20 min/day × 4 week)

2) NS

CG: Compression garment (25-50 mmHg × 4 week)

Brambilla

IG: Compression garment (custom-made, mean pressure = 40 mmHg, worn morning-to-night, changed every 6 month)

1) Limb volume

IG: Mean 66 week

NR

2006 [53]

Italy

CG: No Tx

2) IG: 30/50 mean reduction = 9.3 ml; 20/50 mean increase = 78.7 ml

CG: Mean 64 week

CG: 15/15 mean increase = 29.6 ml

(p < 0.0001 between groups)

Frischenschlager

IG: Psychosocial therapy and exercise (2 h/week × 10 week) + MLD (3 × /day × 10 week) + compression stocking during day

1) Psychic well being and physical complaints scales

10 week

NR

1991 [54]

Austria

CG: As above except for psychosocial therapy

2) Improved psychic well-being in IG (p = 0.02), NS (physical complaints)

Johansson

IG: Compression bandage (2 week) + MLD (45 min/day × 5 days in wk 3)

1) Limb volume, body weight, pain/heaviness/tension using visual analogue scales

19 days

NR

1999 [55]

Sweden

CG: Compression bandage (2 week)

2) NS (mean volume reduction, body weight, pain/heaviness/tension),% volume decrease favored IG (11% vs. 4%; p = 0.04)

Pinell

IG: CDT (MLD + bandaging; MLD modified for patients with axillary or inguinal disease)

1) Limb volume

39 month

NR

2007 [56]

U.S.

CG: As above (no modified MLD)

2) NS