Background: Several conservative (i.e., nonpharmacologic, nonsurgical) treatments exist for secondary\r\nlymphedema. The optimal treatment is unknown. We examined the effectiveness of conservative treatments for\r\nsecondary lymphedema, as well as harms related to these treatments.\r\nMethods: We searched MEDLINE�®, EMBASE�®, Cochrane Central Register of Controlled Trials�®, AMED, and CINAHL\r\nfrom 1990 to January 19, 2010. We obtained English- and non-English-language randomized controlled trials or\r\nobservational studies (with comparison groups) that reported primary effectiveness data on conservative\r\ntreatments for secondary lymphedema. For English-language studies, we extracted data in tabular form and\r\nsummarized the tables descriptively. For non-English-language studies, we summarized the results descriptively and\r\ndiscussed similarities with the English-language studies.\r\nResults: Thirty-six English-language and eight non-English-language studies were included in the review. Most of\r\nthese studies involved upper-limb lymphedema secondary to breast cancer. Despite lymphedemaâ��s chronicity,\r\nlengths of follow-up in most studies were under 6 months. Many trial reports contained inadequate descriptions of\r\nrandomization, blinding, and methods to assess harms. Most observational studies did not control for confounding.\r\nMany studies showed that active treatments reduced the size of lymphatic limbs, although extensive betweenstudy\r\nheterogeneity in areas such as treatment comparisons and protocols, and outcome measures, prevented us\r\nfrom assessing whether any one treatment was superior. This heterogeneity also precluded us from statistically\r\npooling results. Harms were rare (< 1% incidence) and mostly minor (e.g., headache, arm pain).\r\nConclusions: The literature contains no evidence to suggest the most effective treatment for secondary\r\nlymphedema. Harms are few and unlikely to cause major clinical problems.
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