Clarifying lymphedema treatment

Re: Compression bandages effective for lymphedema treatment: McMaster study
John Mulligan, RMT
November 20, 2013
By John Mulligan, RMT
In regard to your article “Compression bandages effective for lymphedema treatment: McMaster study,” I would like to make a comment. Complex Decongestive Therapy, or CDT, is the established gold standard for the treatment of lymphedema worldwide. As a lymphedema therapist for 15 years I can tell you that I have seen many patients who were given a compression sleeve and glove which did nothing to arrest the development of their lymphedema. The treatment that these patients responded to was CDT, a regimen of regular Manual Lymph Drainage, compression bandaging, decongestive exercise, patient education and meticulous skin care.
CDT as the gold standard for treatment of lymphedema is supported by the International Society of Lymphology, the International Lymphedema Framework, the Canadian Lymphedema Framework, the Lymphology Association of North America and the National Lymphedema Network in the US. The National lymphedema Network also has a position paper on the question of treatment of lymphedema. If you will look up the position papers on the NLN website you will see that the paper on treatment of lymphedema cites over 200 sources.
The headline of the article states that “compression bandages are effective for lymphedema treatment.”  In the study, however, you will see that bandages were used as part of CDT, and that this was compared to the use of elastic sleeves and gloves.
While I do not advocate over-treating patients who are in the very earliest stage of lymphedema, I do recognize that lymphedema is a progressive condition. Patients who have lymphedema that has progressed into Stage 2 require knowledgeable and thorough treatment. (Lymphedema has 4 Stages: Stage 0 or latent; Stage 1, or spontaneously reversible; Stage 2 or spontaneously irreversible, and Stage 3, or elephantiasis.) Patients in the Stage 0 or Stage 1 may find that a compression sleeve adequately addresses their needs. However, the physician and the clinician need to be able to differentiate between the stages of lymphedema to adequately arrive at treatment strategies. The sleeve-and-glove approach to lymphedema therapy as a panacea is an outmoded approach that has resulted in distress and inadequately treated lymphedema.
Please encourage those who have lymphedema to seek out a qualified lymphedema therapist with 135 hours or more training in CDT. Massage therapists should network with the lymphedema therapists in their area to create a referral network to see that patients are adequately assessed for treatment, then treated according to their assessment. If a patient who needs treatment for the lifelong condition of chronic lymphedema receives only a sleeve and a glove, then they should indeed feel that their health care has been compromised.

My colleague at Toronto Physiotherapy, Ryan Davey, ran a blog post about this study in late September, after the study was initially published. I think he offers a concise analysis of what the study actually said. You can read his blog post here.

Thank you.
John Mulligan
Registered Massage Therapist
Certified Lymphedema Therapist
Lymphedema Therapy, Education & Consulting

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