Cancer is a leading cause of death and disability around the world. Of all cancers, breast cancer commonly ranks amongst the top three. Surgical intervention for breast cancer is common and a possible side effect of this is breast cancer related lymphoedema (BCRL). Women with breast cancer related lymphoedema commonly have regional limb swelling and pain, which can negatively impact mental and social well-being as well as upper limb function. Hydrotherapy is therapeutic modality which may be used as an adjunct to self-management strategies after the intensive phase of lymphoedema management. Yet despite its popularity, recent research has questioned its effectiveness in clinical practice.
Purpose: To determine the effectiveness of hydrotherapy as an adjunct treatment to usual care on arm volume and pain when compared with usual care alone for women with breast cancer related lymphoedema.
Method: A comprehensive search of eight electronic databases, including Medline, Embase, CINAHL, Scopus, Web of Science, AMED, The Cochrane Library and PEDro was completed. Studies of adult women with secondary upper limb lymphoedema following breast cancer surgery, which measured lymphoedema volume, pain, upper limb and QOL outcomes were included. Methodological quality was assessed using a modified CASP tool for randomised controlled trials. The NHMRC FORM methodology was utilised to synthesise the evidence and provide an overall grade of recommendation.
Results: Four randomised controlled trials and one controlled clinical trial were included in this systematic review. Critical appraisal of the included studies revealed overall methodological quality to be moderate. Hydrotherapy interventions duration varied between 8 to 12 weeks with some similarities between outcome measures assessed. Collectively, there is mixed evidence to support the positive impact of hydrotherapy as an adjunct treatment on reducing lymphoedema volume in the short-term and emerging evidence for upper limb function, pain and QOL.
Conclusion: A small number of studies have investigated the effect of hydrotherapy as an adjunct treatment in the breast cancer related lymphoedema population. Hydrotherapy could be considered as an adjunct treatment for women with breast cancer related lymphoedema, although the evidence base is mixed. Hydrotherapy may have positive physiological as well psychosocial impacts, as it is delivered in a group setting. However, the current literature base is limited by small sample size, lack of standardised exercise parameters, inadequate baseline characteristic assessment and limited long-term follow-up.
Bills E, Delsar M, O'Donnell S, Rice A, Stone C, Kumar S. Effectiveness of hydrotherapy as an adjunct treatment for the management of breast cancer related lymphoedema in women following breast cancer surgery: a systematic review. The Internet Journal of Allied Health Sciences and Practice. 2017 Nov 03;15(4), Article 12.
Figure 1: PRISMA Flowchart
Hydro_BCRL_with changes.docx (75 kB)
Revised manuscript highlighting the changes
Response to Reviewer comments response_18th July 2017.docx (16 kB)
Response to reviwers comments