Role of patient adherence in maintenance of results after manipulative therapy for lymphedema.

Lymphedema (LE) is a chronic side effect of cancer therapy occurring when the axilla or groin is extensively treated; subsequently, the affected limb may swell severely. Early therapy may halt the process. We previously published a prospective trial of complete decongestive therapy (CDT) for LE, but some of our data are concerning. Despite good results after initial therapy, girth and volume returned to baseline by the 12-month follow-up in many cases. Thus, although the value of the active therapy is well established, many patients lose that advantage when they are responsible for their own care. CDT consists of treatment and maintenance phases. The former (phase I) includes (1) manual lymphatic drainage (MLD), (2) skin and nail care, (3) compression bandaging, and (4) therapeutic exercise. During active therapy, the patient is seen for 60- to 90-minute treatment sessions daily, 5 days per week. When girth and volume measurements plateau, the patient begins the maintenance phase (phase II). This is self-care, and includes all components of phase I except MLD; however, patients are responsible for their own bandaging. In an IRB-approved retrospective protocol, we assessed the relationship between patients' self-reported compliance with therapy and results posttreatment. Eleven patients underwent CDT and have been seen in follow-up. Patients reporting compliance had significantly better results than those reporting noncompliance (rank sum p= .042). Patient adherence is crucial to maintenance of relief after therapeutic intervention for LE. Further study is ongoing by our team regarding correlates of patient adherence, but clearly patients must remain compliant with therapy for optimal results.