Title: Comparative effects of lymphatic drainage and soft tissue mobilization on pain threshold,
shoulder mobility and quality of life in patients with axillary web syndrome after mastectomy
Version: 1 Date: 27 Sep 2023
Reviewer:  Ricardo Da Silva Alves
Reviewer's report:
Abstract
I see no need to include statistical analysis software in the summary. I suggest removing it.
In which variable was this reduction demonstrated?
In which parameters were no differences evident between the groups.
In which group was this significant reduction demonstrated?
Redo the conclusion after correcting the results.
Introduction
I believe that the manuscript is well founded, however, I missed the authors pointing out a clearer
justification for the need to develop this study with women who had undergone mastectomies.
At the end of the introduction, insert the objective of the study.
In all instruments, is it necessary to inform whether the scale is translated and validated for the
country of origin of the study? How is scoring done? Is there a cutoff point? Higher or lower
score, what does the scale indicate?
Did the authors measure the circumference of the limb before and after, which justifies the
intervention?
Is it necessary to inform which muscle group the upper limb was used for? What was the
member's position when making the assessment? How many repetitions were performed and
rest between repetitions?
How was the upper limb positioned? For example, in a sitting position, the limb hangs next to
the body and when draining due to gravity, the lymph can return to the area again. How was the
positioning of the upper limb adopted?
I suggest reviewing the statistical analysis. Because I see that a condition of two groups and two
times was analyzed, leading to the use of the two-way Anova test. To do this, it is also necessary
to consider whether or not the data violate the assumed sphericity, and use the appropriate tests
if it does or does not.
When using these tests, you may be subject to type 1 errors.
However, the differences in means between the groups in the pre and post moments were carried
out, but I was unable to find the differences between the groups in relation to the intervention.
Review the way in which data and statistical analyzes are presented.
The discussion needs some adjustments.
For example, I missed the authors talking about why after the intervention both groups improved
the variables.
What effects does MLD promote in association with the results found.
The authors report that “. Both treatment plans were clinically effective; Only two outcome
measures, DASH and PSFS in the manual lymphatic drainage group, showed significant effects
that showed the MLD group showed more improvement than the STM group. “ However, with
the statistical methods adopted and data presentation, it is not possible to observe which of the
treatments was more effective, so I suggest redoing the statistics to observe this finding.
Another important point to highlight that both techniques contributed to the improvement may be
associated with the population studied. This generates an important point that can be highlighted
that both techniques improved the evaluated functions. But could this improvement also be
associated with the reduction of lymphedema due to the exercises performed for mastectomy
patients with grade 1 lymphedema. This may be associated to this degree, perhaps strengthening
and stretching exercises can generate soft tissue and skin contractions that generate stimuli in
the lymphatic system, contributing to the reduction of lymphedema.