Endermologie Versus Negative Pressure Therapy on Postmastectomy Lymphedema
Condition: Mastectomy; Lymphedema
MeSH terms: Lymphedema; Breast Cancer Lymphedema
Study type: Interventional

Summary: 
      Statement of the problem:

      The problem will be stated in a questionary form:

      "Which will be more effective endermologie or negative pressure therapy in reducing limb
      circumference and volume in postmastectomy lymphedema?".

      Hypothesis:

      It will be hypothesized that:

      There is no significant difference between endermologie and negative pressure therapy in
      reducing circumference and limb volume in post mastectomy lymphedema.
    

Detailed description: 
      Subject:

      Sixty- eight women treated for unilateral breast cancer with secondary upper limb lymphedema
      post mastectomy will participate in this study. Their ages will be ranged from 40 to 60
      years, they will be free from any other diseases that will affect or influence the results
      and the participants will be selected from National Cancer Institute and randomly distributed
      into two equal groups in number.

      Study design:

      In this study the patients will be randomly assigned into two groups equal in number (34
      patients for each group).

      Inclusion Criteria:

      The subject selection will be according to the following criteria:

        -  Only females will participate in the study.

        -  Patients' age will be ranged between 40-60 years.

        -  All patients will suffer from post mastectomy lymph-edema.

        -  All patients have a modified radical mastectomy.

        -  All patients will suffer from grade II lymph edema without skin changes one year post
           mastectomy.

        -  All patients are right-dominant hand.

        -  All patients enrolled to the study have their informed consent.

      Exclusion Criteria:

      The potential participants will be excluded if they meet one of the following criteria:

        -  primary lymph-edema.

        -  Diabetes mellitus.

        -  Pregnancy.

        -  Recurrent cancer.

        -  Current or recent cellulitis.

        -  Current metastases.

        -  Venous thrombosis.

        -  Photosensitivity.

        -  Phlebitis in development stage.

        -  Infection.

        -  Receiving anti-coagulant treatment.

      Equipment:

      The study equipment's will be divided into measurement and therapeutic equipment and tools:

      1: Measurement equipment

      1(a):Limb volume measurement:

      This will be performed by measuring the circumference of each segment of the limb between two
      consecutive circumferences as a truncated zone. The volume of the segment was calculated as:

      V=h (c12+c1c2+c22 )/12π, where V is the volume of the segment, c1 and c2 are the
      circumferences at the ends of the segment, and h is the distance between them.

      Measurement of limb volume measurement will be conducted pre-treatment and after treatment
      course (6 weeks).

        1. (b): Measuring Disability of the arm, shoulder and hand by: .Quick DASH questionnaire
           (Disability of the arm, shoulder, and hand).

             -  The Quick- DASH has five response options for each item from 0=no difficulty to
                perform or no symptoms to 5=unable to do.

             -  Quick DASH scale will be conducted pre-treatment and after treatment course (6
                weeks).

        2. Therapeutic equipment :

      2. a. Endermologie: endermologie therapy will be three sessions per week for six weeks (total
      18 sessions).

      The study group will receive 18 sessions by Endermologie system ( used to decrease
      postmastectomy lymphedema for group (A), three sessions per week for six weeks.

      Each session was 30 minutes at the posterior thorax, upper arm, forearm and the hand.

      2.b. Negative pressure therapy:

        -  Pressure: 20-250 mm Hg.

        -  Total treatment period: six weeks.

        -  A number of sessions: 3 sessions/ week. Time of application : 30 min
    

Intervention name(s): Endermologie; Negative pressure therapy
Intervention type(s): Device; Device
Intervention description(s): Group A will receive -18 sessions by Endermologie system used to decrease postmastectomy lymphedema for group (A), three sessions per week for six weeks.
Each session was 30 minutes at the posterior thorax, upper arm, forearm and the hand.
-In addition to physical therapy program (active range of motion and elevation); hygiene and skin care; Group B will receive negative pressure therapy with
Pressure: 20-250 mmHg.
Total treatment period: 6weeks
A number of sessions: 3sessions/ week. Time of application : 30 min
In addition to physical therapy program (active range of motion and elevation); hygiene and skin care
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment