Efficacy of Aquatic Physiotherapy in the Treatment of Upper Limb Lymphedema in Women With Breast Cancer.

Study Overview
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Brief Summary
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This study aims to evaluate the effectiveness of Aquatic Therapeutic Exercise by providing a set of exercises in the reduction and / or control the volume of secondary lymphedema treatment of breast cancer in patients who are in the maintenance phase of conventional treatment. It is an experimental, randomized, unifactorial, and intersubjective study. The intervention group will be treated by guided underwater exercises while the control group will receive the same set of exercises out-of-water. The research will be based on comparing the difference on the volume of lymphedema obtained by the exercises provided aquatic environment and out-of-water exercises. The study population will be obtained from rehabilitation service Bellvitge Hospital. The goal is to evaluate the volume of lymphedema and the quality of life related to the health of patients will be evaluated before starting the treatment, at the end of the 20 sessions, when the treatment reaches 3 months and when patient is discharged.

Detailed Description
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A randomized controlled experimental study has been carried out where two work groups were compared, experimental N: 43 that carried out an exercise regimen designed in the aquatic environment and control N: 47 that carried out the same regimen of exercises in a physiotherapy room. Both groups did 20 treatment sessions of 45 minutes duration with a frequency of 2 or 3 days per week. Lymphedema changes, quality of life and adherence to treatment were evaluated. The evaluations were 3 days prior to the start of the program, at the end of the 20 sessions, and at 3 months.

Official Title
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Efficacy of Aquatic Physiotherapy in the Treatment of Upper Limb Lymphedema in Women With Breast Cancer: a Randomised Controlled Trial.

Conditions
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Breast Cancer Lymphedema

Intervention / Treatment
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* Other: Exercise guideline


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Female gender. Age between 18 and 75 years. Diagnosis of lymphedema in the upper limb secondary to breast cancer treatment. Present mild lymphedema or moderate (types I and II respectively according to the volumetric classification of the types of edema according to severity). Exclusion Criteria: Primary lymphedema or secondary to other surgery. Bilateral lymphedema. Presence of hydrophobia. Severe cardiovascular and respiratory diseases. Urinary and fecal incontinence.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Experimental study randomized controlled
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Aquatic exercise plan in the pool.<br>The experimental group underwent 20 sessions with an aquatic exercise plan in the pool at the rehabilitation department. | Other: Exercise guideline<br>* The experimental group underwent 20 sessions with an aquatic exercise plan in the pool at the rehabilitation department. The control group did the same exercises in one of the rooms in the rehabilitation department, with the same number of sessions. Both groups were guided by a physiotherapist. The main outcome variables were assessed at the start of the study, at the end of the 20 sessions, and at 3 months after completing the sessions.<br>|
| Active Comparator: Exercises in a rehabilitation room.<br>The control group did the same exercises and sessions in one of the rooms in the rehabilitation department. | Other: Exercise guideline<br>* The experimental group underwent 20 sessions with an aquatic exercise plan in the pool at the rehabilitation department. The control group did the same exercises in one of the rooms in the rehabilitation department, with the same number of sessions. Both groups were guided by a physiotherapist. The main outcome variables were assessed at the start of the study, at the end of the 20 sessions, and at 3 months after completing the sessions.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Volume of the affected limb. | The investigators assessed changes in the volume of the affected limb over a specified period of time and possible long-term improvements. The independent variable studied was the effect of exercise in water compared with exercise out of water. The expected outcome (dependent variable) was a reduction or maintenance of the volume of the lymphedema-affected limb. A measuring tape was used to take serial circumferential measurements of both limbs using anatomical reference points on both sides. | 3 days before the start of the program, at 30 days, and at 3 months after completing the sessions. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of life health related. | FACT-B+4 scale: general physical wellbeing, family/social wellbeing, emotional wellbeing, functional wellbeing and additional patient concerns. | 3 days before the start of the program, at 30 days and at 3 months after completing the sessions. | 
| Adherence | Rate of adherence to treatment. Adherence to treatment questionnaire: YES / NO | At 3 months after completing the sessions. | 
| Age. | Possible influence of age and confounding factors. | 3 days before the start of the program. | 
| Severity of lymphedema | Volume of limb. Possible influence and confounding factors. | 3 days before the start of the program, at 30 days and at 3 months after completing the sessions. |