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, 27 (6), 1403-1414

Manual Lymphatic Drainage and Quality of Life in Patients With Lymphoedema and Mixed Oedema: A Systematic Review of Randomised Controlled Trials


Manual Lymphatic Drainage and Quality of Life in Patients With Lymphoedema and Mixed Oedema: A Systematic Review of Randomised Controlled Trials

Martin Müller et al. Qual Life Res.


Purpose: To assess the impact of manual lymphatic drainage (MLD) on the health-related quality of life (HRQoL) of adults with lymphoedema or mixed oedema, through a systematic review of randomised controlled trials (RCTs).

Methods: MEDLINE, EMBASE, PsycINFO, CENTRAL, the Cochrane Database of Systematic Reviews and were searched to identify RCTs evaluating HRQoL after a MLD intervention compared to non-MLD interventions (PROSPERO 2016:CRD42016042255). We extracted the effect of the interventions on the HRQoL (primary outcome) as well as data on volume and functional changes, and adverse events when available (secondary outcomes).

Results: Eight studies were eligible. The studies were heterogeneous in the aetiology of oedema, schemes of MLD applied, additional treatments offered with MLD, length of follow-up, instruments used to assess HRQoL and interventions offered to the control group. Five studies included patients with breast cancer-related arm lymphoedema; one study reported increased HRQoL among patients randomised to the MLD group. The two RCTs that involved patients with leg mixed oedema due to chronic venous insufficiency did not find between-group differences in the overall HRQoL. One trial included patients with hand oedema from systemic sclerosis and showed higher HRQoL in the group that received MLD. No studies reported reductions in HRQoL, or severe adverse events after MLD. The small numbers of patients analysed in all studies may have resulted in lack of power to detect between-group differences in HRQoL.

Conclusions: The effect of MLD on the HRQoL of patients with chronic oedema is unclear.

Keywords: Edema; Musculoskeletal manipulations; Quality of life; Review; Systematic.

Conflict of interest statement

Conflict of interest

The authors declare no conflicts of interest..

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


Fig. 1
Fig. 1
Flowchart of the systematic review process. HRQoL health-related quality of life, MLD manual lymphatic drainage, RCT randomised controlled trial. *No additional studies were identified through screening of the references of the included articles
Fig. 2
Fig. 2
Risk of bias summary. Footnotes: blinding of the patients could not be done due to the nature of the intervention and outcome. The selective reporting category judges the evidence of incomplete reporting of outcomes, time points, subgroups or analyses. Treatment adherence measures whether the prescribed therapy sessions were completed as planned. Quality of MLD categorises the risk of bias due to an incorrect/insufficient MLD intervention (e.g. when applied by unskilled therapists). MLD manual lymphatic drainage; HRQoL health-related quality of life

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