Self-management of lymphedema: A systematic review of the literature from 2004 to 2011

BACKGROUND:: Little is known about the effectiveness of activities used to self-manage lymphedema. OBJECTIVE:: The aim of this study was to evaluate the level of evidence of peer-reviewed lymphedema self-care literature published from January 2004 to May 2011. METHODS:: Eleven major medical databases were searched. Articles were selected for inclusion or exclusion into the category of self-management of lymphedema by topic experts. The definition of self-management included activities that individuals initiate and perform for themselves without the assistance of others. Articles were scored according to the Oncology Nursing Society's Putting Evidence Into Practice levels of evidence. RESULTS:: Sixteen articles met criteria for inclusion in this review, with self-management as the independent variable. Ten categories of self-management were established subsequently and articles were classified by levels of evidence. In these categories, no self-management studies were rated as "recommended for practice," 2 studies were rated "likely to be effective," none was rated "benefits balanced with harms," 7were rated "effectiveness not established," and 1 was rated "effectiveness unlikely." DISCUSSION:: Few studies included measures of outcomes associated with lymphedema, and there was a scarcity of randomized controlled trials in lymphedema self-management. A demonstrated need exists for the design and testing of self-management interventions that include appropriate outcome measures.