A comparison of LymphaTouch® with standard manual lymphatic drainage for secondary arm lymphoedema

The aim of this project is to determine if a single session of LymphaTouch® treatment is as effective, than standard manual lymphatic drainage (MLD) in improving lymphoedema outcomes, such as limb size and tissue softness as well as participant satisfaction with the treatment. Brief description of LymphaTouch: LymphaTouch, also known as PhysioTouch, is a hand-held massage device that uses negative pressure for lymphatic drainage. Being created in 2009 in Finland, the mechanism of action is opposite to MLD as rather than a positive or pushing force being applied to the tissues, a negative force or lifting force, is applied to the tissues. By creating changes in local tissue pressure lymphatic vessels it is theorised that local lymphatic vessels can be opened with improved flow rates. Case studies and small case series on patients with lymphoedema have shown positive treatment outcomes in patients with lymphoedema. Negative pressure technology is well documented in chronic wound management. Apart from vacuum assisted closure of the wounds, tissue healing has been shown to be promoted through controlling inflammation and improving the inflammatory properties of the tissues. This is relevant in lymphoedema considering that tissue inflammation in lymphoedema contributes to fibrosis, fat deposition and cellulitis risk. Brief description of MLD: MLD uses a series of manual massage techniques that involve light strokes designed to move fluid through the superficial lymphatic capillary network. A “central reservoir” is created by clearing areas that are further most away from the congestion before working on areas of congestion. Who will deliver the treatment intervention: Treatments will occur immediately after randomisation and last for approximately 30 to 60 minutes, depending on group allocation. The LymphaTouch treatment will be completed by one RA, an experienced Lymphoedema Physiotherapist trained in Finland on the LymphaTouch technique. The MLD will be performed by a RA trained in MLD technique. Both RA will base the treatment on standard clinical protocols. For LymphaTouch, the manufacturing company, HLD, has provided a drainage protocol for arm drainage, fibrosis and scars treatment. Setting parameters are defined in this guideline. Treatment titration: As part of the assessment the participant elects areas of the arm or trunk that feel most firm and/or swollen. Within the given treatment time allocation, the RA may elect to focus more time on this area, as fitting within the standard setting parameters of the treatment protocols. If any pain or discomfort is reported by the participant, the LymphaTouch dosage will be reduced until pain or discomfort is no longer experienced. If this occurs, this is to be documented as part of this participant’s treatment record. Intervention adherence: No additional adherence required. Participants will return 24 to 48 hours later to undergo follow-up assessments by a RA blinded to treatment group. The participant self reports whether they abided by their "usual lymphoedema management regime" following the treatment.