Physical function assessment scales used in rehabilitation for upper limb lymphedema: a scoping review

Figures & data

Table 1. List of the key concepts and search terms.

Key concepts	No.	Search terms
Pathological condition	#1	lymphedema
Treatment	#2	rehabilitation
Site	#3	“upper limb”
	#4	“upper extremity”
	#5	(#3 OR #4)
Physical function	#6	physical
	#7	function*
	#8	performance
	#9	(#6 OR #7 OR #8)
Outcome measurement	#10	outcome
	#11	parameter
	#12	measurement
	#13	task
	#14	assessment
	#15	(#10 OR #11 OR #12 OR #13 OR #14)
search formula	#16	#1 AND #2 AND #5 AND #9 AND #15

Table 2. Synthesis of eligibility article characteristics.

No.	First Author, Year of publication	Study location	Title	Study design	Number of subjects	Intervention	lymphedema measurement
							Circumference	Volume
1	Kim Y, 2023	South Korea	The effect of myofascial release in patients with breast cancer-related lymphedema: a cross-over randomized controlled trial	RCT	30 patients with BCRL	2 groups: (crossover design) Group A: Myofascial release for 4 weeks, followed by 4 weeks of washout period, and then received placebo Myofascial release. Group B: Group B received interventions in the reverse order of Group A.		〇
2	Pajero Otero V, 2022	Spain	Intensive complex physical therapy combined with intermittent pneumatic compression versus Kinesio taping for treating breast cancer-related lymphedema of the upper limb: A randomized cross-over clinical trial	RCT	43 patients with BCRL	2 groups: (crossover design) Group A: Complex physical therapy combined with intermittent pneumatic compression during the first phase of intervention and Kinesio taping during the second phase of intervention. Group B: Group B received the same therapies in the reverse order.		〇
3	Baran E, 2021	Turkey	Upper limb sensory evaluations and ultrasonographic skin measurements in breast cancer-related lymphedema receiving complex decongestive physiotherapy	pretest-posttest design	27 patients with BCRL	All patients underwent complex decongestive physiotherapy phase 1 program for BRCL. Complex decongestive physiotherapy consists of five sessions per week, for 3 weeks (a total of 15 sessions, 60 min per session).		〇
4	Korucu TS, 2021	Turkey	Comparison of Shoulder-Arm Complex Pain, Function, and Scapular Dyskinesia in Women With and Without Unilateral Lymphedema After Breast Cancer Surgery	case-control study	117 patients (patients with BRCL: healthy = 50: 57)	No intervention (Because, observational study)		〇
5	Lampinen R, 2021	USA	Treatment of Breast Cancer-Related Lymphedema Using Negative Pressure Massage: A Pilot Randomized Controlled Trial	RCT	25 patients with BCRL	2 Groups: (single blinded) Group 1: The intervention group received treatment with the negative pressure massage treatment device. Group 2: Group 2 received manual lymph drainage.		〇
6	Sen EI, 2020	Turkey	Manual Lymphatic Drainage May Not Have an Additional Effect on the Intensive Phase of Breast Cancer-Related Lymphedema: A Randomized Controlled Trial	RCT	54 patients with BCRL	2 Groups: The patients in both groups participated in a 15-session program (every weekday for 3 weeks) that included compressive multilayer bandaging and exercise training. Complex decongestive therapy group: The patients in this group received manual lymph drainage (a 45 min to 1 h session) before bandaging in addition to the standard therapy group. Standard therapy group: No manual lymph drainage.		〇
7	Tastaban E, 2020	Turkey	Role of intermittent pneumatic compression in the treatment of breast cancer-related lymphoedema: a randomized controlled trial	RCT	76 patients with BRCL	2 Groups: Group 1: The patients received complex decongestive therapy including skin care, manual lymphatic drainage, multi-layer compression bandaging, and exercise. Group 2: The patients received Group 1 program in combination with intermittent pneumatic compression.		〇
8	Tantawy SA, 2019	Kingdom of Bahrain	Comparative Study Between the Effects of Kinesio Taping and Pressure Garment on Secondary Upper Extremity Lymphedema and Quality of Life Following Mastectomy: A Randomized Controlled Trial	RCT	66 patients with BCRL	2 Groups: Both groups received a home exercise program in the form of range of motion exercises. KT group: This group received Kinesio taping application twice per week. PG group: This group received pressure garment (20–60 mmHg) for at least 15–18 h per day for 3 weeks.	〇
9	Pajero Otero V, 2019	Spain	Kinesio taping versus compression garments for treating breast cancer-related lymphedema: a randomized, cross-over, controlled trial	RCT	30 patients with BCRL	2 Groups: Group A: This group received the intervention with Kinesio taping first which was followed by therapy with compression garments. Group B: This group received the same interventions in the reverse order.		〇
10	Sezgin Ozcan D, 2018	Turkey	Complex Decongestive Therapy Enhances Upper Limb Functions in Patients with Breast Cancer-Related Lymphedema	pretest-posttest design	37 patients with BCRL	Treatment protocol: Treatment protocol Complex decongestive therapy-phase 1 program, consisting of meticulous skin and nail care, MLD, compression bandaging, and remedial exercises, was applied to all participants. All patients received MLD for five times a week during 3 weeks (a total of 15 sessions). Each MLD session lasted 45–60 min.		〇
11	Lee D, 2015	South Korea	Analysis of factors related to arm weakness in patients with breast cancer-related lymphedema	Cross-sectional study	80 patients with BCRL	No intervention (Because, cross-sectional study)	ー	ー
12	Buragadda S, 2015	Saudi Arabia	Effect of complete decongestive therapy and a home program for patients with post mastectomy lymphedema	RCT	60 patients with BCRL	2 Groups: CDT group: This group received manual lymphatic drainage, wore a compression garment for 23 h daily, and performed remedial exercises and a home program. CDT group individuals and occasionally family members received training in self-massage. Conventional treatment group: non home program	〇
13	Dayes IS, 2013	Germany	Randomized trial of decongestive lymphatic therapy for the treatment of lymphedema in women with breast cancer	RCT	95 patients with BCRL	2 Groups: CDT group: This group received for 1 h of manual lymphatic drainage each day. This intervention continued for 4 weeks (5 working days per week) for a total of 20 sessions. Control group: This group was fitted with immediate elastic compression garments consisting of a sleeve (30 to 40 mmHg) and glove and instructed to wear the garments for 12 waking hours per day.		〇
14	King M, 2012	Canada	Compression garments versus compression bandaging in decongestive lymphatic therapy for breast cancer-related lymphedema: a randomized controlled trial	RCT	21 patients with BCRL	2 Groups: Participants received manual lymph drainage massage, followed by skin care, compression glove/sleeve, and exercise. During the initial treatment phase, day, and night, as tolerated. Group 1: wear a compression glove and sleeve Group 2: compression bandages		〇
15	Smoot B, 2010	USA	Upper extremity impairments in women with or without lymphedema following breast cancer treatment	cross-sectional design	144 patients with BCRL	No intervention (Because, cross-sectional study)		〇
16	Didem K, 2005	Turkey	The comparison of two different physiotherapy methods in treatment of lymphedema after breast surgery	RCT	53 patients with BCRL	2 Groups: CDP group: This group served as the experimental group and was treated with CDP applications including manual lymph drainage, compression bandaging, remedial exercises, and skin care. SP group: This group was treated with standard physiotherapy applications including bandaging, elevation, head – neck and shoulder exercises.	〇	〇
No.	Physical function assessment scales							Another measurement tools
	Motion	Strength	Sensory	PROMS	Manual dexterity	Fine motor skill	Other
1	●			●				NRS(pain) Chest mobility FACT-B
2	●			●				Lymphedema-related symptom SQ-TTD-BCRL
3			●					Ultrasonographic
4				●				VAS(heaviness) Pain threshold Observational scapular dyskinesia Lateral scapular test
5				●				Bioimpedance
6				●				VAS Lymph-ICF
7		●		●				VAS(activity pain, rest pain, night pain, heaviness, tightness) Beck Depression Inventory
8		●		●				QLQ-c30
9	●							Lymphedema-related symptom Self-perception of comfort
10	●			●				VAS (pain, heaviness) SF-36
11		●		●				VAS (pain, fear, limitation) Physical activity score
12				●				VAS(pain)
13				●				SF-36
14				●
15	●	●		●	●	●
16	●

RCT: Randomized Controlled Trial, BCRL: Breast Cancer-Related Lymphoedema, VAS: Visual Analogue Scale, NRS: Numerical Rating Scale.

Figure 1. PRISMA flow diagram.

Table 3. Reported physical function assessment scales in upper limb lymphedema.

Category	Assessment scale	Authors (year of publication)
Motion	Range of Motion	Kim Y, et al. (2023) [9]
		Pajero Otero V, et al. (2022) [10]
		Pajero Otero V, et al. (2019) [11]
		Sezgin Ozcan D, et al. (2018) [12]
		Smoot B, et al. (2010) [13]
		Didem K, et al. (2005) [14]
Strength	Grip strength (hand dynamometer)	Tastaban E, et al. (2020) [15]
		Tantawy SA, et al. (2019) [16]
		Lee D, et al. (2015) [17]
		Smoot B, et al. (2010) [13]
	Pinch	Smoot B, et al. (2010) [13]
Sensory	Semmes Weinstein Monofilament test	Baran E, et al. (2021) [18]
		Smoot B, et al. (2010) [13]
	2 point discrimination	Baran E, et al. (2021) [18]
	Pressure pain threshold	Baran E, et al. (2021) [18]
	Tactile localization test	Baran E, et al. (2021) [18]
	Vibration perception threshold	Smoot B, et al. (2010) [13]
Manual dexterity	Purdue Pegboard	Smoot B, et al. (2010) [13]
Fine motor skill	Finger tapper	Smoot B, et al. (2010) [13]
PROMS	DASH	Kim Y, et al. (2023) [9]
		Pajero Otero V, et al. (2022) [10]
		Korucu TS, et al. (2021) [19]
		Lampinen R, et al. (2021) [20]
		Sezgin Ozcan D, et al. (2018) [12]
		Lee D, et al. (2015) [17]
		Buragadda S, et al. (2015) [21]
		Dayes IS, et al. (2013) [22]
		King M, et al. (2012) [23]
		Smoot B, et al. (2010) [13]
	Quick-DASH	Sen EI, et al. (2020) [24]
		Tastaban E, et al. (2020) [15]
	SPADI	Tantawy SA, et al. (2019) [16]

PROMs: Patient Reported Outcome measures, DASH: Disability of the Arm, Shoulder, and Hand, SPADI: Shoulder Pain and Disability Index.

Kim Y, Park EY, Lee H. The effect of myofascial release in patients with breast cancer-related lymphedema: a cross-over randomized controlled trial. Eur J Phys Rehabil Med. 2023;59(1):85–93. doi:10.23736/S1973-9087.22.07698-5

 PubMed Web of Science ®Google Scholar

Pajero Otero V, García Delgado E, Martín Cortijo C, et al. Intensive complex physical therapy combined with intermittent pneumatic compression versus kinesio taping for treating breast cancer-related lymphedema of the upper limb: a randomised cross-over clinical trial. Eur J Cancer Care (Engl). 2022;31(5):e13625. doi:10.1111/ecc.13625

 PubMed Web of Science ®Google Scholar

Pajero Otero V, García Delgado E, Martín Cortijo C, et al. Kinesio taping versus compression garments for treating breast cancer-related lymphedema: a randomized, cross-over, controlled trial. Clin Rehabil. 2019;33(12):1887–1897. doi:10.1177/0269215519874107

 PubMed Web of Science ®Google Scholar

Sezgin Ozcan D, Dalyan M, Unsal Delialioglu S, et al. Complex decongestive therapy enhances upper limb functions in patients with breast cancer-related lymphedema. Lymphat Res Biol. 2018;16(5):446–452. doi:10.1089/lrb.2017.0061

 PubMed Web of Science ®Google Scholar

Smoot B, Wong J, Cooper B, et al. Upper extremity impairments in women with or without lymphedema following breast cancer treatment. J Cancer Surviv. 2010;4(2):167–178. doi:10.1007/s11764-010-0118-x

 PubMed Web of Science ®Google Scholar

Didem K, Ufuk YS, Serdar S, et al. The comparison of two different physiotherapy methods in treatment of lymphedema after breast surgery. Breast Cancer Res Treat. 2005;93(1):49–54. doi:10.1007/s10549-005-3781-2

 PubMed Web of Science ®Google Scholar

Tastaban E, Soyder A, Aydin E, et al. Role of intermittent pneumatic compression in the treatment of breast cancer-related lymphoedema: a randomized controlled trial. Clin Rehabil. 2020;34(2):220–228. doi:10.1177/0269215519888792

 PubMed Web of Science ®Google Scholar

Tantawy SA, Abdelbasset WK, Nambi G, et al. Comparative study between the effects of kinesio taping and pressure garment on secondary upper extremity lymphedema and quality of life following mastectomy: a randomized controlled trial. Integr Cancer Ther. 2019;18:1534735419847276. doi:10.1177/1534735419847276

 Web of Science ®Google Scholar

Lee D, Hwang JH, Chu I, et al. Analysis of factors related to arm weakness in patients with breast cancer-related lymphedema. Support Care Cancer. 2015;23(8):2297–2304. doi:10.1007/s00520-014-2584-6

 PubMed Web of Science ®Google Scholar

Baran E, Özçakar L, Özgül S, et al. Upper limb sensory evaluations and ultrasonographic skin measurements in breast cancer-related lymphedema receiving complex decongestive physiotherapy. Support Care Cancer. 2021;29(11):6545–6553. doi:10.1007/s00520-021-06235-4

 PubMed Web of Science ®Google Scholar

Korucu TS, Ucurum SG, Tastaban E, et al. Comparison of shoulder-arm complex pain, function, and scapular dyskinesia in women with and without unilateral lymphedema after breast cancer surgery. Clin Breast Cancer. 2021;21(3):e285–e293. doi:10.1016/j.clbc.2020.10.008

 PubMed Web of Science ®Google Scholar

Lampinen R, Lee JQ, Leano J, et al. Treatment of breast cancer-related lymphedema using negative pressure massage: a pilot randomized controlled trial. Arch Phys Med Rehabil. 2021;102(8):1465–1472.e2. doi:10.1016/j.apmr.2021.03.022

 PubMed Web of Science ®Google Scholar

Buragadda S, Alhusaini AA, Melam GR, et al. Effect of complete decongestive therapy and a home program for patients with post mastectomy lymphedema. J Phys Ther Sci. 2015;27(9):2743–2748. doi:10.1589/jpts.27.2743

 PubMed Web of Science ®Google Scholar

Dayes IS, Whelan TJ, Julian JA, et al. Randomized trial of decongestive lymphatic therapy for the treatment of lymphedema in women with breast cancer. J Clin Oncol. 2013;31(30):3758–3763. doi:10.1200/JCO.2012.45.7192

 PubMed Web of Science ®Google Scholar

King M, Deveaux A, White H, et al. Compression garments versus compression bandaging in decongestive lymphatic therapy for breast cancer-related lymphedema: a randomized controlled trial. Support Care Cancer. 2012;20(5):1031–1036. doi:10.1007/s00520-011-1178-9

 PubMed Web of Science ®Google Scholar

Sen EI, Arman S, Zure M, et al. Manual lymphatic drainage may not have an additional effect on the intensive phase of breast cancer-related lymphedema: a randomized controlled trial. Lymphat Res Biol. 2021;19(2):141–150. doi:10.1089/lrb.2020.0049

 PubMed Web of Science ®Google Scholar

Data availability statement

Data are available upon reasonable request from corresponding author.