However, not all studies have found a benefit for MLD over standard management for reducing limb volume [38,44].However, MLD as a component of multimodal therapy in the form of complete decongestive therapy does appear to reliably reduce limb volume . In observational studies, the reduction in limb volume ranged from 33 to 68 percent and was associated with improved pain, cosmoses, and/or function [39,40,46-51]. In a small phase III trial, 53 patients with lymphedema after breast cancer treatment were randomly assigned to complete decongestive therapy (MLD, multilayer compression bandaging, elevation, remedial exercise, and skin care) versus standard physiotherapy (bandages, elevation, head-neck and shoulder exercises, and skin care) . The group receiving complete decongestive therapy had a significantly greater improvement in edema as measured by circumferential and volumetric measurements.
However, another trial suggested that the benefit is minimal for complete decongestive therapy compared with compression therapy as a first-line treatment for lymphedema . In this trial, 95 female breast cancer survivors with lymphedema (defined as an absolute increase in arm volume of at least 10 percent between the affected and unaffected arm) were randomly assigned to complete decongestive therapy or the use of compression garments alone. Compared with compression garment use, complete decongestive therapy resulted in a significantly greater absolute reduction in arm volume (250 versus 142 mL), but the mean reduction in arm volume was not significantly different (29 versus 23 percent). There were no differences in severe adverse events, which consisted of a temporary rash or mild to moderate pain in the affected arm.
The following physical therapy services are not considered for payment:
Services not related to the written treatment plan
Services that do not require the professional skills of a physician or a physical therapist to perform or supervise them.