Intermittent Pneumatic Compression Dosage for Adults and Children with Lymphedema: A Systematic Review

Area of Science:

• Medical Science
• Rehabilitation Medicine
• Vascular Health

Background:

• Pneumatic compression therapy has been utilized for lymphedema (LE) management for over four decades.
• Optimal treatment parameters and dosage for intermittent pneumatic compression (IPC) lack established consensus.
• Evolution of IPC application modes necessitates a review of current evidence.

Purpose of the Study:

• To systematically review and report evidence on the dosage of intermittent pneumatic compression (IPC) for lymphedema (LE).
• To specifically analyze dosage differences for upper versus lower limbs.
• To compare pediatric versus adult dosage recommendations for IPC in LE management.

Main Methods:

• Comprehensive literature search across Medline, Embase, CINAHL, PubMed, and Scopus for studies on LE and IPC devices.
• Inclusion of reference lists from identified articles.
• Systematic review registration (PROSPERO ID: CRD42017054338) and adherence to PRISMA guidelines.
• Exclusion of non-English, non-human, physiological outcome, or combination therapy studies.
• Quality appraisal using the McMaster University Critical Review Tool by multiple researchers.

Main Results:

• Sixteen studies met inclusion criteria; four were analyzed separately due to concurrent compression garment use.
• One randomized controlled trial achieved Level II evidence; others were Level III-2 or below.
• Recent trends show multichamber sleeve devices using lower pressures and shorter treatment times.
• Limited evidence exists for specific IPC dosages for pediatric populations or particular limbs.
• Newer devices with lower pressures facilitate home use and self-management of LE.

Conclusions:

• Moderate quality, low-level evidence suggests optimal outcomes with sequential IPC programs using pressures of 30-60 mmHg for 45-60 minutes.
• Methodological limitations across the included studies necessitate cautious interpretation of findings.
• Further high-quality research is needed to establish definitive IPC dosage guidelines for lymphedema.