Role of Electro-Therapeutic Modalities in Breast Cancer-Related Lymphedema and Shoulder Dysfunction: A Systematic...

Breast cancer-related lymphedema (BCRL) is one of the most significant complications among survivors, leading to physical as well as psycho-social issues such as pain, joint restriction, heaviness, body image issues, and overall affecting quality of life (QOL). Various electro-therapeutic modalities are being used for its treatment, which is proven to be safe and effective. This systematic review and meta-analysis aimed to explore the evidence of the effectiveness of electro-therapeutic modalities in BCRL and shoulder dysfunction. This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Electronic search was conducted in PubMed, Scopus, physiotherapy evidence database (PEDro) and Cochrane databases for eligible studies. Quality assessment was conducted by the PEDro scale for Randomised Controlled Trials and Modified McMaster Critical Review Form for other studies. The primary outcomes were arm volume, circumference and shoulder range of motion (ROM). Secondary outcome measures were QOL by QOL scale and functional assessment of cancer therapy-breast (FACT-B), and shoulder pain and disability by disability of arm, shoulder and hand (DASH), Quick DASH (Q-DASH) and shoulder pain and disability index. A descriptive synthesis of the studies was done, followed by a meta-analysis carried by Stata version 16 software. Twenty-eight studies were included in the review, and six in the meta-analysis. In summary, we found that electro-therapeutic modalities significantly improve arm volume, arm circumference at wrist level and shoulder ROM of flexion, abduction and external rotation. However, there was no significant improvement in arm circumference below the elbow, the elbow or below the axilla. This systematic review and meta-analysis identified significant improvement in terms of arm volume, circumference, shoulder ROM, shoulder pain and disability and overall QOL in BCRL and shoulder dysfunction. This review recommends the utilisation of these modalities in a clinical setting.