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This Journal Club Podcast is brought to you by Association of Academic Physiatrists and features research published in the American Journal of Physical Medicine & Rehabilitation.

Dr. Andrea Cheville interviews Marie-Eve Letellier, MSc, author of the article entitled "The Effects of Aqua Lymphatic Therapy on Arm Disability, Quality of Life and Pain in Women with Chronic Breast Cancer Related Lymphedema."

OBJECTIVES: Chronic lymphedema occurs frequently in breast cancer patients and is associated with significant morbidity and reduced quality of life (QOL). In this pilot study we: 1) addressed whether conducting a larger RCT of aqua lymphatic therapy (ALT) would be feasible and 2) estimated the extent to which ALT combined with home based exercise, compared to home based exercise alone would reduce arm disability in patients with breast cancer related lymphedema (BCRL).

DESIGN: Twenty five women with BCRL were randomized to either ALT in addition to a home land-based exercise program (ALT group) (n=13) or to a home land-based exercise program alone (control group) (n=12). Participants were evaluated prior to and following a 12-week intervention period comprised of weekly pool exercise sessions. Main outcome measures were arm volume, arm disability, pain and QOL.

RESULTS: At follow-up, there was no statistical difference between the control and ALT groups in any of the outcomes, except for present pain intensity. At the end of study period, there was no change in the lymphedematous limb volume in either group. Grip strength was improved in both groups. Only the ALT group showed a statistical significant difference with a reduction in pain intensity score and arm disability. Furthermore, QOL significantly improved only in the ALT group.

CONCLUSIONS: Conducting a larger RCT would be feasible. In comparison to the beginning of the intervention, participants in the ALT group showed significant beneficial changes after 12 weeks of treatment, while the control group did not improve. ALT did not make the lymphedema volume worse and therefore may serve as a safe alternative to land-based treatments for BCRL.

CONTRIBUTORS

• Marie-Eve Letellier, M.Sc Letellier s a kinesiologist who has training in Combined Decongestive Therapy (Vodder), Aqualymphatic Therapy (Tidhar), and Exercise Therapy following breast cancer (Lebed). After graduating with her masters in kinesiology in 2004, Ms. Letellier started working as a research assistant in breast cancer. This led her to discover the field of arm dysfunction, with a particular interest in lymphedema. She soon realized that there was a lack of awareness and therapists dealing with this issue. She the completed the training to become a lymphedema (Vodder) and aqualymphatic (Tidhar) therapist. In order to gain knowledge in both clinical and research fields, she is currently pursuing a doctoral degree in Rehabilitation Science at McGill University (supervisor: Dr. Nancy Mayo) looking at arm dysfunction after breast cancer. In addition, since 2008, she is in charge of the Kinesiology Clinic at the Cedars Breast Clinic, Royal Victoria Hospital (Montreal, Canada).