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Self-Management of Lymphedema: A Systematic Review of the Literature From 2004 to 2011

Ridner, Sheila H.; Fu, Mei R.; Wanchai, Ausanee; Stewart, Bob R.; Armer, Jane M.; Cormier, Janice N.

doi: 10.1097/NNR.0b013e31824f82b2

Background: Little is known about the effectiveness of activities used to self-manage lymphedema.

Objective: The aim of this study was to evaluate the level of evidence of peer-reviewed lymphedema self-care literature published from January 2004 to May 2011.

Methods: Eleven major medical databases were searched. Articles were selected for inclusion or exclusion into the category of self-management of lymphedema by topic experts. The definition of self-management included activities that individuals initiate and perform for themselves without the assistance of others. Articles were scored according to the Oncology Nursing Society’s Putting Evidence Into Practice levels of evidence.

Results: Sixteen articles met criteria for inclusion in this review, with self-management as the independent variable. Ten categories of self-management were established subsequently and articles were classified by levels of evidence. In these categories, no self-management studies were rated as “recommended for practice,” 2 studies were rated “likely to be effective,” none was rated “benefits balanced with harms,” 7were rated “effectiveness not established,” and 1 was rated “effectiveness unlikely.”

Discussion: Few studies included measures of outcomes associated with lymphedema, and there was a scarcity of randomized controlled trials in lymphedema self-management. A demonstrated need exists for the design and testing of self-management interventions that include appropriate outcome measures.

Sheila H. Ridner, PhD, RN, FAAN, is Associate Professor, School of Nursing, Vanderbilt University, Nashville, Tennessee.

Mei R. Fu, PhD, RN, ACNS-BC, is Assistant Professor, College of Nursing, New York University.

Ausanee Wanchai, RN, is Graduate Research Assistant; Bob R. Stewart, EdD, is Professor Emeritus; and Jane M. Armer, PhD, RN, FAAN, is Professor, Sinclair School of Nursing, University of Missouri, Columbia.

Janice N. Cormier, MD, MPH, is Associate Professor, MD Anderson Cancer Center, University of Texas, Houston.

Accepted for publication February 7, 2012.

On behalf of the American Lymphedema Framework Project, thank you to the Vanderbilt University School of Nursing staff Joey O’Dell and Kandis Smith, Melanie Schneider Austin, and the reference librarians of the University of Missouri for their assistance.

The authors have no funding or conflicts of interest to disclose.

Corresponding author: Sheila H. Ridner, PhD, RN, FAAN, Vanderbilt University, 526 Godchaux Hall, Nashville, TN 37240 (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.