A comprehensive systematic review of the clinical, patient centred and economic effectiveness of manual lymph drainage (MLD) and other forms of massage that aim to improve lymph uptake.

The overall objective of this systematic review is to determine whether the addition of massage improves the physical, psychological and social outcomes in patients at risk of, or with all types and sites of lymphoedema/chronic oedema. There are three specific objectives which are as follows: - What are the clinical benefits of a course of massage or MLD on patients considered at risk of lymphoedema/chronic oedema? In particular, what are the potential benefits in terms of the presence or absence of limb swelling, maintaining a healthy skin condition and the incidence of cellulitis? - What are the benefits to patients of massage and MLD, in terms of symptom reduction, improvements in function and health related qualtiy of life? - What are the economic costs or economic effectiveness of lymphatic massage and other types of massage as delivered by various therapists or professional groups, i.e physiotherapists/nurses vs massage therapists? - Is the addition of MLD/massage to treatment and prevention strategies cost effective? Inclusion criteria Types of participants The review will consider all studies that include patients at risk of developing lymphoedema and those with any type and site of lymphoedema/chronic oedema who received MLD/SLD or any form of massage as an intervention. Studies will include the treatment of adults and children in any care setting (Primary, Secondary or Tertiary care). Animal studies examining the role of MLD will be excluded from this review. Types of intervention(s)/phenomena of interest The types of intervention will consist of the various clinical and economic oriented methods of MLD and other forms of massage (for example, Shiatsu, Swedish massage, etc) on patients. The phenomena of interest will focus on the patient and economic benefit of the use of massage in the management regime. Types of outcomes Three types of outcomes are envisaged as emerging from this systematic review and they reflect its clinical, patient-centred and economic foci: - Clinical outcomes of interest will be: changes in limb volume and shape, skin and subcutaneous tissue changes as assessed by ISL staging and tonometry, bioimpedance, ultrasound and MRI. TRUNCATED AT 350 WORDS