The effect of adding respiratory physiotherapy to common physiotherapy on patients with lymphedema

INTERVENTION: Intervention 1: Control group: The Complete Decongestive Therapy of lymphedema is given to the patient which includes: Manual lymphatic Drainage , exercises (stretching and proprioceptive neuromuscular facilitation that repeats in 3 sets of 10 times), skin care and garment (compression sleeve). 12 treatment sessions (4 treatment weeks with a frequency of 3 times a week) and in each session 30 minutes of lymphatic massage and 10 minutes of exercise are performed. Intervention 2: Intervention group: The Common treatment of lymphedema is given to the patient along with the correction of the breathing pattern. 12 treatment sessions (4 weeks of treatment with a frequency of 3 times a week) and each session includes 30 minutes of lymphatic massage and 10 minutes of exercise. The treatment for correcting the breathing pattern includes: breathing exercises (3 diaphragmatic breathing exercises, chest mobilization and butterfly breathing technique) in all sessions 10 times and the person will be taught how to do it at home. In patients who suffer from surgery (chest surgery), the movement of the ribs is limited, the rhythm of breathing is affected, and accessory muscles replace the main muscles. For this reason, one of the essential treatments is diaphragmatic breathing training, exercise to facilitate chest movement and improve breathing pattern. These exercises do not require equipment, they are taught by the therapist, and the patient will perform them at home in addition to the treatment session. CONDITION: I97.2 Upper limb lymphedema after breast cancer. ; Postmastectomy lymphedema syndrome PRIMARY OUTCOME: Arterial carbon dioxide pressure(PaCO2) (biochemical lung function test). Timepoint: Before, immediately and one month after the treatment. Method of measurement: capnograph. Arterial oxygen concentration(PaO2) (biochemical lung function test). Timepoint: Before, immediately and one month after the treatment. Method of measurement: capnograph. Breathing Forced Expiratory Volume in First second(FEV1) (Volumetric lung function test). Timepoint: Before, immediately and one month after the treatment. Method of measurement: Spirometer. Circumference size of upper limb. Timepoint: Before, immediately and one month after the treatment. Method of measurement: meter. End‐expiratory carbon dioxide concentration(End Tidal CO2) (biochemical lung function test). Timepoint: Before, immediately and one month after the treatment. Method of measurement: capnograph. Forced Vital Capacity of breathing(FVC) (Volumetric lung function test). Timepoint: Before, immediately and one month after the treatment. Method of measurement: Spirometer. Pain. Timepoint: Before, immediately and one month after the treatment. Method of measurement: Visual Analog Scale. Respiratory rate (biochemical lung function test). Timepoint: Before, immediately and one month after the treatment. Method of measurement: capnograph. Vital Capacity of breathing(VC) (Volumetric lung function test). Timepoint: Before, immediately and one month after the treatment. Method of measurement: Spirometer. SECONDARY OUTCOME: Quality Of Life(QOL). Timepoint: Before the intervention, immediately and one month after the end of the intervention. Method of measurement: lymphedema life impact scale Questionnaire (LLIS). Range Of Motion(ROM). Timepoint: Before the intervention, immediately and one month after the end of the intervention. Method of measurement: Goniometer. INCLUSION CRITERIA: Patients with breast cancer who had axillary lymph node surgery with and without radiotherapy or taxane chemotherapy or unilateral mastectomy First‐degree unilateral lymphedema according to the lymphology assembly Age 32 to 80 years Body mass inde Xless than 30 The difference in the measured points between two organs should be between 2 and 8 cm at least in one point of the organ