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The effectiveness and safety of heat/cold therapy in adults with lymphoedema: systematic review - PubMed

Review

The effectiveness and safety of heat/cold therapy in adults with lymphoedema: systematic review

J E Hill et al. Disabil Rehabil. 2024 Jun.

Abstract

Purpose: The aim of this review is to assess the efficacy and safety of using heat and cold therapy for adults with lymphoedema.

Methods: A multi-database search was undertaken. Only studies which included adults with lymphoedema who were treated with heat or cold therapy reporting any outcome were included. Screening, data extraction, and assessment of bias were undertaken by a single reviewer and verified by a second. Due to the substantial heterogeneity, a descriptive synthesis was undertaken.

Results: Eighteen studies were included. All nine studies which assessed the effects of heat-therapy on changes in limb circumference reported a point estimate indicating some reduction from baseline to end of study. Similarly, the five studies evaluating the use of heat-therapy on limb volume demonstrated a reduction in limb volume from baseline to end-of-study. Only four studies reported adverse events of which all were deemed to be minor. Only two studies explored the effects of cold therapy on lymphoedema.

Conclusions: Tentative evidence suggests heat-therapy may have some benefit in treating lymphoedema with minimal side effects. However, further high-quality randomised controlled trials are required, with a particular focus on moderating factors and assessment of adverse events.Implications for rehabilitationThis review highlights the potential benefit that heat therapy may have on reducing limb circumference and volume for adults with lymphoedema.There was no evidence that controlled localised heat therapy was unsafe.The current evidence-base is at a point where no specific clinical recommendations can be made.The use of heat therapy should only be applied as part of a methodologically robust study to treat lymphoedema.

Keywords: Lymphoedema; cold therapy; heat therapy; limb circumference; limb volume.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

PRISMA flow diagram illustrating the number of papers excluded at each phase of the screening process with n = 1684 being identified after duplicate removal and after screening 18 papers were included in the systematic review.
Figure 1.

PRISMA flow diagram.

A forest plot showing attrition rates of treatment with only one study had a less than a hundred percent completion rate.
Figure 2.

Meta-analysis of attrition rates of treatment.

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This research was funded by the National Institute for Health and Care Research Applied Research Collaboration North West Coast (NIHR ARC NWC). Additional funding was received from the University MedTech Solutions Group.

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