![]() ![]() In addition to providing abstracts for most articles, CINAHL also provides access to the full-text version of some articles. New citations are usually added to CINAHL 4 to 10 weeks after publication. I selected this database because I wanted to focus on journals that might deal specifically with physical therapy interventions, and CINAHL purportedly covers some physical therapy journals that are not indexed in other databases such as MEDLINE. ![]() The Cumulative Index to Nursing and Allied Health Literature (CINAHL) is a database that covers approximately 1,200 journals related to nursing, physical therapy, health care administration, and other allied health professions. ![]() Further reproduction is prohibited without permission. Reproduced with permission of ProQuest Information and Learning Co and CINAHL Information Systems. I decided to search for articles that document the effectiveness of comprehensive lymphedema management programs.ĬINAHL Search Screen as Accessed Through ProQuest. I was aware that this type of program is described in the literature using several terms such as “complex physical therapy,” “complex decongestive physical therapy,” and “complete decongestive physical therapy.” I wanted to find evidence that such a program is successful in reducing these impairments in people with lymphedema following breast cancer treatment. Such a program obviously should combine several interventions that are designed to resolve specific impairments, including some form of external compression to reduce swelling and an exercise program designed to increase range of motion and muscle force. Given the degree of swelling and the increased risk of infection, I wanted to initiate an intervention program that would reduce limb size, improve joint mobility, and reduce the incidence of infection. This lymphedema was very upsetting to the patient, and she stated that she did not want “people staring at my arm all the time.” The patient also wanted to reduce the size of her upper extremity to help increase function and, if possible, help prevent infections. The increase in limb size was consistent with chronic lymphedema secondary to a radical mastectomy. The patient also reported feelings of tightness and heaviness in the right upper extremity, and muscle force and joint range of motion were reduced throughout the upper extremity, especially at the shoulder (eg, she could actively flex her shoulder only to 80 degrees). Limb girth was measured at 11 standard sites, and, in terms of the total girth difference, the right upper extremity was 51 cm greater than the left upper extremity. ![]() I examined this patient and found a noticeable increase in the size of her right upper extremity. These infections were usually treated by oral administration of penicillin (eg, penicillin V, 250 mg 3 times each day). She described these infections as “painful, fiery red blotches” that covered various areas of her upper thorax, arm, forearm, and hand. Over the past year, the patient developed 3 infections in her right upper extremity. She also has been receiving tamoxifen (Nolvadex) continuously since the mastectomy (20 mg administered orally once per day). The mastectomy was followed by a series of irradiation treatments to the right axilla, starting in September 1999 and ending in December 1999. The cancer recurred, however, and she underwent a right radical mastectomy in July 1999. Cancer was detected originally in her right breast in 1996, and she was treated surgically by lumpectomy at that time. A 57-year-old woman with a history of breast cancer was referred to our clinic for treatment of lymphedema in the right upper extremity. ![]()
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