Autor:
González Calzada, Cristina.
Fisioterapeuta cl49-1999
Trabajo fin de grado, Universidad Rey Juan Carlos, año 2012.
1- Introducción
El linfedema, tras el tratamiento del cáncer de mama, es una complicación crónica, frecuente y angustiosa que afecta a un número significativo de mujeres dado el aumento de supervivencia en esta enfermedad.
El objetivo de esta revisión es analizar el estado actual de la fisioterapia como prevención y tratamiento y, por tanto, si existe consenso entre los autores para la elaboración de un protocolo de actuación eficaz.
2. Material y métodos
2.1 diagrama de flujos
2.2 tabla estrategia de búsqueda
Se revisaron los textos completos de las bases de datos Medline, Physiotherapy Evidence Database, Pubmed, Biblioteca Cochrane, SBESCO desde el año 2006 hasta el 2011 con restricción en el idioma (inglés y español). Se completó la búsqueda utilizando la web con base Google. Se utilizaron “lymphedema” y “breast cancer” como palabras clave principales y se añadieron otros términos como “physioterapy”y “prevention”.
Posteriormente, se seleccionaron los artículos con mayor evidencia científica. Incluyendo, únicamente, diez ensayos clínicos aleatorizados (ECA’s) en la revisión.
3. Resultados:
Destacable el estudio de Torres M. 2010 con una evidencia alta y buena calidad metodológica (8/10 en la escala PEDro). Importantes resultados positivos sobre la cinesiterapia activo-resistida progresiva tanto en prevención como tratamiento
Evidencia muy alta con buena calidad metodológica (8/10 en la escala PEDro) y convincente, en un protocolo de fisioterapia temprana como medida de prevención del linfedema. Importantes resultados positivos sobre la cinesiterapia activo-resistida progresiva tanto en prevención como tratamiento. El drenaje linfático manual presenta resultados contradictorios y débiles sobre su uso, mientras, la terapia física compleja sigue siendo la base del tratamiento.
4. Discusión
La fisioterapia precoz ha demostrado ser una herramienta eficaz de prevención del linfedema, en la que se incluyen diferentes técnicas como DLM, masaje de la cicatriz, estiramientos, ejercicios activo-asistidos, activo-resistidos progresivos y estrategia educacional. Sin embargo, son muy pocos los estudios que presentan esta clara diferencia entre prevención y tratamiento. Por otro lado, se prevé un importante cambio en la orientación del tratamiento hacia una terapia física en el que el uso del miembro afecto no sea un temor, mejorando la funcionalidad global y, por tanto, la calidad de vida de la paciente.
5.Conclusión
La fisioterapia es clave en la prevención y tratamiento del linfedema después del cáncer de mama, sin embargo, se necesitan más estudios para asentar estas diferencias, elaborando protocolos eficaces y ver, posteriormente, sus efectos a largo plazo.
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