OBJECTIVE: The aim of this study was to answer the question: what are the immediate, short, and long-term, effects of complex physical therapy and multimodal approaches on lymphedema secondary to breast cancer? DATA SOURCES: Four electronic databases (Medline, Embase, Cochrane Library and PEDro) were searched from incipient up to August 2020. STUDY SELECTION: Randomized clinical trials comparing complex physical therapy and multimodal approaches to the conservative treatment of lymphedema secondary to breast cancer. DATA EXTRACTION: Two independent researchers performed data extraction and assessed the risk of bias, respectively, using the predefined form and Cochrane Collaboration of risk of bias. The determination of evidence quality was carried out using the Grading of Recommendations Assessment, Development and Evaluation tools. DATA SYNTHESIS: Fourteen studies were identified for the systematic review and eleven studies for the meta-analysis with standardized mean difference, 95% confidence interval and random effect model. The common outcomes involved total volume, pain, and physical function of the upper limb. Complex physical therapy has shown a favorable tendency to control outcomes in the short and long-term. The meta-analysis indicated a small effect for volume reduction (SMD -0.18; 95% CI -0.35 to -0.00), and a moderate effect for short-term pain reduction (SMD -0.61; 95% CI -1.19 to -0.02). CONCLUSION: High quality evidence suggests a more significant effect of complex physical therapy on multimodal approaches to the control of the upper limb total volume, substantiating the absence of changes in the current clinical practice in the management of lymphedema secondary to breast cancer. Future research should aim to identify concrete effect of therapeutic modalities in immediate, short, and long-term.

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