Comparison of IPC Therapy as an Alternative or an Adjunct to MLD Within CDT for BCRL

Arm volume will be calculated using circumferential measurements taken with a standard 7 mm measuring tape at 4 cm intervals along the arm. Segmental arm volumes (mL-cm³) will be calculated using the simplified frustum formula (Frustum Model). This formula, as described by Sitzia et al., has shown high correlation with water displacement measurements and is widely used in the literature as a valid and reliable indirect method for assessing lymphedema.

Goniometric measurements of the affected shoulder will be performed to assess flexion, extension, abduction, adduction, internal rotation, and external rotation in patients with lymphedema.

ULL-27 quality of life questionnaire, developed specifically for upper extremity lymphedema patients. The scale has physical, psychological and social dimensions. It consists of 27 questions. A high score on the scale indicates that lymphedema negatively affects the quality of life.

To assess lymphedema severity, circumferential measurements of the affected and unaffected upper extremities will be performed. Patients' forearms will be in a supine position, elbows fully extended, and arms abducted at 90 degrees. Arm-hand circumference will be measured at four points: metacarpal region, wrist, 10 cm below the lateral epicondyle, and 15 cm above the lateral epicondyle, using a non-stretchable 7 mm tape of 150 cm length. Measurements will be taken on both upper extremities, and the differences between sides will be recorded in centimeters.

The Quick-DASH is an 11-item questionnaire used to assess activity limitations of the upper extremity in patients with lymphedema related to breast cancer. Each item is scored from 1 to 5, and total scores are summed. A total score of 0 indicates no disability, while a score of 100 indicates the highest level of disability. The Turkish version was validated in 2011 and has been found valid and reliable for assessing upper extremity activity limitations in breast cancer-related lymphedema.

Swelling in the affected extremity will be assessed using a 0-10 cm (0-100 mm) horizontal Visual Analog Scale (VAS). A score of 0 indicates no symptom, and 10 cm indicates the most severe presence of the symptom. Participants will mark the severity of each symptom and the discomfort caused by the symptom on the VAS ("0" = no complaint, "10" = maximal complaint). The mark will be measured in centimeters with a ruler. The VAS is a valid and reliable method for measuring experimental and clinical pain as well as lymphedema-specific symptoms, and it is sensitive to small changes in symptom intensity.

Heaviness in the affected extremity will be assessed using a 0-10 cm (0-100 mm) horizontal Visual Analog Scale (VAS). A score of 0 indicates no symptom, and 10 cm indicates the most severe presence of the symptom. Participants will mark the severity of each symptom and the discomfort caused by the symptom on the VAS ("0" = no complaint, "10" = maximal complaint). The mark will be measured in centimeters with a ruler. The VAS is a valid and reliable method for measuring experimental and clinical pain as well as lymphedema-specific symptoms, and it is sensitive to small changes in symptom intensity.

Tightness in the affected extremity will be assessed using a 0-10 cm (0-100 mm) horizontal Visual Analog Scale (VAS). A score of 0 indicates no symptom, and 10 cm indicates the most severe presence of the symptom. Participants will mark the severity of each symptom and the discomfort caused by the symptom on the VAS ("0" = no complaint, "10" = maximal complaint). The mark will be measured in centimeters with a ruler. The VAS is a valid and reliable method for measuring experimental and clinical pain as well as lymphedema-specific symptoms, and it is sensitive to small changes in symptom intensity.

Pain in the affected extremity will be assessed using a 0-10 cm (0-100 mm) horizontal Visual Analog Scale (VAS). A score of 0 indicates no symptom, and 10 cm indicates the most severe presence of the symptom. Participants will mark the severity of each symptom and the discomfort caused by the symptom on the VAS ("0" = no complaint, "10" = maximal complaint). The mark will be measured in centimeters with a ruler. The VAS is a valid and reliable method for measuring experimental and clinical pain as well as lymphedema-specific symptoms, and it is sensitive to small changes in symptom intensity.

Patient satisfaction with the exercise programs will be assessed using a 4-point Likert scale (0 = not satisfied, 1 = slightly satisfied, 2 = satisfied, 3 = very satisfied).

Patients' perceived improvement will be measured using the Patient Global Perceived Improvement Scale, asking participants to compare their current condition with baseline regarding lymphedema (1 = much better, 2 = better, 3 = slightly better, 4 = no change, 5 = slightly worse, 6 = worse, 7 = much worse). The Turkish version of this scale was validated and culturally adapted by Yalçın et al. in 2003, showing good internal consistency (Cronbach's α = 0.79) and test-retest reliability (ICC = 0.75).