Combined Decongestive Therapy (CDT), also called Complex Decongestive Therapy (CDT), is an intensive program that combines many of the different treatment approaches which including bandaging, compression garments, manual lymphatic drainage, remedial exercise, therapeutic skin care and self-care. It may also include breathing and aquatic exercises, adjunct therapies such as low-level laser and Deep Tissue Oscillation Therapy, Kinesio Tape as well as dietary measures.
CDT is considered the gold standard of treatment for lymphedema that has progressed beyond stage 1 — meaning there is visible swelling without pitting (a temporary indentation forms on the skin when pressed) and there may be evidence of fibrosis (scarring of soft tissue).
According to the International Society of Lymphology, this is the treatment of choice for lymphoedema. Treatment involves an Initial Phase and a Maintenance Phase for successful, long-term results. Limb volume measurements are taken before treatment begins and again at the end of the CDT intensive phase to assess total volume loss.
CDT Has Two Main Phases
During the intensive phase of CDT, the patient is seen 5 days a week for 3-5 weeks for treatment and the aim is to reduce the swelling as much as possible from the affected area. Treatment plans are tailored to each patients’ individual needs and some may need to be treated 3 days per week for 3-5 weeks. Bandages are worn round the clock during this phase, removing them only for showering and MLD sessions. Deep breathing exercises and remedial exercises are taught to patient who carries these out at home. At the end of this phase patients are measured and fitted with flat knit, custom made compression garments.
Maintenance CDT is crucial in retaining the reduction achieved in the intensive phase. As lymphoedema is a chronic condition, patients must be treated with CDT every 3-4 weeks. At this stage patients are taught self-lymph drainage and encourage to carry this out at home along with their exercises and skin care. Weight is monitored regularly.