Safety and efficacy of Meridian sinew tuina (MST) for post-surgical upper limb lymphedema: a systematic review and meta-analysis.
MST shows promise in reducing upper limb swelling and improving symptoms in patients with breast cancer-related lymphedema, but should not be unconditionally recommended due to potential biases.
Where it sits
this study against the rest of the vip (vasoactive intestinal polypeptide) corpusSummary and findings
This study systematically reviews the safety and clinical efficacy of Meridian Sinew Tuina (MST) for post-surgical upper limb lymphedema in patients with breast cancer. Fifteen randomized controlled trials (RCTs) were included, evaluating MST's impact on upper limb circumference and clinical response efficacy. Significant reductions in swelling and improvements in functional scores were observed, but confidence in these findings is moderated by potential biases.
Abstract
Background Complex Decongestive Therapy (CDT) is the non-operative standard for breast cancer-related lymphedema (BCRL), but many patients experience persistent subcutaneous stiffness, pain, and restricted mobility. This study systematically reviews the safety and clinical efficacy of Meridian Sinew Tuina (MST) protocols for BCRL. Methods Global and regional databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP) were searched from inception to January 15, 2026, with alerts monitored through April 30, 2026. Randomised controlled trials (RCTs) evaluating MST (deep tissue mobilisation along the six-hand meridian sinew [Jingjin] lines via plucking, kneading, and pressing) were included. Two reviewers independently extracted data, evaluated risk of bias using Cochrane RoB 2, and assessed evidence certainty via GRADE using a random-effects model. Results Fifteen RCTs were included. For the primary anthropometric outcome, MST significantly reduced upper limb circumference compared to controls (SMD = 1.59; 95% CI: 1.44 to 1.74; Z = 20.81; p < 0.0001; I2=0.0%; N = 924; GRADE: Moderate certainty). The Clinical Response Efficacy Rate (≥ 30% swelling reduction and symptom relief) favoured MST (RR = 1.69; 95% CI: 1.54 to 1.87; Z = 10.62; p < 0.0001; I2=0.0%; N = 1,114; GRADE: Moderate certainty). Trial Sequential Analysis confirmed sample size sufficiency. For secondary outcomes (N = 924; GRADE: Low to Very Low certainty due to performance bias and clinical heterogeneity), MST showed favourable 3-month improvements in DASH functional scores (SMD = -1.81; 95% CI: -2.11 to -1.51; I2=45.1%), pain intensity (SMD = -2.44; 95% CI: -2.93 to -1.95; I2=50.4%), and quality of life (SMD = 1.04; 95% CI: 0.79 to 1.29; I2=0.0%). No serious adverse events occurred. Conclusions MST protocols are associated with favourable short- and mid-term reductions in upper limb swelling. However, confidence is tempered by unblinded performance bias and control group variations. MST cannot be unconditionally recommended for standalone implementation but represents a promising, optional supportive adjunctive intervention within oncological rehabilitation.
Background
The study addresses the efficacy of Meridian Sinew Tuina (MST) as a treatment for breast cancer-related lymphedema (BCRL), a condition often managed with Complex Decongestive Therapy (CDT). Previous literature has established CDT as the standard, but many patients still suffer from symptoms like stiffness and pain. This systematic review aims to evaluate whether MST can provide additional benefits for these patients.
Methods
The authors conducted a systematic review of global and regional databases, including PubMed and Cochrane Library, up to January 15, 2026. They included randomized controlled trials (RCTs) that evaluated MST protocols involving deep tissue mobilization along specific meridian lines. Two reviewers independently extracted data and assessed risk of bias and evidence certainty using GRADE.
Results
The primary outcome showed that MST significantly reduced upper limb circumference with an SMD of 1.59 (95% CI: 1.44 to 1.74; Z = 20.81; p < 0.0001) across 924 participants. The Clinical Response Efficacy Rate favored MST with a relative risk of 1.69 (95% CI: 1.54 to 1.87; Z = 10.62; p < 0.0001) based on 1,114 participants. Secondary outcomes indicated improvements in DASH functional scores, pain intensity, and quality of life, though with lower certainty ratings.
Interpretation
The findings suggest that MST may offer significant reductions in swelling and improvements in function for BCRL patients, aligning with some previous studies on alternative therapies. However, the effect sizes, while statistically significant, may not be clinically meaningful for all patients, especially considering the limitations in study design and potential biases. The presence of performance bias and clinical heterogeneity further complicates the interpretation of these results.
Key findings
- SMD = 1.59; 95% CI: 1.44 to 1.74; Z = 20.81; p < 0.0001; N = 924.
- RR = 1.69; 95% CI: 1.54 to 1.87; Z = 10.62; p < 0.0001; N = 1,114.
- SMD = -1.81; 95% CI: -2.11 to -1.51; I² = 45.1%; N = 924.
- SMD = -2.44; 95% CI: -2.93 to -1.95; I² = 50.4%; N = 924.
- SMD = 1.04; 95% CI: 0.79 to 1.29; I² = 0.0%; N = 924.
Limitations
- Unblinded performance bias.
- Clinical heterogeneity among trials.
- Moderate to low certainty in secondary outcomes.
- Variations in control group interventions.
- Not all studies reported adverse events.