Comparative Effectiveness of Different Physical Therapies for Axillary Web Syndrome after Breast Cancer Surgery: A Network Meta-Analysis of Randomized Controlled Trials

Background Axillary web syndrome (AWS) commonly occurs after breast cancer surgery, impairing shoulder range of motion (shoulder ROM) and upper limb function. Various physical therapies (PTs) have been applied in the management of AWS, but their comparative effectiveness remains unclear. Objectives This network meta-analysis compared multiple PTs for pain, shoulder ROM, and upper limb function in AWS patients. Data sources Embase, PubMed, CINAHL, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and CBM were systematically searched from inception to March 26, 2026. Methods A Bayesian network meta-analysis was performed using a fixed-effects model (primary) and a random-effects model (sensitivity). Interventions were ranked by the surface under the cumulative ranking curve (SUCRA). Results Fourteen RCTs (1,007 patients, 11 interventions) were included. In fixed-effects analysis, soft tissue manual therapy (STMT) + therapeutic exercise + low-level laser therapy (LLLT) significantly reduced pain (SMD=−4.40, 95% Credible Interval (CrI): −5.52 to −3.28) and improved abduction (MD=59.51, 95% CrI: 53.08 to 65.91) and flexion (MD=59.5 degrees, 95% CrI: 53.1 to 66.0) and flexion (MD=77.3 degrees, 95% CrI: 66.3 to 88.3). MLD + therapeutic exercise showed the largest improvement in upper-limb disability (MD=−19.01, 95% CrI: −22.52 to −15.52). Ranking orders remained broadly consistent in sensitivity analyses, albeit with wider CrIs. Limitations Sparse network (11 interventions/14 studies), clinical heterogeneity, and model-dependent results (several CrIs crossing null in random-effects analysis) limit evidence certainty. Conclusions In the fixed-effects analysis, soft tissue manual therapy combined with therapeutic exercise and low-level laser therapy improved pain and shoulder range of movement, while manual lymphatic drainage and therapeutic exercise improved upper limb function. Further validation is warranted.